A typical day in the ICU
In the ICU, the day starts early. It may still be dark outside when morning labwork is drawn. This may seem early, but allows the lab to have time to complete the tests and have results ready for the team to review when they come by for rounds later in the morning. A technician may also perform a chest x-ray for the teams to review.
Rounds –what are they and how do they work?
During rounds, groups of healthcare providers go from room to room checking on their patients, discussing what has happened over the past 24 hours, and coming up with a To Do list for the day. The main teams –ICU physicians and nurse practitioners, surgeons and their trainees, medical doctors and physicians-in-training –usually round early in the morning. Specialists often come by later in the day. Other groups of providers may also do rounds. The charge nurse may round with the chaplain to check in with families;respiratory and physical therapy may round together to plan patient exercise for the day. Traditionally, patients and families have not been included in rounds, but that is beginning to change. At UCSF, we invite you to listen in to rounds and want you to be actively involved in your care.There may be a fair bit of medical jargon used, but we welcome the opportunity to help you understand our ‘language’ over the course of your stay.
Between 6am and 8am, members of the various teams may come by to see you and gather information in preparation for rounds later in the morning. They may want to perform a physical exam, ask you questions about how you are feeling, and review your chart, medications, and vital signs.
At 7am, the nurses will be completing a process called report as they change shifts. Your nurses will review your history, medications, vital signs, and plan of care in a detailed, organized manner. Depending on the policies of your ICU, your family may be asked to step out during this time. You will always be included as part of this conversation – think of report more as a 3 way conversation between you, your new nurse, and the nurse who is wrapping up his or her shift.
Between 8am and 11am, both the primary team and ICU team will complete rounds. They will discuss your condition, vital signs, medications, and lab results as well as any other important information in detail and develop a plan of care for the day. This is a great time to ask any questions you may have, or let your care team know of any new developments since they last saw you.
The afternoon can be a very busy time for you when in the ICU:
- Many of the specialty teams, such as cardiologists and endocrinologists, round in the afternoon and will come see you.
- Physical therapists, should you need help maintaining your mobility, will often see you during this time to develop a plan for mobility and to help you exercise.
- Many diagnostic tests such as CT scans, MRIs, and other procedures are performed in the afternoon. Your team or your nurse will discuss these with you and answer any questions you may have.
- The primary team and the ICU team often check on you frequently during this time. It is a great time to ask questions that you have about the plan of care or anything else you want to discuss in more detail.
In the evening, around 7pm, your nurse will give report to the nurse taking over for the night. Tell your nurses of any new or leftover questions and concerns from your day. If you’re not clear on the plan for tomorrow, this is a great time to ask.
At night, the ICU can be a noisy environment and it can be hard to sleep. You may travel for tests, get blood drawn, or have procedures even at night if your situation requires it. However, we know that sleep is very important for your recovery. If you would like ear plugs or an eyeshade, just ask your nurse. We want you to be comfortable and rested while you are in the ICU and will make every effort to help in this regard. If you have particular sleep habits like always having the TV on or the room cold, we will try to continue them in the ICU.
How can I participate?
The Patient’s Role
As a patient, it is your right to ask that medical information be shared with you and with family members you choose. Let your nurse know if you would like to participate in rounds and if you would like a friend or family member with you. Healthcare providers, including hospitals, are required by a federal law called HIPAA to take steps to protect your privacy. For this reason, hospital staff may seem uncomfortable discussing your care in your family’s presence. Additionally, a provider or team doing rounds may need to uncover part of your body to examine it—providers do not want to expose you without your permission. Telling staff that you give permission for a specific family member to receive information and/or be present during an exam eases their concern.
As a family member or friend of the patient how can I help?
- Ask your loved one whether they want you to be present during rounds and other discussions of their medical care.
- If you are able to be present during rounds, ask your nurse ahead of time for a quick orientation to the rounds process so that you will know what to expect.
- When the rounding team comes to you, listen carefully and write down questions or things you didn’t understand.
- Be ready to briefly share your view of how your loved one seems and what their goals are.
It may not be possible to get all questions answered right away;rounds can be a great opportunity to connect with the people you can talk to in more depth later in the day. Bring your “what did they mean by …” questions to the bedside nurse along with any outstanding concerns. If you are not able to be present for rounds, you can have the bedside nurse speak on your behalf and follow up with you by phone or in person afterward.