Jackson Memorial Hospital Surgical Intensive Care Unit (SICU)

To establish standardized processes for patient management, communication, and workflow in the Jackson Memorial Hospital Surgical Intensive Care Unit (SICU). This SOP defines the structure, daily routine, and team responsibilities to ensure optimal, consistent, and safe care delivery for all critically ill surgical patients.

This SOP applies to all medical staff working in the SICU, including attending physicians, fellows, residents, interns, advanced registered nurse practitioners (ARNPs).

A. Team Configuration – Day shift
Team / Attending Fellow / Resident Interns / ARNP
Low Side
(601-633) / SICU Attending 1 / Fellow 1 or 2 Intern 1, Intern 3, ARNP

High Side
(635-661) / SICU Attending 2 / Fellow 1or 2 / Intern 2, Intern 3, ARNP

B. Night Coverage
Team / Attending Fellow / Resident Resident / ARNP
Low Side
(601-633) / SICU Attending 1 / PGY-3 / ARNP

High Side
(635-661) / SICU Attending 2 / PGY-3 / ARNP

The PGY-3 night resident begins duty at 19:00 and covers both Low and High sides under the supervision of the on-call SICU High side and Low side attendings and is responsible for ongoing patient management and new admissions. The PGY-3 night resident works together in a team with the night ARNP’s.
On days with a single fellow, the on call SICU fellow should select and go to the higher acuity side.

Shift times / Work hours:

Interns:
Intern 1: 6:00 am – 20:00
Intern 2: 6:00 am – 18:00
Intern 3: 6:00 am –14:00

Interns are NOT allowed to arrive before 6:00 am for any reasons. Duty hour violations in any form will result in disciplinary suspension.

PGY-3 Night Resident:

Tuesday – Saturday, 19:00 – 08:30

Fellows:

Heavy fellow: Tuesday – Saturday 7:00 – 20:00
Sunday – Monday 07:00 – 8:00

Light fellow: Wednesday – Friday 7:00 – 14:00

ARNP’s

Dayshift: 7:00 am – 19:30
Nightshift: 19:00 – 7:30

Time / Activity / Responsible Parties

• 06:00
  Intern pre-rounds begin
  Interns
• 07:00
  Team handover (AM/PM)
  Fellows, Resident, Interns, ARNP’s
• 08:30 – 11:00
  Formal Attending Teaching Rounds
  Both SICU teams
• 12:00–17:00
  Procedures, transfer orders, documentation / progress nodes, family meetings
  Fellows, ARNPs, Residents, Attendings
• 19:00
  Team handover (PM/AM)
  Incoming night resident, outgoing teams
• 21:00
  Phone rounds (Low Side)
  Night resident, ARNP, Attending 1
• 21:15
  Phone rounds (High Side)
  Night resident, ARNP, Attending 2

A. Shift Handover (07:00 AM / 07:00 PM)

All patient care teams (ARNP’s, Night residents, Fellows, Interns) must be present. Low Side team meets in ARNP office. High side team meets in Fellow/Resident Office.
The night resident joints the low side hand over first and then touch-bases with the high side day team.
Sunday and Monday nights are covered by the SICU fellows. AM handover includes fellow to fellow sign out during 7 am handover meetings, starting with low side in ARNP office and followed by high side in fellow office.
Overnight events, admissions, and critical changes must be reviewed.
At 2 pm the light fellow hands-over the high side patients to the heavy SICU fellow.

A. Pre-Rounds (06:00–07:00 AM): Interns review all patients and data.

B. Multidisciplinary Rounds (08:30 AM–11:00 AM): Led by SICU Attendings; all core staff present.

C. Afternoon Work Rounds (12:00–17:00): Fellows, Interns and ARNPs review labs and progress.

D. Evening Rounds: 19:30 -21:00 PGY-3, ARNP’s, Conduct bedside rounds; phone rounds with attending at 21:00 and 21:15.

E. Night Rounds: 22:00 – 24:00 and 05:00 – 07:00, PGY-3, ARNP’s,

Urgent issues must be escalated to SICU fellow and attending. SICU team responds to in-unit emergencies and codes per hospital policy. Family discussions/meetings documented in EMR. All new patient presentation/consults need to be presented to the respective SICU attendings.

All on duty providers are required to sign into their respective roles for high side and low side SICU teams in Tiger connect. All communications MUST be HIPPA compliant and occur in Tiger connect or verbally via phone. Non-HIPPA compliant communication platforms such as conventional text messages, WhatsApp messages, other messaging platforms, e-mail,

Fellows and attendings provide supervision and procedural teaching. Interns present patients and identify learning goals. Night resident presents all new admissions to SICU attendings.

All notes and orders are entered into EMR during rounds and/or immediately after morning rounds. Resident notes require attending attestation. Medical Student notes need to be reviewed, edited and signed by Interns and relocated into correct SICU Progress Note folder in the EMR.

Daily review of lines, catheters, wounds, ventilator settings, sedation, and prophylaxis. Use of checklists for DVT, ulcer prevention, nutrition, and mobility.

JMH Critical Care Policy Manual; ACGME Common Program Requirements; SCCM Guidelines.

SICU Attending (Low Side), SICU Attending (High Side), Fellows, Residents, Interns, ARNP Charge Nurse: see Tiger connect.
All on duty providers are required to sign into their respective roles for high side and low side SICU teams in Tiger connect.