Updated 9/2026.This document outlines the MICU attending expectations and tips for the rotation. It is intended for both interns AND residents. Please read carefully!

Overall Expectations

  • Be ready to learn! There is a lot to learn on this rotation. Learn from how the plan is formulated on all patients, not just your own. Take an active role in management decisions by being at the bedside as much as possible. Round out your knowledge by taking advantage of morning report and lectures.
  • Be prepared for rounds. There is a lot of information to keep track of for each patient, use the presentation style outlined in this guide to help keep things organized and efficient.
  • Communication is key. There are multiple groups (patient/family, multidisciplinary team members, consultants) invested in the care of our patients. As the primary service, our role is to ensure open, clear and consistent communication with all. Make sure the broader team members know the daily plan (APNS, nurse on rounds, PTOT, etc). Touch base with consulting services regularly to avoid misunderstandings and to ensure consistent messaging for patients and families. Use closed loop communication to ensure all important tasks are completed.
  • Listen to nurses – They are extremely experienced and have very important information to tell you. If they are paging/messaging you, it is because they REALLY need you to come evaluate the patient.
  • Use your pharmacist – Great resource for information about meds (dosing, interactions, etc)
  • Ask your residents, fellows, attending and APNs for help – You will learn a lot on this rotation. This will be enhanced if you ask when you don’t completely understand something. If you are ever in a situation where you are writing an order without knowing why you are doing so, ask your residents, fellows, attending or APN. If a patient is getting worse, let your fellow and attending know!

The Daily Grind

When pre-rounding – Come before 6am. Look at the orders written overnight and ask your cross cover why they made a change. What prompted them to change the vent/start pressors/extubate etc. The expectation is that you have seen all of your patients and reviewed their information (labs, imaging) PRIOR to morning rounds. Interns should run the plan for each patient with their senior resident before rounds. Interns should not present off a phone or computer, writing it out will help you stay organized, efficient, and make it much easier to bring information together and make a plan.

Sign outs and cross-cover are critical– The MICU is an around the clock endeavor. Thus, our mentality is that each MICU patient is a communal patient. Your sign out and presentations on rounds are ways you communicate your plan and anticipated problems to the cross-covering team. High quality sign out and presentations are the only way to deliver quality around the clock critical care.

  • Everyone should know each patient in the MICU
  • For the post call team, the APN/ED day float are designated “helpers”, especially for procedures, road trips, etc.
  • Call consults early – you know your patients the best
  • Complete bedside procedures EARLY, which means OBTAIN CONSENT and OPTIMIZE COAGS for procedures early
  • Maintain active type and screens and put blood consents in the CHART for patients who require blood products
  • Have family contact information and any limits of care (code status) on sign out
  • X-cover patients going to the floor should be given to appropriate service (GENS, HONC, etc)
  • ASK whether X-cover spoke to floor team about your patients who went out overnight

Transfers out of the MICU:

  • Remember to complete the order reconciliation prior to transfer
  • All MICU patients need a VERBAL signout given to the receiving floor team and a WRITTEN transfer note (signed before transfer is placed)

Update family DAILY! – So much can happen in a MICU day and the ICU patients are relatively more likely to have major condition changes compared to floor patients. You will find the family is more prepared for adverse events / need for procedures / status changes, if you keep them in the loop all along. To do this, have the family identify the one person who will be the point person and you can update him/her daily, then he/she will update the family. Also please remember to ask for the PRIVACY CODE (last 4 # of MRN) before giving info via phone or in person.

Visitor policy – Patients are allowed 2 visitors in the room at bedside during the day and 1 visitor to stay overnight (past visiting hours).

  • Visitation rules may change if the patient transitions to comfort-focused care.
  • Please reference the nursing-led visitation policy and check with the bedside nurse, charge nurse, and/or nurse manager regarding any exceptions/special requests or scenarios! It is best to defer to our nursing colleagues rather than set expectations for patients/families that may not be in line with policies.

Keep the work rooms clean -We share these spaces that are almost continually in use 24/7. Please be cognizant of your belongings. Hang up coats. Store bags in/on top of cabinets. Return medical records to the patient’s chart. DO NOT bring supplies into workroom. Unlocked needles are in violation of Illinois Department of Public Health requirements.

Please do hand hygiene when entering and leaving rooms! – There are also specific policies on central lines and Foley catheters that our nurses follow when patients enter and leave the ICU. Please consult the charge nurse and nurse manager if you have any questions!

Listen to nurses – They are extremely experienced and have very important information to tell you. If they are paging you, it is because they REALLY need you to come evaluate the patient.

Use your pharmacist – Great resource for information about meds (dosing, interactions, etc)

Ask your residents, fellows, attending and APNs for help – You will learn a lot on this rotation. This will be enhanced if you ask when you don’t completely understand something. If you are ever in a situation where you are writing an order without knowing why you are doing so, ask your residents, fellows, attending or APN.

While there is no specific dress code in the MICU, we encourage everyone to dress in a manner that inspires confidence in the amazing care you are providing.

How to Present

Due to the complexity of your patients in the MICU, you will have an incredible amount of data on each patient, and it can be challenging to organize and present all that information in a way that is easy to follow for everyone on rounds. Here are our suggestions to help.

Present by Organ System

What we mean by this is to abandon your typical SOAP note format for presentations (especially follow-up presentations). You should combine information from the physical exam and labs/data in your assessment and plan. Lump together hemodynamic data with CV and volume assessment; pulmonary data with vent settings and blood gas results; neurologic data with wake-up assessment, etc. For a typical follow-up patient on rounds, this means stating the patient’s major events overnight (if any) and then launching in to assessment as below. Except in rare instances, the 1st systems addressed should be cardiovascular, pulmonary or neuro. Both an outline format and sample narratives are below. Make sure each system ends with a plan! What do you want to do about all the data that you just presented?

  1. Cardiovascular- BP has remained X/Y on the following vasoactive drugs and doses. She appears to be volume-responsive based on X (physical exam findings, straight leg raise, bedside ultrasound, Pulse pressure Variation, etc). Central venous sat (SVO2) is X. UOP has remained (adequate vs oliguric) and the patient feels (warm with good cap refill vs cold with thread pulses). Tips: ok to give vitals as either a representative sample or as ranges, but if giving ranges, report blood pressure as X/Y – A/B – not as a systolic range and diastolic range – to allow us to hear the pulse pressure. Assessment of cardiac function, myocardial ischemia, dysrhythmia etc. would go here.
    1. Blood pressure
    2. Vasoactive meds and doses
    3. Volume status (with data – CVP, SVO2, I/Os, UOP, PPV)
    4. Heart rate/rhythm
    5. Ischemia or heart function
  1. Pulmonary: Pt remains intubated on the following vent settings: XXXX. By convention, we report vent settings as Mode (AC vs PC vs PS) / Rate/ Tidal Volume/ PEEP/FiO2 – and on these settings the ABG is report as pH/ CO2/ paO2/ sat –ok to round up to the nearest whole number). Patient’s oxygenation is (improving vs worsening) and the CXR is (better vs worse). We plan a SBT today but are concerned that pt’s oxygenation/ventilation/neuro status/airway) may prevent extubation. Patient’s acid-base status is …. and the respiratory alkalosis we are observing might be explained by ……
    1. Vent or oxygen status and effort
    2. ABG
    3. CXR
    4. Plan for SBT/extubation
  1. Neurologic: Pt remains sedated on the ventilator. Awoke when sedation held yesterday, followed all commands. Still requires sedation because XXX.
    1. Exam
    2. Sedation
    3. Radiographic studies
  2. ID: Pt is febrile with a rising WBC despite antibiotics (X,Y, and Z). We think the source of infection is X because of Y (what data?).
    1. Temp, WBC, Culture data
    2. Antibiotics
    3. Source of infection
  3. Heme/Onc: Hb dropped from X to Z with 400cc of coffee grounds from OGT. Plan for an EGD today. She required X units PRBCs, Y platelets, and Z FFP overnight
    1. CBC
    2. Onc issues
  4. Renal: Only necessary if this pertinent information is not already addressed in hemodynamics. UOP, Creatinine trends probably belong under hemodynamic data. Patient tolerated intermittent dialysis yesterday and needs more volume off today.

Tips and Tricks

  • Practice your presentations! Presenting a complex patient is a learnable skill. However, if you only do it on rounds, you will struggle to do it well. Practice with your resident, attending, fellow, etc. and ask for feedback. Listen to the other residents; what skills can you pick up from them?
  • All presentations should start with the chief complaint and MICU indication – attendings and fellows need to hear why the patient is still in the MICU.
  • Under each organ system, start with the most important/active problem!
    • Are they in the unit for their stable heart failure or because of DKA? (The answer is probably DKA…so list DKA as their first problem!) Chronic, stable problems should be listed last.
    • Give away the diagnosis if it is known. “Shortness of breath” should not be the presenting complaint if “hypoxic respiratory failure, ARDS, and septic shock” is known to be the most likely etiology.
  • Efficiency is key. There are many complex patients, so avoid repeating extraneous data that was already presented (or is superfluous). Rounds will go faster, stay focused on the pertinent issues, and be a better learning experience. 2 examples of extraneous information:
    • “Endocrine: problem #1) Hypothyroidism: Well controlled. TSH pending. Continuing home dose of levothyroxine” – These types of problems are not too important for their ICU stay!
    • “In summary, this is a 68-y/o man with hypertension, tobacco abuse, and COPD presenting with fevers, chills, and a positive RVP for Parainfluneza presenting with ventilatory failure” – Did you already go over all of this information in your presentation? Jump straight to the problem list.
  • Make a plan and try not to focus on the numbers! – Things can change so quickly, and someone can look up the numbers more quickly than you can say them. It is better to have an understanding of the data than to have every last piece of it.
    • Example: Your patient is suffering from hyponatremia, hyperkalemia, gap acidosis, and acute kidney injury. It is better to know how you’re treating the K+, why the acidosis is present, and how you’re working up the AKI than to know the Na+ is 128, K+ is 5.9, etc.

Conferences

7:00 – 7:30am – MICU Teaching Case, followed by MICU Rounds

  • On weekdays, one post-call patient will be presented to both MegaTeams as a teaching case
  • Bedside patient care rounds are performed outside of the patient’s room. If you do not see the patient’s RN participating in rounds, please call their phone and let them know you are rounding on their patient.
  • Resident presents patient within 10-15 minutes. All members of the team are expected to listen and learn from these presentations.
  • Pharmacy needs are addressed.
  • RN needs are addressed.
  • Fellows/Attendings provide high-yield teaching on this case.

10:00 am – Pulmonary Morning Report

  • If you are able (time sensitive tasks completed, no decompensating patients), you can join your fellows on the tenth floor for pulm morning report

2:00pm – Afternoon Lecture

  • Lecture series given by the attendings/fellows on service. Must attend every day unless a patient is decompensating. By the end of the block, you should understand the 4 types of respiratory failure, mechanisms of hypoxemia, types of shock, types of vasoactive meds, modes of mechanical ventilation, and sepsis

MICU Multidisciplinary Team

Advanced Practice Nurses (APNs)

  • Contact:
    • Stefanie Blummer
    • Ana Huaringa
    • Kalina Gorczyca
    • Kitty Cavanaugh
    • Tolu Adeyemi
    • Katie Hoedtke
  • Role: Assist with post-call team tasks. Rotate through procedure service. Provide procedural oversight.

Nursing

  • Bedside Nurse
    • Please do not adjust IV pumps and/or ventilators without discussing with nurse in room.
    • If you enter a STAT order, please speak with the bedside RN.
    • Restraint orders must be entered in EPIC within an hour of application and every 24 hours. Check/renew during rounds.
    • Try to cluster labs together. If available in epic, use “add-on” to add labs to existing vials of blood to avoid frequent re-sticking the patient
  • Charge Nurse: x61504
  • Nurse Manager: Sydney Ford and Stephenie Blossomgame

Nutrition

  • Consult: Epic is preferred. Also available verbally, by page and during MICU Multidisciplinary Huddle
  • Role: Assess patients (lab data, medical/surgical history, nutrition focused physical exam, anthropometric data, diet history, medical plan of care), diagnose malnutrition (where applicable), and provide recommendations regarding: tube feeding for patients with enteral tubes (OG, NG, DHT, PEG/PEJ), standard peripheral or standard central parenteral nutrition (PPN/TPN), oral nutrition supplements, oral diet, vitamin/mineral repletion, nutrition related medications (bowel meds, appetite stimulants), etc., monitor progress toward goals and re-evaluate as appropriate.
  • Tips: ASPEN/SCCM guideline “highlights” regarding feeding critically ill patients are: 1. Early enteral feeding (within first 24-48 hours) reduces infectious morbidity, mortality, and length of stay. 2. We DO NOT routinely check gastric residual volumes as they are poorly correlated with aspiration events. 3. Serum protein markers (albumin, transferrin, pre-albumin, retinol binding protein) are NOT a good representation of the nutritional status of critically ill patients.

Physical Therapy

  • Role: Facilitate early mobility on any hemodynamically stable patient regardless of their level of alertness or intubated status.
  • Consult: When consulting PT and OT, place two consult orders (one to evaluate and another to treat).
  • Tips: Consult as soon as possible and consider upon MICU admission. The goal is to provide early mobility within 72h of MICU admission to all appropriate patients. PT also provides wound care, specifically negative pressure therapy and debridement.

Occupational Therapy

  • Consult: Please make sure to place two consult orders (one to evaluate and one to treat).
  • Role: Assist with early mobilization with PT as well as assess/treat cognitive impairments; prolonged periods of immobility lead to increased rates of delirium and skeletal muscle breakdown resulting in ICU acquired weakness. Occupational Therapists also perform splint fabrication to prevent joint immobility.
  • Tips: Address the CAM ICU sooner than later. Occupational therapy can assist with helping family members understand delirium and provide interventions to prevent this while in the ICU.

Pharmacy

  • Consult: Please enter an EPIC consult order AND page pharmacist with pharmacokinetics consults on vancomycin and aminoglycosides. Call/page when considering any high risk drug (ex: TPA, Kcentra).
  • Tips: Call with anything and everything drug related! Use the Antimicrobial Stewardship website on the intranet

Respiratory Therapy

  • Contact: 9N RT x 61889, 9S RT x61898
  • Tips: Verify all of your intubated patients have a “Mechanical Ventilation” order that includes vent settings. Update the order when you change the vent settings. Notify RT of all vent changes.

Social Work/Care Coordination

  • There will always be an assigned Care Coordinator (social work or case manager, we do a combined role here!) for each of your patients
  • Consult: Epic consult, page (90596), text/call conversation, multidisciplinary daily rounds with fellows, or come find in office 9-490
    • Weekend/holiday pager 8165
  • Role:
    • Placement (LTACH, rehab, hospice, etc.) based on individual care needs
    • Health Care Power of Attorney
    • Psychosocial pt/family needs
    • Assessments of all patients on the unit
    • Participation in family meetings and goals of care discussions
    • Assist pt/families with financial needs such as UCM financial aid/SSDI/etc.
    • Substance abuse treatment resources
    • Identification of unidentified pts and/or location of families
    • Setting up DME
    • Resumption of home health
    • Being a general supportive face
    • A varying assortment of other interesting patient needs (I might not know the answer, but I’m happy to work as a team to figure it out!).

MICU Procedure Guidance

Expectations

  • Start planning and preparing for procedures immediately after rounds. Goal to complete procedures prior to lunch/lectures.
  • Obtain consent – must be documented and in patient chart beforehand!
  • Gather supplies prior to start of procedure. Return all extra supplies to supply room (not the work room!)
  • Notify RN of procedure. Perform procedure timeout as a team. Request RN to complete time out documentation. Request RN to set up transduction supplies for arterial lines.
  • All procedures should be supervised by an attending +/- fellow.
  • Take care of the ultrasounds. These are a shared resource and necessary to provide care to our ICU patients. Please clean and return them after use (please don’t leave off the floor!!)

Pearls

  • Order lidocaine 1% injection (WITHOUT epinephrine) 20ml bottle
  • Utilize order sets to order diagnostics
    • IP Lumbar Puncture (#1947)
    • IP Thoracentesis/Paracentesis (#1101)
  • Verify specimens have been labeled. Request RN to release the labs in the system. Hand deliver specimens to Mitchell lab
  • Proceduralist should collect and dispose of all sharps.
  • Clean up all procedure supplies and garbage.
  • Order and follow up CXR following central line placement and thoracentesis.
  • Document all procedures (procedure type note, seniors have SmartPhrase templates)
    • Click on left sided “Procedure” tab. Document under CL Insert 1 section.
    • Request RN to complete observer documentation.
    • Place ok to use order after CXR verification

NEJM Procedure Resources

Supplies

Central line

  • Chux
  • Sterile Gloves
  • Additional PPE (masks, gloves, bouffants, gowns) for additional proceduralists
  • Central line supply bundle
  • Central line (e.g. triple lumen, trialysis, cordis)
  • 2inch 16g angiocath/IV (for trialysis lines)
  • Scalpel (for trialysis lines)

Lumbar Puncture

  • 1 Chux
  • Betadine
  • Gauze pack
  • LP kit
  • Specimen bag
  • Sterile gloves
  • Mask
  • Consider ordering additional lidocaine

Arterial Line

  • Sterile gloves
  • Mask
  • Chux
  • Chlorhexidine
  • Sterile towel pack
  • Sterile ultrasound probe cover
  • Gauze pack
  • Arterial line arrow
  • Tegaderm
  • Tape

Thoracentesis

  • Lidocaine: Order in epic. Request RN to get out of omincell prior to procedure
  • Sterile gloves
  • Mask
  • Skin marking pen
  • 1 Chux
  • Chlorhexidine
  • Thoracentesis kit
  • 60 cc syringe
  • 19g needle or pink vacutainer to transfer fluid for diagnostic specimens
  • ABG syringe
  • Anaerobic culture bottle
  • Aerobic culture bottle
  • Lavender top tube
  • Gold top tube
  • Sterile specimen cup
  • Specimen bag

Paracentesis

  • Lidocaine: Order in epic. Request RN to get out of omincell prior to procedure
  • Sterile gloves
  • Mask
  • Skin marking pen
  • 2 Chux: 1 for patient’s lap, 1 for floor
  • Chlorhexidine
  • OR towel pack
  • 14 g angiocath
  • 10 ml syringe
  • 5ml syringe
  • 19g needle
  • 25g needle
  • 19g needle or pink vacutainer to transfer fluid for diagnostic specimens
  • 60cc syringe
  • Suction tubing
  • Orange containers
  • Gauze pack
  • Tegaderm
  • Anaerobic culture bottle
  • Aerobic culture bottle
  • Lavender top tube
  • Gold top tube
  • Sterile specimen cup
  • Specimen bag
  • Gold top tube
  • Sterile specimen cup
  • Specimen bag