TICU Overflow

Authors: Nicholas Namias, Brandon Parker, Valerie Hart – 9/3/25
Approval: Namias

TICU Overflow and OR to PATU to TICU patient flow and responsibilities

  • The TICU team manages patients in the TICU and in the TICU designated beds (up to 4) on T3A.
  • The on-call trauma team manages patients in the PATU and Resuscitation. Off service patients in PATU awaiting a TICU bed are cared for by the on-call Trauma team with critical care notes written by trauma team as needed.
  • All patients in PATU (including Geri) can be deemed to not need ICU status by Trauma Attending

Postoperative ICU Patients

  • Any patient who enters the OR under Trauma Surgery for acute hemorrhage control and then undergoes a subsequent procedure by another service (e.g., Orthopedics, Interventional Radiology) must be evaluated by the on-call Trauma team (PGY-5 or above) before leaving the operating room. The Anesthesia care team will contact the Trauma team at the conclusion of the case.

Orthopedic, Neurosurgery and other off trauma service patient flow when waiting for Critical Care bed.

  1. Operating service requests a bed from ICU when they decide the patient needs a ICU bed.
  2. ICU resident/fellow/APP evaluates, discusses with ICU attending, and with rare exception, accepts the patient.
  3. Patient remains admitted to operating service while admitted to ICU – the patient is not transferred to trauma.
  4. Operating service writes a service specific set of orders – wound care, diet, activity, etc.
  5. If patient goes directly to ICU, ICU writes set of critical care orders.
    a. All patients in TICU are admitted with “blunt/penetrating” powerplan. Provider writing the orders will incorporate the service specific orders.
  6. If no ICU bed immediately available, patient goes to PATU. Trauma resident is informed of the patient by the accepting ICU service– this job is not bounced back to the operating team or OR staff. Patient remains admitted to operating service while an ICU level patient in PATU – it is not necessary to transfer to trauma. Operating service writes a service specific set of orders – wound care, diet, activity, etc. Trauma, not ICU resident, writes powerplan. Provider writing the orders will incorporate the service specific orders. Trauma team manages critical care while in the PATU.

Summary:

  • Post-op patients are cleared by Trauma team before leaving operating room.
  • The TICU team manages patients in the TICU and in the TICU designated beds (up to 4) on T3A.
  • The on-call trauma team manages patients in the PATU and Resuscitation.
  • Off service patient in PATU awaiting a TICU bed are cared for by the on-call Trauma team with critical care notes written by trauma team as needed.

This has to be consistent, no exceptions for when there are no patients on T3A.

TICU Overflow and OR to PATU to TICU patient flow and responsibilities

  • The TICU team manages patients in the TICU and in the TICU designated beds (up to 4) on T3A.
  • The on-call trauma team manages patients in the PATU and Resuscitation. Off service patients in PATU awaiting a TICU bed are cared for by the on-call Trauma team with critical care notes written by trauma team as needed.
  • All patients in PATU (including Geri) can be deemed to not need ICU status by Trauma Attending

Postoperative ICU Patients

  • Any patient who enters the OR under Trauma Surgery for acute hemorrhage control and then undergoes a subsequent procedure by another service (e.g., Orthopedics, Interventional Radiology) must be evaluated by the on-call Trauma team (PGY-5 or above) before leaving the operating room. The Anesthesia care team will contact the Trauma team at the conclusion of the case.

Orthopedic, Neurosurgery and other off trauma service patient flow when waiting for Critical Care bed.

  1. Operating service requests a bed from ICU when they decide the patient needs a ICU bed.
  2. ICU resident/fellow/APP evaluates, discusses with ICU attending, and with rare exception, accepts the patient.
  3. Patient remains admitted to operating service while admitted to ICU – the patient is not transferred to trauma.
  4. Operating service writes a service specific set of orders – wound care, diet, activity, etc.
  5. If patient goes directly to ICU, ICU writes set of critical care orders.
    a. All patients in TICU are admitted with “blunt/penetrating” powerplan. Provider writing the orders will incorporate the service specific orders.
  6. If no ICU bed immediately available, patient goes to PATU. Trauma resident is informed of the patient by the accepting ICU service– this job is not bounced back to the operating team or OR staff. Patient remains admitted to operating service while an ICU level patient in PATU – it is not necessary to transfer to trauma. Operating service writes a service specific set of orders – wound care, diet, activity, etc. Trauma, not ICU resident, writes powerplan. Provider writing the orders will incorporate the service specific orders. Trauma team manages critical care while in the PATU.

Summary:

  • Post-op patients are cleared by Trauma team before leaving operating room.
  • The TICU team manages patients in the TICU and in the TICU designated beds (up to 4) on T3A.
  • The on-call trauma team manages patients in the PATU and Resuscitation.
  • Off service patient in PATU awaiting a TICU bed are cared for by the on-call Trauma team with critical care notes written by trauma team as needed.

This has to be consistent, no exceptions for when there are no patients on T3A.