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  • 1. Multidisciplinary Critical Care Fellowship Rotational Outline-Goals and Objectives Trauma Critical Care Rotation Goals: The goal of this rotation is to provide the trainee with additional exposure to the evaluation and management of the critically ill trauma patient. The trainee should be exposed to more advanced traumatic pathophysiology and learn advanced techniques to correctly diagnose, initiate corrective therapy, and guide basic resuscitative and advanced trauma surgical critical care. The critical care fellow should develop the appropriate knowledge, skills/behaviors, and attitudes to manage patients with traumatic injuries and complex critical care needs. It is unreasonable and indeed impossible to expect that a Critical Care Fellow could master the specialty of Critical Care during a one month rotation. In order to focus the educational and performance expectations of a fellow for the specialty area of Critical Care, a “weighted curriculum” has been developed. This curriculum defines and prioritizes the learning objectives or content items required of a specialist in critical care. According to the definitions below, the listed objectives are prioritized to indicate the depth and breadth of knowledge required in that area. Although a fellow is not expected to complete all of the following objectives during a Core rotation, this prioritized list of objectives should be used by both the Faculty preceptor and the resident to guide their educational experience and the specifics listed within should be covered/completed at the end of the fellow’s training. Educational Strategy: Fellows will be assigned to the trauma critical care service for a duration of 3-4 weeks. During this time, the fellow will participate in acute resuscitative management, guide trauma critical care rounds, and participate in diagnostic and therapeutic procedures to include hemodynamic monitoring, chest thoracostomy, bronchoscopy, tracheostomy, and cardiovascular procedures. In addition to partaking in this rotation, fellows will participate in teaching conferences, basic computer-based modules, and skills training sessions. Objectives (1) Mastery -Knowledge or skills that are essential to the independent and timely management of acute illness and injury in critically ill patients. This level of knowledge or skill is required to manage clinical problems that: a) pose significant risks to patients' health or well-being, b) require prompt diagnosis and/or management to insure optimal outcome, and c) are typically diagnosed and/or managed by an intensivist. Because this knowledge/skill leads to critically important, time-dependent decisions and interventions, it must be comprehensive in breadth and depth, and accessible to the critical care physician without the benefit of consultation. (2) Proficiency-Knowledge or skills that are used in the critical care setting, but are not essential for the independent and timely diagnosis and/or management of acute illness and injury. This level of knowledge or skill may be possessed by highly trained specialists but lacking in-depth knowledge/skill, an intensivist may review reference texts, consult other specialists, or refer to other physicians without posing a risk to patients' health or well-being. Typically clinical problems requiring this level of knowledge/skill are managed in other settings or by other specialists. The intensivist physician may commonly provide initial evaluation of these problems, but generally will default to the level of co manager. (3) Familiarity-Knowledge pertaining to clinical conditions that are either benign or chronic, do not pose an imminent threat to patients' health or well-being, and for which critical diagnosis and management are either unnecessary or beyond the scope of standard practice. This level of knowledge facilitates comprehensive and thorough diagnosis and/or management of complex clinical problems encountered in the critical care environment, but more detailed knowledge seldom benefits patients' health or well-being. Referral to other specialists is generally required for the diagnosis and/or management of these conditions. Multidisciplinary Curriculum Trauma Critical Care1
  • 2. General Objectives: 1. Develop the ability to rapidly evaluate, diagnose, stabilize, and disposition critically ill patients. 2. Learn respiratory, cardiovascular, renal and neurological physiology and the pathophysiology of tissue injury, toxins, shock, sepsis, cardiac failure, and respiratory failure which affect critically ill trauma patients. 3. Understand the traumatic effects of environmental hazards & injuries: hypo- and hyperthermia, near-drowning, electrocution, radiations, chemical injuries, electrical safety/micro shock 4. Understand the effects and acute complications of severe trauma on organs and organ systems. 5. Understand the relevance of mechanism of injury to clinical presentation, the secondary insults that potentiate the primary injury, and the immediate specific treatment of life-threatening injury. 6. Demonstrate the performance and interpretation of a primary and secondary trauma survey. 7. Learn the principals of trauma triage and management of competing priorities and the recognition of life threatening changes in physiological parameters that alter those priorities. 8. Understand the principles of outcome prediction / prognostic indicators, the treatment intensity scales and the limitations of scoring systems in predicting individual patient outcome. 9. Understand the causes, recognition, and management of shock states and the techniques for effective fluid resuscitation. 10. Learn the management of severe acute hemorrhage including blood transfusion and the correction of coagulation disorders and hemoglobinopathies. 11. Understand the principles of blood and blood component therapy including the principles and effects of massive transfusion. 12. Understand the factors for determining peri-operative risk, the indications for, and interpretation of pre-operative investigations and methods of optimizing high risk surgical patients. 13. Understand the special considerations in the evaluation and management of the pregnant, pediatric, and geriatric trauma victim. 14. Consider the impact of long-term and chronic treatment on acute surgical care 15. Identify life-threatening cardio-respiratory complications; manage hypovolemia and impaired oxygen delivery. 16. Communicate the risk of surgery and the understanding of the peri-operative course to patients and family. 17. Consult, communicate and collaborate effectively with anesthesiology, surgery, nursing staff, other professionals, patients and relatives where appropriate. 18. Lead, delegate and supervise others appropriately according to experience and role. Derived from: CoBaTrICE Domain 1.5 (pg 11-12) 1.1 ADOPTS A STRUCTURED AND TIMELY APPROACH TO THE RECOGNITION, ASSESSMENT AND STABILISATION OF THE ACUTELY ILL PATIENT WITH DISORDERED PHYSIOLOGY 1.5 ASSESSES AND PROVIDES INITIAL MANAGEMENT OF THE TRAUMA PATIENT 1.6 ASSESSES AND PROVIDE INITIAL MANAGEMENT OF THE PATIENT WITH BURNS 2.9 MONITORS AND RESPONDS TO TRENDS IN PHYSIOLOGICAL VARIABLES 2.10 INTEGRATES CLINICAL FINDINGS WITH LABORATORY INVESTIGATIONS TO FORM A DIFFERENTIAL DIAGNOSIS 3.1 MANAGES THE CARE OF THE CRITICALLY ILL PATIENT WITH SPECIFIC ACUTE MEDICAL CONDITIONS 3.2 IDENTIFIES THE IMPLICATIONS OF CHRONIC AND CO-MORBID DISEASE IN THE ACUTELY ILL PATIENT 3.3 RECOGNISES AND MANAGES THE PATIENT WITH CIRCULATORY FAILURE 3.4 RECOGNISES AND MANAGES THE PATIENT WITH, OR AT RISK OF, ACUTE RENAL FAILURE 3.6 RECOGNISES AND MANAGES THE PATIENT WITH ACUTE NEUROLOGIC IMPAIRMENT 3.8 RECOGNISES AND MANAGES THE PAITIENT WITH ACUTE LUNG INJURY SYNDROMES (ALI/ARDS) 4.3 ADMINISTERS BLOOD AND BLOOD PRODUCTS SAFELY 4.4 USES FLUIDS AND VASOACTIVE / INOTROPIC DRUGS TO SUPPORT CIRCULATION 4.6 INITIATES, MANAGES, AND WEANS PATIENTS FROM INVASIVE AND NON-INVASIVE VENTILATORY SUPPORT 4.8 RECOGNIZES AND MANAGES ELECTROLYE, GLUCOSE, AND ACID-BASE DISTURBANCES 4.9 CO-CORDINATES AND PROVIDES NUTRITIONAL ASSESSMENT AND SUPPORT 5.3 PERFORMS EMERGENCY AIRWAY MANAGEMENT 5.4 PERFORMS DIFFICULT AND FAILED AIRWAY MANAGEMENT ACCORDING TO LOCAL PROTOCOLS 5.6 PERFORMS FIBREOPTIC BRONCHOSCOPY AND BAL IN THE INTUBATED PATIEND UNDER SUPERVISION 5.7 PERFORMS PERCUTANEOUS TRACHEOSTOMY UNDER SUPERVISION 5.8 PERFORMS THORACENTESIS VIA A CHEST DRAIN 5.13 PERFORMS CENTRAL VENOUS CATHETERIZATION 5.17 DEMONSTRATES A METHOD FOR MEASURING CARDIAC OUTPUT AND DERIVED HAEMODYNAMIC VARIABLES 5.23 DESCRIBES INDICATIONS FOR, AND SAFE CONDUCT OF GASTROSCOPY 6.1 MANAGES THE PRE- AND POST-OPERATIVE CARE OF THE HIGH RISK SURGICAL PATIENT 6.3 MANGAES THE CARE OF THE PATIENT FOLLOWING CRANIOTOMY UNDER SUPERVISION 6.5 MANAGES THE PRE- AND POST-OPERATIVE CARE OF THE TRAUMA PATIENT UNDER SUPERVISION 7.2 MANAGES THE ASSESSMENT, PREVENTION, AND TREATMENT OF PAIN AND DELERIUM 7.3 MANAGES SEDATION AND NEUROMUSCULAR BLOCKADE 7.4 COMMUNICATES THE CONTINUING CARE REQUIREMENTS OF PATIENTS AT ICU DISCHARGE TO HEALTH CARE PROFESSIONALS, PATIENTS, AND RELATIVES 7.5 MANAGES THE SAFE AND TIMELY DISCHARGE OF PATIENTS FROM THE ICU 8.2 DISCUSSES END OF LIFE CARE WITH THE PATIENT AND THEIR FAMILIES / SURROGATES 11.1 LEADS A DAILY MULTIDISCIPLINARY WARD ROUND Multidisciplinary Curriculum Trauma Critical Care2
  • 3. Specific Objectives: 1. Demonstrate ability to rapidly perform history and physical exams in critically ill patients. (1) (PC, MK, ICS) 2. Demonstrate the ability to perform the following procedures: oral endotracheal intubation, nasotracheal intubation, bronchoscopy, cricothyrotomy, needle thoracostomy, tube thoracostomy, central intravenous placement, swan Ganz placement, transvenous cardiac pacing, arterial line placement, ABG, and Foley catheterization. (1) (PC, MK) A. Endotracheal Intubation B. Nasotracheal Intubation C. Cricothyrotomy D. Needle/Tube Thoracostomy E. Central Intravenous Placement F. Swan-Ganz Placement G. Transvenous Cardiac Pacing H. Arterial Line Placement I. Bronchoscopy 3. Demonstrate the ability to use and interpret data from ECG monitors, ECGs, cardiac outputs, hemodynamic monitoring, arterial blood gases, pulse oximetry, end tidal CO2 monitors and respirators. (1) (PC, MK, SBP, PBL) A. ECG Monitors/ECG's B. Cardiac Output C. Hemodynamic Monitoring D. Arterial Blood Gases E. Pulse Oximetry F. Respirators 4. Describe the dosages, indications and contraindications of pharmacologic interventions for shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic failure, renal failure, and neurologic illnesses. (1) (PC, MK, ICS, PBL) A. General B. Shock C. Cardiac Failure D. Dysrhythmias E. Sepsis F. Trauma G. Toxins: H. Respiratory Failure I. Renal Failure J. Neurologic Illness 5. Demonstrate the ability to manage a patient on a ventilator and appropriately manage traumatic lung injury. (1) (PC, MK, PBL) 6. Demonstrate appropriate judgement in the management of the critically ill surgical patient. (1) (PC, MK, PBL, P, SBP) 7. Demonstrate appropriate prioritization of diagnostic and therapeutic interventions in critically patients. (1) (PC, MK, PBL, SBP) 8. Demonstrate ability to diagnose and treat shock, sepsis, fluid and electrolyte abnormalities, cardiac failure, cardiac dysrhythmias, renal failure, hepatic failure, and toxicologic emergencies. (1) (PC, MK, P, ICS, PBL, SBP) A. Shock B. Sepsis C. Fluid and Electrolyte Abnormalities D. Cardiac Failure E. Dysrhythmias F. Renal Failure G. Hepatic Failure H. Toxicologic Emergencies Multidisciplinary Curriculum Trauma Critical Care3
  • 4. 9. Demonstrate an understanding of the appropriate use of consultants in critically ill patients. (1) (PC, MK, P, ICS, PBL, SBP) 10. Demonstrate an understanding of the ethical and legal principles applicable to the care of critically ill patients. (1) (PC, MK, P, ICS, PBL, SBP) 11. Demonstrate an understanding of the effects and acute complications of severe trauma on organs and organ systems: Respiratory - thoracic trauma; acute lung injury; tension pneumothorax Cardiovascular - hypovolaemic shock; cardiac tamponade Renal - acute renal failure; rhabdomyolysis Neurological - altered consciousness; traumatic brain injury; post-anoxic brain injury; coup and contra-coup injuries; intracranial haemorrhage and infarction; spinal cord injury Gastrointestinal - abdominal trauma; abdominal tamponade; rupture of liver or spleen Musculoskeletal system - soft tissue injury; short term complications of fractures; fat embolism; crush injury & compartment syndromes; maxillofacial injuries (PC, MK, P, ICS, PBL, SBP) BASIC DUTIES Basic duties for fellows include: 1) assisting with trauma surgical daily critical care rounds 2) assisting with trauma resuscitations 3) attending to the day-to-day needs of the patients in consultation with the assigned attending 4) performing procedures or assisting in diagnostic/interventional procedures appropriate to the fellow’s skill level 5) recording daily patient encounters, observations, and procedures REQUIREMENTS Fellows are to assume the following responsibilities: 1) develop a personal program of self-study and professional growth [P, MK,PBL] 2) participate in daily rounds when available [P,PC,ICS] 3) complete dictations appropriately and timely [PC,ICS,P] 4) document duty hours weekly [P] 5) document all procedures in their personal procedure log [P,PBL] 6) monitor themselves for fatigue [P] 7) dress professionally, as each resident represents both the fellowship and the attending physician [P] 8) participate in effective and compassionate patient care [PC] 9) complete evaluation forms for rotation and all other documents requested at the conclusion of each rotation [P] EVALUATION 1. The fellowship will evaluate the fellow’s performance in the six competencies by having preceptors complete the Fellow Competency Performance evaluation. 2. Evaluate residents’ teaching, time management skills, professionalism, communication skills, patient care, and medical knowledge by having peers complete an evaluation after each rotation. 3. Review faculty, peer, and nursing evaluations with the residents at least every six months with the Fellowship Director. 4. Review the fellow’s procedure log at least every six months with the Fellowship Director. 5. Track the completion of each PACT module. KEY PC = Patient Care Competency MK = Medical Knowledge Competency P = Professionalism Competency ICS = Interpersonal Communication Skills SBP = Systems Based Practice PBL = Practice Based Learning and Improvement Multidisciplinary Curriculum Trauma Critical Care4
  • 5. SUGGESTED EDUCATIONAL RESOURCES 1. Critical Care Board Review Series Lectures: 1-Hemodynamic Monitoring, 2-Shock, 3-Issues in Airway Management, Sedation and Paralytic Use, 4-Selected Issues in Post-operative Management, 5-Burns and Trauma, 6-Bleeding Disorders, Coagulation, and Massive Transfusion, 7- Blood, Blood Products, and Blood Substitutes 2. PACT Modules: 1-Airway Management, 2-Respiratory Monitoring, 3-Sedation, 4- High Risk Surgical Patients 3. SCCM RICU Series: 1-Surgical Issues, 2- Peri-operative Management 4. Book Readings: Please see monthly reading assignment. 5. Journal Readings: Please see monthly reading assignment 6. Web Sites: General Rotational Competencies Medical Knowledge 1. Lists both critical and non-critical etiologies of a disease process/presentation and is able to elaborate on the clinical presentations, diagnostic findings, and indicated treatments of each. 2. Is able to describe the involved anatomy and pathophysiology of the common causes of a disease process/presentation. 3. Develops an understanding of the natural history of critical illnesses 4. Can discuss the accuracy (or lack there of) of physical exam findings associated with a disease process/presentation. 5. Learns the appropriate use of laboratory tests, imaging procedures and nuclear medicine tests in the diagnostic evaluation of critically ill patients. 6. Is able to discuss the evidence supporting the use of diagnostic testing and its cost effectiveness. 7. Correctly interprets EKG, laboratory, hemodynamic readings, and radiographic findings pertinent to a disease process/presentation. 8. Understands the indications, contraindications, and techniques required for placement of invasive and noninvasive hemodynamic monitoring devices, including (but not limited to) intra-arterial catheters, central venous catheters, Swan-Ganz catheters, intracranial pressure monitors and transvenous pacing catheters. 9. Understands the basic methods for searching, reviewing, and evaluating the medical and scientific literature. 10. Is able to discuss the evidence supporting therapeutic interventions and their cost effectiveness. 11. Analyzes current and novel clinical practices by identifying relevant scientific publications and evaluating them using evidence-based medicine techniques 12. Supports ongoing basic science or clinical studies designed to evaluate and improve the understanding of critical illness and the care of the critically ill as well as process improvement protocols. 13. Understands advanced concepts important for compensation of critical care services and contractual issues related to providing critical care services and performing the business of medicine. 14. The fellow will have a co-supervisory role over residents and medical students functioning within the critical care environment and will be responsible for providing educational and procedural guidance as part of this role. 15. The fellow will participate in resident/student critical care didactic lectures, chest conferences, and journal club discussions Patient Care 1. Triage critically ill patients to optimize care delivery within the institution 2. Improve resource utilization and maintain patient care quality by facilitating triage of patients to limited institutional critical care beds and caregivers 3. Initially assesses the ABCs of acute evaluation, intervenes as appropriate, and establishes a plan to stabilize and treat as deemed necessary. Includes bedside laboratory and hemodynamic testing as necessary. 4. Provide resuscitation, including advanced techniques to any patients sustaining a life-threatening event 5. Initiate critical care to stabilize and manage patients who require transport to another facility for a higher level of critical care support. 6. Performs a problem focused H&P as possible that includes pertinent history/physical exam points. Multidisciplinary Curriculum Trauma Critical Care5
  • 6. 7. Is able to predict clinical improvement vs. impending deterioration and establishes a plan for weaned intervention vs. a plan for stabilization. 8. Based on the H&P appropriately synthesizes a DDx including life threatening causes of a disease process/presentation. 9. Obtains information necessary to provide optimal patient care from all available resources (ED charts, hospital records, ECR records and personnel, PCPs/consultants, family members, etc.). 10. Learn the appropriate use of laboratory tests, imaging procedures and nuclear medicine tests in the diagnostic evaluation of critically ill patients. 11. Displays appropriate cognitive and psychomotor skills when performing procedures. 12. Orders the indicated diagnostic studies in a cost-effective manner. 13. Understands the indications, contraindications, and techniques required for placement of invasive and noninvasive hemodynamic monitoring devices, including (but not limited to) intra-arterial catheters, central venous catheters, Swan-Ganz catheters, intracranial pressure monitors and transvenous pacing catheters. 14. Understands and directs patient care based on the interpretation of information acquired from the aforementioned invasive and noninvasive hemodynamic monitoring devices. 15. Prioritize complex data by a problem oriented approach to support an action plan. 16. Institutes the appropriate treatment plan in a timely fashion including comprehensive discharge instructions and follow-up if discharged. 17. Initiate, manage, and wean patients from mechanical ventilation using a variety of techniques and ventilators. 18. Diagnose and stabilize patients with impending organ failure (respiratory, cardiac, neurologic, hepatic, gastrointestinal, hematologic, renal, etc.) 19. Recognize the potential for multiple organ failure and institute measures to avoid or reverse this syndrome 20. Treat cardiogenic, traumatic, hypovolemic, and distributive shock using conventional and state-of-the-art approaches 21. Identify life-threatening electrolyte and acid-base disturbances, provide treatment, and monitor outcome. 22. Perform diagnostic and therapeutic bronchoscopies. 23. Diagnose malnutrition and use and monitor advanced nutrition support methodologies 24. Diagnose infection and use advanced antimicrobial agents 25. Use and help enforce advanced methods of infection control. 26. Use medication safe practice guidelines and determine cost-effectiveness of therapeutic interventions. 27. Instruct others in appropriate use and monitoring of conscious and deep sedation and use advanced pain management strategies. 28. Initiate consultation with other specialist physicians and negotiate a joint clinical plan in managing complex ICU problems. 29. Initiate discussions involving ethical issues and patients’ wishes in making treatment decisions, using advance directives, and using other methods. Communicate effectively with families and all members of the healthcare team about SICU capabilities and patient-specific issues 30. Communicate with and support patients, their families, and all members of the healthcare team through the physical and psychological complexities of critical illness 31. Facilitate resident education and guides/supervises resident functions in regards to patient care. 32. Supervise residents on procedures under the supervision of the attending intensivist or the attending surgeon. Interpersonal/Communication Skills 1. Introduces themselves and establishes rapport with the patient to degree permitted by the patient’s condition and with the patient’s family. 2. Performs a focused interview if possible that quickly elicits the pertinent information. 3. Explains to the patient/family what will occur in terms of diagnostic and therapeutic interventions and discusses the anticipated critical care course. 4. When appropriate, discusses pertinent information with family members. 5. Keeps patients and family informed of test results, impact of therapeutic interventions, and plans for alterations in care pathways. 6. Initiate discussions involving ethical issues and patients’ wishes in making treatment decisions, using advance directives, and using other methods 7. Communicates effectively with patients, families, and other involved members of the healthcare team about all treatment decisions and patient prognosis. 8. Support patients, their families, and other members of the healthcare team through the trauma of critical illness. Multidisciplinary Curriculum Trauma Critical Care6
  • 7. 9. Communicate effectively with families and all members of the healthcare team about CC capabilities and patient-specific issues. 10. Communicate with and support patients, their families, and all members of the healthcare team through the physical and psychological complexities of critical illness. 11. Presents a concise, problem focused presentation to the faculty. 12. Interacts with the health team (nurses, ancillary support staff, and consultants) as both a team member and team leader using effective interpersonal and communication skills. 13. Provides and discusses with the patient (and family) any reasons for a change in change in hospital course or any discharge instructions including patient education. 14. Charting skills demonstrates appropriate legibility and thoroughness from a medico legal and coding perspective. 15. Supervise residents on procedures under the supervision of the attending intensivist or the attending surgeon 16. Develop skills for teaching critical care Professionalism 1. Is appropriately dressed 2. Displays appropriate work ethic 3. Displays an attentive interest in learning and self-improvement. 4. Demonstrates a professional demeanor (respect, compassion, integrity, honesty) while interacting with patients, families, peers, and the health care team. 5. Projects empathy and a non-judgmental attitude towards patients. 6. Places the patient’s best interests above all else. 7. Maintains patient confidentiality and is compliant with HIPAA regulations. 8. Uses and increases the skills of ICU nurses and ancillary personnel in caring for critically ill patients by acting as the SICU team leader 9. Initiates/seeks consultation with other specialist physicians and negotiate a joint clinical plan in managing complex ICU problems 10. Initiates discussions involving ethical issues and patients’ wishes in making treatment decisions, using advance directives, and using other methods 11. Communicates effectively with patients, families, and other involved members of the healthcare team about all treatment decisions and patient prognosis 12. Understand advanced concepts important for compensation of critical care services and contractual issues related to providing critical care services and performing the business of medicine. Practice-Based Learning 1. Is an active and enthusiastic learner. 2. Actively evaluates their own performance (self-critique). 3. Prioritize complex data by a problem oriented approach to support an action plan. 4. Readily accepts teaching points and constructive criticism and applies this information to self-improvement. 5. Closes the learning loop with timely case-based reading. 6. Utilizes available information resources including computer resources to enhance patient care. 7. Actively participates in quality assurance processes, including mortality and morbidity conferences, process improvement teams and Joint Commission on Accreditation of Healthcare Organizations preparation. 8. Understands the basic methods for searching, reviewing, and evaluating the medical and scientific literature. 9. Is able to discuss the evidence supporting therapeutic interventions and their cost effectiveness. 10. Analyzes current and novel clinical practices by identifying relevant scientific publications and evaluating them using evidence-based medicine techniques 11. Supports ongoing basic science or clinical studies designed to evaluate and improve the understanding of critical illness and the care of the critically ill as well as process improvement protocols. 12. Understands advanced concepts important for compensation of critical care services and contractual issues related to providing critical care services and performing the business of medicine. 13. The fellow will have a co-supervisory role over residents and medical students functioning within the critical care environment and will be responsible for providing educational and procedural guidance as part of this role. Multidisciplinary Curriculum Trauma Critical Care7
  • 8. Systems Based Practice 1. Effectively accesses and utilizes outside resources to enhance patient care. 2. Involves the appropriate consultants and ancillary services (RT, PT, OT, social work, chaplainry, case managers) in a timely fashion to enhance patient care. 3. When appropriate, helps close the patient care loop with patient/family education before discharge and helps to arrange appropriate follow-up. 4. Notifies primary care providers of their patient’s course. 5. Practices situational awareness in the critical care environment and efficient multi-patient skills. 6. Demonstrates effective leadership and team member skills during resuscitations. 7. Interacts with support personnel to enhance patient care and effect accurate transfer of information. 8. Uses medication safe practice guidelines and determine cost-effectiveness of therapeutic interventions. 9. Uses and increase the skill of ICU nurses and ancillary personnel in caring for critically ill patients by acting as the SICU team leader. 10. Initiates consultation with other specialist physicians and negotiate a joint clinical plan in managing complex ICU problems. 11. Improves resource utilization and maintain patient care quality by facilitating triage of patients to limited institutional critical care beds and caregivers. 12. Actively participates in quality assurance processes, including mortality and morbidity conferences, process improvement teams, and Joint Commission on Accreditation of Healthcare Organizations preparation. 13. Understand advanced concepts important for compensation of critical care services and contractual issues related to providing critical care services and performing the business of medicine. 14. Develop skills for teaching critical care 15. Recognizes imperfections within the health care system and works to correct them. 16. Advocates for patients within the health care system and the community. 17. Understands the need for patient safety monitoring and error reduction strategies. 18. Understands the need for and help in the process of assessing patient and family satisfaction. 19. Understands and ensure compliance with institutional and unit policies and procedures as well as regulatory policies from accreditors, regulators, and payers. 20. Evaluates current ICU policies. Multidisciplinary Curriculum Trauma Critical Care8

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