FAQ

The CCTC is located at Victoria Hospital; This is a 30-bed unit. Approximately 2,000 patients are admitted per year. This is a multidisciplinary unit; patients include trauma, surgery (general, vascular, thoracics, plastic and other), obstetrics, emergency and medical (general, oncology ward, respirology ward and other) patients.

There are usually four Seniors rotating in the CCTC at any time. The Seniors are residents in the Critical Care residency program, which is a two-year Royal College subspecialty program, or Critical Care Fellows. The Seniors have completed, or are in their final year of residency (in anaesthesia, medicine, emergency medicine or surgery). The Seniors are responsible for coordinating patient care and supervising you (i.e. the junior house staff), and are supervised by the Consultants. They will have a large role in your educational experience in the unit and will review all patients and new admissions with you. They will also teach and supervise procedures such as central catheters, chest tubes etc.

The day begins at 0730 hrs with the seminars and attendance is mandatory. Sometimes lecture rounds start at 0700 hrs so please check the schedules frequently. At 0830 hrs until approximately 1000 hrs there are ‘morning rounds’. The Junior resident on call presents each patient the night before. The focus is on reviewing the major patient problems, and developing a care plan for the day. After morning rounds you should ‘divide up’ the responsibilities for the day. This means going to the patient board in the CCTC conference room and assigning patient responsibilities to the resident team.

Shortly after morning rounds there are ‘X-Ray Rounds’ in the conference room - this is our opportunity to review the morning X-rays on the patients.

You should then see each of your assigned patients briefly and address any questions from the nurse and respiratory therapist. Please identify yourself to the Bay that you are assigned so the staff are aware of who they need to speak to with their concerns or should someone get worse clinically. You should make sure that diagnostic tests, consults etc. are organized early in the day. Remember, if you order a test, follow up on results. Personally, call the consult to the service if you need your patient seen urgently so you can answer questions about your patient. You will then be able to go back to your patients and examine them thoroughly and write your daily note. Try to ensure that families are updated daily. In the afternoon there are ‘sign-over’ or ‘walk around rounds’. These are usually around 1500 or 1600 hrs, but on busy days they can be later! The goal of these rounds is to update the team, and especially to ensure that the on-call resident understands the issues and concerns for the night.

There is a Senior resident and usually two Junior residents on call every night. At night, the first call resident carries the arrest pager and is responsible for Consults/Codes and Bays 4 and 5. The second call resident carries the Trauma Pager and is responsible for Bay 1, 2, and 3. The Trauma pager will go off when the Trauma Team gets activated but your role is to attend when you can and learn as much as you can but not to be actively involved at this time. You are responsible for your Bays through the night and presenting rounds in the morning. Please make sure you don’t switch this around arbitrarily through the night or for rounds as it is difficult for others to keep track of who you are responsible for. Remember, you work as a team so there will be instances when you may need to help each other.

If you have the first call/arrest pager you are part of the cardiac arrest team. This will be announced as Adult Code Blue. The team consists of: CCTC resident, CCU resident, SMR, RT, CCU RN, and Pastoral Care. The CCU RN and RT can defibrillate/pace and deliver medications. Please note that there is a Paediatric Code Blue Team but you are not part of that team. In general you will be responsible for establishing the airway, and the Senior medical resident is responsible for central access. The CCU resident is the designated Team Leader and should supervise the course of the arrest. However, these roles sometimes change based on who is there first and who has the expertise so prepare yourself to be flexible. However, please make sure that ONE person is in charge during a code to avoid confusion!

There is also a ‘pre-arrest’ category. This is an emergency system designed to get help quickly for unstable patients who haven’t actually arrested. (In general it is easier to resuscitate unstable patients than try to resuscitate patients who have gone on to arrest).

The pre-arrest code will contact the CCTC pager and a respiratory therapist as well as CCOT. Assess the patient urgently - do not hesitate to call for help from the Senior resident. If the patient needs to be admitted to the CCTC, contact the Charge Nurse … they will help to arrange a bed.

If you are called to assess a patient on the floor or in the Emergency Department, the first thing to do is to see the patient (not read the chart!). This occurs much less frequently as CCOT is usually the first team that gets called to Emergency. CCOT will protect your time by seeing these patients, but if CCOT calls you, please arrive promptly. Remember your ABCs and always stabilize the patient above all. If the patient needs immediate admission contact the Charge Nurse and Senior resident before moving the patient to the CCTC. If there are airway/respiratoy issues, call for an RT. If you need more help with managing the airway or if there are difficulties or complexities, call the Senior/anaesthesia early. Always remember that CCOT can be called at any time. They are always willing to help.

You may be called to assess a patient who does not seem to require admission to the CCTC.

In this case you should assess the patient, write a note, discuss the consult with the Senior resident and talk with the attending service.

Don’t worry. Help is always nearby or only a phone call away. You can get help with an emergency intubation from the Senior, and in the middle of the night be aware that many of the respiratory therapists are certified to intubate. Also, there is an in-house anaesthesia resident for difficult emergent intubations.

Critical Care Seniors will help to teach you and supervise procedures. Our nurses/most RT’s are certified in ACLS, and can help you with procedures such as cardioversion, transcutaneous pacemakers etc. On the floor, you may see a patient already seen or followed by CCOT. Our CCOT RN and the CCOT cart also has most things you may need on the ward. This is a valuable asset.

Nosocomial infections are common in the CCTC and contribute to CCTC morbidity and mortality. What can you do? First - hand washing is the most important preventative step. Wash your hands or use alcohol sanitizer before/after every patient encounter. Use sterile precautions for all procedures. This includes gown/mask/gloves and a large sterile field for procedures such as central lines and chest tubes. Chlorhexidine is the skin prep of choice for prevention of catheter related infections. Patients with resistant organisms or transmissible infections will be isolated (MRSA and C. difficile are very common in the CCTC). Pay attention to isolation precautions - they are not just for nurses!! Also – protect yourself.  Masks/gloves/gowns and visors are to be worn for all procedures. Please protect yourself and staff/ patients by following universal precautions.

Good news. This is not your problem. The consultant on call, the Senior resident, Consultant and the Charge Nurse will worry about beds. You just worry about patient care.

The schedule is made by one of the Senior Residents. It conforms to PAIRO guidelines. If you have a holiday or call requests forward the information to Rebecca Rondinelli (rebecca.rondinelli@lhsc.on.ca), your requests will be forwarded to the Senior Resident in charge of the scheduling and once approved the changes can be made the schedule, we will do everything we can to accommodate you. 

For any major holidays, or time off needed please forward your request to DOMEDUCATION@lhsc.on.ca. Holidays conform to PAIRO guidelines. You must request holiday time in writing four weeks prior to the expected commencement of vacation and not later than February 15th. Vacation requests are granted on a ‘first come’ basis and only one resident will be allowed holiday time per week. Conference time and examination request are extraordinary circumstances and we will do our best to accommodate you however do not leave it to the last minute!

Short answer: usually, as long as you aren’t on call. Arrange this with the Senior resident on call - we need to know when you will be away for teaching, and when you will be back. Sometimes patient care requirements will mean that you won’t be able to attend.

Please contact Dr. Rob Arntfield or contact Rebecca Rondinelli (rebecca.rondinelli@lhsc.on.ca) to organize an appointment. We will do our best to help with any concerns you have in a timely manner.

Yes, absolutely. We will complete your resident assessment at the end of the rotation with input from the Consultants, Senior residents, nursing and social work. We also ask that you provide feedback about the rotation, evaluate the CCTC Consultants and the Seniors. Thank you in advance.