Critical Care Medicine - Adult


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Critical Care Medicine - Adult

  2. 2. ADULT CRITICAL CARE MEDICINE 2 PART II - 2008 IV. RESOURCES Standard B.4 "There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in the specialty or subspecialty." Where the resources to provide "full training" are not available at the sponsoring university, several different types of inter-university affiliations may be negotiated, as stated in the grey book "General Information Concerning Accreditation of Residency Programs." It should be noted that the exchange of residents between two fully accredited programs does not require an inter-university affiliation. Coordination of Adult and Pediatric Subspecialty Programs a) Is this university accredited for (check one only): adult critical care medicine only pediatric critical care medicine only b) If the university is accredited for both programs, describe the extent to which the two programs are integrated in the following areas: 1) Program administration 2) Academic program 3) Clinical program 4) Technical and/or laboratory skills
  3. 3. ADULT CRITICAL CARE MEDICINE 3 PART II - 2008 1. Teaching Faculty List by teaching site the members of the teaching faculty who have a major role in this program, including members from other departments. In indicating a subspecialty, use as a criterion whether he or she is considered by colleagues as a subspecialist and functions academically and professionally as one. Teaching Site Name University Rank Specialty Qualifications Subspecialty (If any) Nature of Interaction with Resident (e.g. clinical, teaching, research) What percentage of faculty listed above (#2.) have been practising in the specialty/subspecialty: < 15 years % > 25 years % 2. Financing of the program a) Describe the source of funding for residency positions in this program. b) How is the program funding the following? i. Resident travel to conferences? ii. The Society of Critical Care Medicine Multiple Choice Exam? iii. Computers for the residents?
  4. 4. ADULT CRITICAL CARE MEDICINE 4 PART II - 2008 iv. Courses such as ACLS, ATLS, and PALS? c) How is the Program Director supported to run the program? Comment on resources available, money available, and if the Director has protected time to devote to the program.
  5. 5. ADULT CRITICAL CARE MEDICINE 5 PART II - 2008 3. General Critical Care Data a. Demographic Data for each ICU where residents rotate Complete the following table for a 12-month period. Specify the 12-month period used, the source of data, and which ICU acuity scoring system was used (APACHE score, MPM, SAPS etc) in the comments section. Add rows as needed to include all units where residents rotate for primary ICU experience. Standard deviations can be included in the table if the data is available. Only full ICU beds should be counted. If there are lower acuity beds (stepdown unit) attached to the ICU these should be described in the comments section. Open or closed refers to the management functioning of the unit. In a closed unit the ICU team is responsible for all orders and all admission and discharge decisions. Open units allow non ICU services to write orders and make admission/discharge decisions. Unit Name Number of ICU beds Open or Closed unit Number of admissions Average LOS Average acuity score ICU mortality (%) TOTAL Comments: b. Narrative description of units where residents train Provide a written description of the purpose of each unit in the training program and the case mix of the admissions to the unit. Indicate if one type of patient (ie post op cardiac, trauma etc) dominates the population of the unit. Comment on the capabilities available for support of critically ill patients in each unit. Comment on the frequency of out of unit consultations, and if the residents are responsible for responding to cardiac arrests or trauma victims outside of the ICU. Describe the clinical responsibility of Critical Care residents in each unit. Use a separate paragraph or section for each unit. c. Specific ICU activities important for training residents Complete the table below by recording the number of admissions during a 12-month period where the primary admission diagnosis is one of the four listed in the table. Specify the 12-month period used and the source of data in the comments section. Add rows as needed to include all units and hospitals that receive ICU program residents.
  6. 6. ADULT CRITICAL CARE MEDICINE 6 PART II - 2008 Diagnostic information HOSPITAL/Unit Cardiogenic shock ARDS Post Cardiac Surgery Head injury TOTAL Comments: Interventions used in ICU over a 12 month period Complete the table below by recording the actual or approximate number of the listed interventions for a 12 month period. Specify the period used and the source of data in the comments section. Use the comments section to outline the involvement of critical care residents in these interventions. HOSPITAL/Unit Mechanical Ventilation Conventional Hemodialysis Continuous Renal Replacement Therapy Intraaortic balloon pump Intracranial pressure monitoring TOTAL Comments: Nutritional Describe the training that residents in critical care receive to evaluate the nutritional status of patients, to determine current deficiencies, and how to provide the appropriate nutrition in the most effective manner, be it enteral or parenteral, to sustain the patient throughout the period of critical illness.
  7. 7. ADULT CRITICAL CARE MEDICINE 7 PART II - 2008 Does a dietician attend daily rounds in the unit? Do residents receive exposure to metabolic charts during their ICU rotations? What percentage of patients admitted to each ICU receives total parenteral nutrition during their ICU stay? Trauma Complete the following table for all hospitals. Include the 12-month period used and the source of data in the comments section. Add rows as needed to account for all units and hospitals that admit trauma patients. Use the comment section to outline the involvement of critical care residents in trauma care in your primary trauma unit. HOSPITAL/Unit Type of Trauma centre Number of trauma victims managed at Hospital with Injury Severity Score greater than 16 Number of trauma victims admitted to ICU TOTAL Comments: Describe the team and organization responsible for the care of multiple injuries. Please indicate the hospital(s) involved, the general plan of management from initial care to definitive treatment, and the role played by the critical care residents in this process. Does the hospital have a designated trauma team? How is the critical care resident involved in the early phase of trauma resuscitation?
  8. 8. ADULT CRITICAL CARE MEDICINE 8 PART II - 2008 Describe the specific trauma training provided to critical care residents. Sepsis Complete the table below for a 12-month period. Use the comments section to indicate the 12-month period used and the source of data. Add rows as needed to include all units where residents rotate for primary ICU experience. INTENSIVE CARE UNIT Number of septic shock admissions TOTAL Comments: Describe the role of the critical care residents in managing patients with septic shock. Is there an Infectious Disease service available for consultation? Are there any antimicrobial agents or other medical therapies that CANNOT be ordered by the critical care team? What training do critical care residents receive in infection control procedures? Toxicology Complete the table below by recording the number of toxicologic emergencies responsible for ICU admission in each of your units. Specify the 12-month period used and the source of data. INTENSIVE CARE UNIT Toxicologic Emergency Admissions TOTAL
  9. 9. ADULT CRITICAL CARE MEDICINE 9 PART II - 2008 Is there a liaison with a poison control centre? Describe any additional toxicology training available and the opportunities available for critical care residents to receive toxicology training. Burns and Electrical Injuries Complete the following table for a 12 month period. Use the comments section to indicate the time period used, the specific acuity score reported, and the source of the data. Add more rows as needed if several intensive care units admit burn patients. Use the comments section to describe the involvement of critical care residents in the unit where most of the burn care is delivered. Hospital/Unit Number of Burn admissions to ICU Average Acuity score of burned ICU admissions Average LOS of burned ICU admissions ICU mortality of Burn admissions (%) TOTAL Comments: Describe the facilities to provide training to residents in fluid resuscitation, early grafting, prevention and management of burn wound sepsis and the minimization of metabolic complications of burns. Transplantation Which of the following types of transplantation programs are operating in your centre?
  10. 10. ADULT CRITICAL CARE MEDICINE 10 PART II - 2008 Cardiac Transplant Lung Transplant Hepatic Transplant Renal Transplant Bone Marrow Transplant Other (specify) No Transplant programs in operation Which type of transplant patients are admitted to ICU in the immediate post transplant period? Cardiac Transplant Lung Transplant Hepatic Transplant Renal Transplant Bone Marrow Transplant Other (specify) None routinely admitted to ICU If you admit recently transplanted patients to ICU complete the following table. In the comments section indicate what 12 month period you are using, what the source of the data is, and what units are admitting the patients. Use the comments section to describe any additional training related to transplant care. Type of transplant Number of admissions per year Average Length of stay in ICU Total Comments: Complete the following table including all Intensive care units that routinely receive residents from your program. Provide data over a 12 month period. Use the comments section to specify the 12 month period used and the source of data. Add rows as needed to include all units. Unit/Hospital Number of patients who were declared brain dead Number of patients who were organ donors TOTAL
  11. 11. ADULT CRITICAL CARE MEDICINE 11 PART II - 2008 Comments: Pediatric ICU Experience Is Pediatric ICU experience mandatory for residents in your program? Yes No Is there a pediatric component to your adult ICU? Yes No If yes, outline how pediatric patients are integrated into the adult ICU. Is there a pediatric intensivist? How many pediatric admissions do you get per year? _________ What is the minimum age that can be accepted in your adult ICU by policy? _________ Over the last 2 academic years have ANY of your residents done a rotation in a pediatric ICU? Yes How many? ______ No Describe the PICU where your residents might rotate. Hospital Number of ICU Admissions Per Year Number of Ventilated Cases Per Year TOTAL 4. Skills Who routinely performs the following procedures in your Critical Care Units? You may indicate the actual or estimated number of procedures performed by Critical Care residents if you have the data, by placing the number of procedures performed in the appropriate column. Indicate if the number is estimated or if you are tracking the procedure as part of your program. Routinely performed by (check all that apply) CHECK skills that
  12. 12. ADULT CRITICAL CARE MEDICINE 12 PART II - 2008 Skill/Procedure residents will leave program with BOTH competence and practical experience ICU attending ICU Resident Other (specify) Orotracheal intubation Mechanical ventilation (invasive) Non invasive ventilation Liberation from prolonged mechanical ventilation Bronchoscopy (INTUBATED PATIENT) Arterial line insertion Central line insertion Pulmonary artery catheterization Dialysis catheter insertion Neurologic declaration of death and organ donor management Defibrillation and cardioversion Temporary pacemaker insertion Lumbar puncture Peritoneal tap Resuscitation of patients with undefined shock states Thoracentesis Thoracostomy tube insertion Insertion of ICP monitor Management of ICP monitor Insertion of intra-aortic balloon pump Management of intra-aortic balloon pump Calculation of nutritional plan End of life discussion with patient/family
  13. 13. ADULT CRITICAL CARE MEDICINE 13 PART II - 2008 5. Critical Patient Transport a) Is there a Critical Patient Transport Program for adult patients? YES NO b) Is there a Critical Care Patient Transport Program for pediatric patients? YES NO c) Do critical care residents physically leave the ICU to transport patients? YES NO d) Describe the organization of patient transfers into the tertiary critical care units in your city. What is the role of the critical care resident in this process? Are they involved in the decision to transfer to or from the tertiary unit? How are they involved in organizing the transfer? How are they involved in the actual transfer? e) Are residents involved in transfers between intensive care units in your city? How? What is their role? f) What training do residents in your program receive regarding transport of critically ill patients? 6. Epidemiology a) List staff with expertise in epidemiology and biostatistics and provide their qualifications. b) Describe the arrangements within the program to allow the resident to gain expertise in the use of epidemiological techniques to relate environmental, socio- economic and life style factors to critical illness and the critical care milieu and specifically in tabulation and evaluation of institutional and regional morbidity and mortality. Provide details with respect to any didactic teaching. c) Describe any opportunities for residents to gain experience in high risk scoring systems (e.g. Injury Severity Scores), and patient evaluation systems (e.g., APACHE, TISS, etc.)
  14. 14. ADULT CRITICAL CARE MEDICINE 14 PART II - 2008 d) Do your units have a dedicated ICU database? Describe how you obtain demographic and outcome data if you do not. Describe the data collected and the data collection process if you use an ICU database. 7. Biomedical Ethics a) Is there an ethicist available for consultations in the Intensive Care Unit? YES NO Describe his/her role. b) Does the ethicist participate in: Teaching conferences? YES NO Case discussions? YES NO b) If applicable, describe any opportunities provided for instruction in coping with the moral and ethical issues which impact on patients, their families, and the critical care specialist. c) What instruction and experience do residents get around end of life care and withdrawal of life support? d) Describe any opportunities that provide residents with experience in the medico-legal considerations specific to the critically ill patient. 8. Supporting Diagnostic and Laboratory Services Are there any limitations for the Critical Care training program in areas of pathology, biochemistry, microbiology, or diagnostic imaging?
  15. 15. ADULT CRITICAL CARE MEDICINE 15 PART II - 2008 9. Supporting Clinical Services Are there any limitations for the Critical Care training program in any of the following: cardiology, endocrinology, hematology, immunology, infectious diseases, neurology, nephrology, pharmacology, general surgery, neurosurgery, anesthesiology, cardiovascular surgery, orthopedic surgery, plastic surgery, otolaryngology, urology, and respirology? 10. Summary of Adequacy of Resources Comment on the adequacy of the resources in the overall clinical program, with particular reference to the relationship between such resources and the number of residents dependent upon them. Identify any areas where deficiencies of staff, suitable patients, or essential facilities are affecting adversely the training of residents, indicating measures under consideration to correct such deficiencies.