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ACS Team Structure AY 2024-2025

Roles and Responsibilities

Purpose:  The purpose of this document is to outline the roles and responsibilities for each team member providing patient management on the Acute Care Surgery service in order to provide coordinated and timely care. This document serves as a guideline that can and should be adjusted according to the needs of the patient and the needs of other patients requiring concurrent care.

Guiding Principles

  • Teamwork: Acute Care Surgery includes multiple service lines, each unique to their patient population and staff coverage.  In addition, we are one team with one mission- to offer the highest level of care to our patients.  We will support each other in any way needed to achieve our mission.
  • Communication: Caring for acutely injured and ill patients requires clear, closed loop communication delivered in a respectful and professional manner. 
  • Leadership: Acute Care Surgery is present in all arenas of Nebraska Medicine- including the ER, OR, floor, ICU and clinic.  Given our large footprint, all members of the Acute Care Surgery team must act as leaders and a resource to any person or patient at Nebraska Medicine who asks for our help or input.

8th floor ICU attending

  • Daily sign out from night ICU (and trauma/EGS) attending at 7 am in Chairman’s conference room
  • Attends weekly resident education on Tues at 7:30 am
  • Begin rounds in 8th fl SICU at 8:30 am DAILY (except Weds, rounds start at 9 am)
  • Attend RADR rounds 1 pm M-F
  • Attend Transplant multidisciplinary rounds 1:30 pm M-F
  • Supports the Non-8th fl ICU attending
  • Daily sign out to night ICU attending at 4 pm in faculty office
  • Carries trauma phone on night call
  • Covers 8th fl and non-8th fl ICUs at night
  • In PerfectServe, all ICU pages/questions will go to the 8th floor ICU attending/APPs/residents
  • 8th floor ICU attending is expected to be physically present, as needed, in the ICU.  To support this:
      • Will not operate in OR, unless needed.  EGS attending should do EGS cases, and Trauma attending should do trauma cases.
      • 8th floor ICU attending will do bedside procedures (perc trach, PEGs, wound care, etc)

8th floor ICU fellows - days

  • Preround on assigned patient from 6a-8:30 am
  • Daily rounding at 8:30 am DAILY (except Weds, rounds start at 9 am)
      • Lead rounds with 8th fl ICU attending
  • Crit care fellow level education Tuesdays at noon
  • Afternoon walking rounds with residents/APPs at 3 pm
  • Daily sign out to night ICU attending at 4 pm in faculty office

8th floor ICU residents - days

  • Preview recorded orientation/problem based charting/patient pathways before rotation begins
  • Daily sign out from night resident and APP at 6 am in the 8th fl work room
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Preround on assigned patient from 6a-8:30 am
  • Daily rounding at 8:30 am DAILY (except Weds, rounds start at 9 am)
  • As one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • Residents and APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Fellow education highly recommended- Tuesdays at noon
  •  Attend RADR rounds 1 pm M-F
  • Attend Transplant multidisciplinary rounds 1:30 pm M-F
  • Afternoon walking rounds with residents/APPs at 3 pm, update the hand off tool
  • Daily verbal sign out to night resident and APP at 6 pm in the 8th fl work room
      • Pertinent points, “watchers”, follow up items in Hand Off tool
  • One ICU resident or APP should attend all FULL activations.
      • Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed.
      • Role does NOT include writing the trauma H and P or entering orders- this is the role of the trauma team members.
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability. 
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.

8th floor ICU APPs -days

  • MUST have at least one 12 hr APP per day who stays through 6 pm sign out
  • Daily sign out from night resident and APP at 6 am in the 8th fl work room
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Preround on assigned patient from 6a-8:30 am
  • Daily rounding at 8:30 am DAILY (except Weds, rounds start at 9 am)
  • Carries -0282 pager
      • Consults will be called through the pager or PerfectServe
      • The person who is carrying the pager is not solely responsible for all consults.
      • Consults should be delegated based on work load and availability.
  • As one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • Residents and APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Fellow education highly recommended- Tuesdays at noon
  • Attend RADR rounds at 1 pm
  • Attend Transplant multidisciplinary rounds 1:30 pm M-F
  • Afternoon walking rounds with residents/APPs at 3 pm, update the hand off tool
  • Daily verbal sign out to night resident and APP at 6 pm in the 8th fl work room
      • Pertinent points, “watchers”, follow up items in Hand Off tool
      • AT LEAST ONE DAY ICU APP needs to stay for 6 pm sign out.  Day APPs cannot sign out their patients to the residents, or vice versa.
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability. 
    • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Additional APP coverage will be required to support the residents’ attending FCCS or their required education time.
  • APPs may flex between 8th fl ICU and non-8th fl ICU, based on patient census
  • One ICU resident or APP should attend all FULL activations.
      • Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed.
      • Role does NOT include writing the trauma H and P or entering orders- this is the role of the trauma team members.

Non-8th floor ICU attending

  • Daily sign out from night ICU attending at 7 am in Chairman’s conference room
  • Attends weekly resident education on Tues at 7:30 am
  • Begin rounds in 5th fl SDCC at 8:30 am DAILY (except Weds, rounds start at 9 am)
  • Supports the 8th fl ICU attending (and EGS, trauma, CWIT as needed, can serve as a “flex”
  • Daily sign out to night ICU attending at 4 pm in faculty office
  • Non-8th floor ICU attending is expected to be physically present, as needed, in the ICUs.  To support this:
      • Will not operate in OR, unless needed.  EGS attending should do EGS cases, and Trauma attending should do trauma cases.
  • Daily discussion with CTN and SW about patients’ dispo.

Non-8th floor ICU APP - days

  • MUST be an APP working a 12 hr shift, and who stays through 6 pm sign out
  • Daily sign out from night resident and APP at 6 am in the 8th fl work room
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Carries -SDCC pager
      • Consults will be called through the pager or PerfectServe
      • The person who is carrying the pager is not solely responsible for all consults.
      • Consults should be delegated based on work load and availability.
  • Daily check in with case managers and social work by 8:30 am via text for potential discharges and patient needs
  • As one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • Residents and APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Afternoon walking rounds with residents/APPs at 3 pm, update the hand off tool
  • Daily sign out to night resident and APP at 6 pm in the 8th fl work room. 
      • Pertinent points, “watchers”, follow up items in Hand Off tool
      • AT LEAST ONE DAY ICU APP needs to stay for 6 pm sign out.  Day APPs cannot sign out their patients to the residents, or vice versa.
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability.
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.

8th floor ICU residents – nights

  • Preview recorded orientation/problem based charting/patient pathways before rotation begins
  • Assign self to patients in PerfectServe daily at 6 pm
  • Daily verbal sign out to night resident and APP at 6 pm in the 8th fl work room
      • Pertinent points, “watchers”, follow up items in Hand Off tool
  • Evenly splits all 8th fl and non 8th fl ICU patients with co-resident or co-APP on call
  • Carries -0282 pager
  • Nightly rounds between 9-10 pm or time agreed upon with Night ICU attending
  • One ICU resident or APP should attend all FULL activations.
      • Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed.
      • Role does NOT include writing the trauma H and P or entering orders- this is the role of the trauma team members.
  • Daily sign out to day residents and APPs at 6 am in the 8th fl work room

8th floor ICU and non-8th fl APPs -nights

  • Daily verbal sign out to night resident and APP at 6 pm in the 8th fl work room
      • Pertinent points, “watchers”, follow up items in Hand Off tool
  • Assign self to patients in PerfectServe daily at 6 pm
  • Evenly splits all 8th fl and non 8th fl ICU patients with co-resident or co-APP on call
  • Carries -0282 pager
  • Nightly rounds between 9-10 pm or time agreed upon with Night ICU attending
  • One ICU resident or APP should attend all FULL activations.
      • Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed.
      • Role does NOT include writing the trauma H and P or entering orders- this is the role of the trauma team members.
  • Daily sign out to day residents and APPs at 6 am in the 8th fl work room

Red resident trauma team attending

  • Daily sign out from night trauma attending at 7 am in Chairman’s conference room
  • Attends weekly resident education on Tues at 7:30 am
  • Table rounds daily M-F at 8:30 am in Chairman’s conference room with residents, Red APP, CTN and SW
  • Begin walking rounds on 9th fl high side at 9 am DAILY (except Weds, table rounds start at 9 am with walking rounds at 9:30 am), unless in trauma activation or OR. 
  • Supports the blue APP trauma team attending
  • Attends all trauma activations with red resident team 7 days a week
  • Sees all trauma consults with red resident team 7 days a week
  • Red resident team attending will round on trauma patients in the ICUs- focusing on their surgical issues. 
      • Use “short progress note” to document assessment and plan.
      • Trauma patients in ICU will be assigned to either Red resident or Blue APP team in Epic
      • Red Resident Trauma team will cover patients who have been operated on by the Red Resident Team, or who are complex, with multisystem injuries.
  • Red resident trauma team attending will operate on Red resident trauma team patients/trauma activations/trauma consults, as applicable.  While operating, the Blue APP trauma team attending will see activations and consults.
  • Red Resident trauma team attending is required to round on all resident patients
  • Carries the trauma phone during the day
  • Daily sign out to night trauma attending at 4 pm in faculty office

Red resident trauma team residents – days

  • Preview recorded orientation/problem-based charting/patient pathways before rotation begins
  • Red residents will be paired as an upper level with a lower level.  This pairing will remain the same for days and nights, all month long (only exception is cross coverage to provide days off, when available)
  • Day shift is 6 am to 6 pm.
  • Red resident trauma team will include one APP Monday thru Friday, as staffing allows.
  • Daily sign out from night resident or APP at 6 am in Resident conference room on 4th fl MSB
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Carries -1938 pager
      • Consults will be called through the pager or PerfectServe
      • The person who is carrying the pager is not solely responsible for all consults.
      • Consults should be delegated based on work load and availability.
  • Preround on assigned patient from 6a-rounds
  • Attends weekly ACS resident education on Tues at 7:30 am (this time is protected for both the Red trauma and EGS attendings, and residents- so Blue trauma APP attending responds to activations as needed.  Exception is OR.)
  • Table rounds daily M-F at 8:30 am in Chairman’s conference room with residents, Red APP, CTN and SW
  • Begin walking rounds on 9th fl high side at 9 am DAILY (except Weds, table rounds start at 9 am with walking rounds at 9:30 am), unless in trauma activation or OR. 
  • As one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • Residents and APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Red resident team attending will round on trauma patients in the ICUs- focusing on their surgical issues. 
      • This also allows for continuity of care from ICU to floor.
      • Use “progress note” to document assessment and plan. Free text **do not use Rounding tab.
      • Trauma patients in ICU will be assigned to either Red resident or Blue APP team in Epic
      • Red Resident Trauma team will cover patients who have been operated on by the Red Resident Team, or who are complex, with multisystem injuries.
  • Attends and evaluates all trauma activations- includes patient evaluation, note and orders
  • Evaluates all trauma consults- includes patient evaluation, note and orders
  • Regarding how patients are admitted to either the Red Resident Team or Blue APP team,
      • Red resident team admits patients who 1) residents operate on, 2) complex/multisystem injury patterns, 3) overflow from Blue APP team (once APP team census is >35)
      • If the Red Resident team operates on a Blue APP patient, that patient moves to the Red Resident Team.
      • If the Blue APP requires a procedure on a Blue APP patient (ie. chest tube, laceration repair, etc), the residents will assist the APPs, but patient remains on the APP team.
  • Afternoon talking rounds with residents/APPs at 4 pm, update the hand off tool
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor ICU residents and APPs will write the orders, upon bed availability.  ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to night resident and APP at 6 pm in the MSB 4th fl resident conference room

Red resident trauma team – night

  • Preview recorded orientation/problem based charting/patient pathways before rotation begins
  • Red residents will be paired as an upper level with a lower level.  This pairing will remain the same for days and nights, all month long.
  • Night shift is 6 pm – 6 am.
  • Friday, Saturday, Sunday and Monday nights are covered by the Red Resident trauma team, along with one night APP (who will cover the Blue APP trauma team pager overnight)
  • Daily sign out from night resident or APP at 6 pm in the Clarkson 9th fl trauma work room
  • Carries -1938 pager
      • Consults will be called through the pager or PerfectServe
      • The person who is carrying the pager is not solely responsible for all consults.
      • Consults should be delegated based on work load and availability.
  • Attends and evaluates all trauma activations- includes patient evaluation, note and orders
  • Evaluates all trauma consults- includes patient evaluation, note and orders
  • Regarding how patients are admitted to either the Red Resident Team or Blue APP team,
      • Red resident team admits patients who 1) residents operate on, 2) complex/multisystem injury patterns, 3) overflow from Blue APP team (once APP team census is >30)
      • If the Red Resident team operates on a Blue APP patient, that patient moves to the Red Resident Team.
      • If the Blue APP requires a procedure on a Blue APP patient (ie. chest tube, laceration repair, etc), the residents will assist the APPs, but patient remains on the APP team.
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability. 
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to day residents and APP at 6 am in the Clarkson 9th fl trauma work room

APP on Red Resident Trauma Team

  • 1 day APP (Mon-Fri) as staffing allows
  • Ideally will be an APP working a 12 hr shift, and who stays through 6 pm sign out
  • Daily sign out from night resident or APP at 6 pm in the MSB 4th fl resident conference room
  • Table rounds daily M-F at 8:30 am in Chairman’s conference room with residents, Red APP, CTN and SW
  • Begin walking rounds on 9th fl high side at 9 am DAILY (except Weds, table rounds start at 9 am with walking rounds at 9:30 am), unless in trauma activation or OR. The day APP is responsible for:
      • Rounding on patients when the Red Resident Trauma team census exceeds 8 patients per resident
      • Takes a primary role on discharges- ensuring patients being discharged have needed appointments and supplies
      • Assist with notes and orders on trauma activations. 
      • Cover consults when number of concurrent consults exceed 2 at any one time
      •  Will hold the Red Resident Trauma team pager only when all residents are scrubbed or in education.  This should be minimal, as residents should divide the pager duty as applicable.
          • Residents need to UNASSIGN themselves from their patients BEFORE OR or education, where PerfectServe will force patient calls to the appropriate pager. 
          • Residents must communicate this to the APP before UNASSIGNING themselves.
      • Assist with patient discharges
      • Attend trauma clinic, as applicable
  • Afternoon talking rounds with residents/APPs at 4 pm, update the hand off tool
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor ICU residents and APPs will write the orders, upon bed availability. 
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to night resident and APP at 6 pm in the MSB 4th floor resident conference room


Blue APP trauma team attending

  • Daily sign out from night trauma attending at 7 am in Chairman’s conference room
  • Attends weekly ACS resident education on Tues at 7:30 am, with trauma education on Tuesdays (this time is protected for both the Red trauma and EGS attendings, and residents- so Blue trauma APP attending responds to activations as needed.  Exception is OR.)
  • Begin table rounds with APPs by 10 am,unless in trauma activation or OR.
  • Blue APP trauma team will not see activations or trauma consults, UNLESS multiple activations arrive concurrently or the Red Resident trauma team asks for support or during Tues and Fri 7:30 am education
  • Supports the Red Resident Trauma team attending.
      • Covers trauma activations and traumas when Red Resident Trauma attending is in the OR
  • Blue APP team attending will round on trauma patients in the ICUs- focusing on their surgical issues. 
      • This also allows for continuity of care from ICU to floor.
      • Use “short progress note” to document assessment and plan.
      • Trauma patients in ICU will be assigned to either Red resident or Blue APP team in Epic
      • Red Resident Trauma team will cover patients who have been operated on by the Red Resident Team, or who are complex, with multisystem injuries.
      • Blue APP team will cover patients who have not been operated on by the Red Resident Team, or who have isolated injuries.
  • Blue APP trauma team attending will operate on Blue APP trauma team patients/trauma activations/trauma consults, as applicable. 
  • Blue APP trauma team attending is not required to round on all APP patients, as APPs are independent providers.  However, Blue APP trauma team attending is required to support the APPs, however needed (ask “Which patients would you like me to see?” at the end of table rounds, making phone calls, calling consultant services, managing challenging patient situations, etc)
  • Unstable or complex or ICU patients covered by the APPs MUST be physically seen by a faculty surgeon daily.
  • Daily sign out to night trauma attending at 4 pm in faculty office

Blue APP Trauma Team APPs

  •  At least 3 day APPs (Mon-Fri)
  • MUST have at least one 12 hr APP per day who stays through 6 pm sign out
  • Daily sign out from night resident or APP at 6 am in the MSB 4th fl APP area
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Round on up to 10-12 patients daily
      • If the Blue APP trauma team census exceeds this 1:10-12 ratio, patients will be overflowed to the Red Resident Trauma team, assuming the Red Resident Trauma team has not exceeded 20 patients (15 patients to be seen by residents, 5 patients to be seen by APP on Red Resident trauma team) DURING the week.  This assumes 4 APPs per day M-F, and currently, 2 APPs on S/S.  On Sat/Sun, the Blue APP team patients cannot be flowed over to the Red resident team to accommodate fewer APPs on the weekend.  This means a rounding ratio on Sat/Sun of up to 1:20 on the trauma floor.
      • If both censuses exceed thresholds, please notify Dr. Evans and Christina Boje by text and email to discuss additional coverage.
  •  APP/patient assignments are made by night APPs by 6 am
  • Preround on assigned patient from 6a-8:30 am
  • Daily check in with case managers and social work by 8:30 am via phone call or text for potential discharges and patient needs
  • Begin table rounds with Blue APP attending by 10 am DAILY unless in trauma activation or OR.
  • Blue APP trauma team will not see activations or trauma consults, UNLESS multiple activations arrive concurrently or the Red Resident trauma team asks for support or during Tues and Fri 7:30 am education
  • For patient’s physically seen by attending, when one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Blue APP team attending will round on trauma patients in the ICUs- focusing on their surgical issues. 
      • This also allows for continuity of care from ICU to floor.
      • Use “progress note” to document assessment and plan.  Free text ***do not use Rounding tab
      • Trauma patients in ICU will be assigned to either Red resident or Blue APP team in Epic
      • Red Resident Trauma team will cover patients who have been operated on by the Red Resident Team, or who are complex, with multisystem injuries.
      • Blue APP team will cover patients who have not been operated on by the Red Resident Team, or who have isolated injuries.
  • Blue APP trauma team APPs will not routinely attend trauma activations or see trauma consults, except when:
      • More than 2 trauma activations occur concurrently.  At that time, at least one APP should attend the trauma activations.
      • Cover consults when number of concurrent consults exceed 2 at any one time.  Red Resident Team will reach out for additional assistance.
  • Carry the Blue APP team 888-4774 pager
  •  Assist with trauma clinic, when clinic census exceeds ­­­­­­­­­­­­­­­­­15.
  •  Afternoon rounds around 4 pm, update the hand off tool
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor ICU residents and APPs will write the orders, upon bed availability.  ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to night resident and APP at 6 pm in the MSB 4th fl APP area
      • AT LEAST ONE DAY BLUE APP needs to stay for 6 pm sign out.  Day APPs cannot sign out their patients to the residents, or vice versa.

Trauma Clinic coverage

  • Monday afternoon and Weds afternoon trauma clinics will be covered by APPs.
  • At least 2 APPs are needed per clinic
      • This can be a half day shift or a full day shift
  • When clinic census exceeds 15 patients, one inpatient Blue APP trauma team APP will assist.

Red Resident Team and Blue APP team on days on Saturday and Sunday

  • On Sat and Sun, 2 residents will cover the Red Resident Team, and 2 APPs will cover the Blue APP team.
      • MUST have at least one 12 hr APP per day who stays through 6 pm sign out
  • On Sat and Sun, the Red Resident Team and Blue APP team will be rounded on by one trauma attending. 
  • Resident and APP rounds will be done separately.
      • APP rounds start at 8:30 am on 9th fl high side, unless in trauma activation or OR
      • Resident rounds will follow
  • All hands on deck for trauma activations and consults
      • Activations- Red Residents and 1 APP will respond
      • Consults- APP will assist when number of concurrent consults exceed 2 at any one time

Red resident team night APP and APPs on APP-only nights

  • Night shift is 6 pm – 6 am.
  • Friday, Saturday, Sunday and Monday nights are covered by the Red Resident trauma team, along with one night APP (who will cover the Blue APP trauma team pager overnight)
  • Tues, Weds, Thursday are covered by 3 night APPs (no residents)
  • Nightly sign out from night resident or APP at 6 pm in the MSB 4th fl APP area
  • One APP will carry the Red Resident Team -1938 pager, the other will carry the Blue APP team -### (old COVID pager) pager- all calls on Red Resident trauma team patients and Blue APP trauma team patients will come to the pager at night.
      • Consults will be called through the -1938 pager or PerfectServe
      • The person who is carrying the pager is not solely responsible for all consults.
      • Consults should be delegated based on work load and availability.
  • APP on Friday, Saturday, Sunday and Monday with Red Resident trauma team
      • APP will carry the Blue APP team pager, respond to Blue APP patient needs
      • Assist with notes and orders on trauma activations. 
      • Cover consults when number of concurrent consults exceed 2 at any one time
      • Will hold the Red Resident Trauma team pager only when all residents are scrubbed.  This should be minimal, as residents should divide the pager duty as applicable.
  • APPs on Tuesday, Wednesday, Thursday without residents
      • Again, one APP will carry the Red Resident Team -1938 pager, the other will carry the Blue APP team -### (old COVID pager) pager
      • Attends and evaluates all trauma activations- includes patient evaluation, note and orders
      • Evaluates all trauma consults- includes patient evaluation, note and orders
      • Trauma consults will be forwarded to the -1938 pager through PerfertServe.
  • Regarding how patients are admitted to either the Red Resident Team or Blue APP team,
      • Red resident team admits patients who 1) residents operate on, 2) complex/multisystem injury patterns, 3) overflow from Blue APP team (once APP team census is >30)
      • If the Blue APP team census is approaching or exceeds 30 patients, night APPs may assign new admits to Red Resident Trauma Team.  Ideally, Red Resident Trauma Team patients will be more complex, multi system injuries, high likelihood for surgical intervention (ie. multiple rib fractures, large laceration, etc)
      • Follow attending physician discretion
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability. 
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to day residents and APP at 6 am in the MSB 4th fl APP area.

Roles and Responsibilities during Trauma activations

·         See separate document

Red EGS Team Attending

  • Daily sign out from night trauma attending at 7 am in Chairman’s conference room
  • Attends weekly ACS resident education on Tues at 7:30 am
  • Begin rounds on 9th fl low side at 8:30 am DAILY (except Weds, rounds start at 9 am), unless in OR.
  • Rounds with Red EGS residents 7 days a week.
  • Supports the Chest Wall Injury Team attending
      • Scrubs case which are not covered by a resident
  • Sees all EGS consults with Red EGS resident team 7 days a week
  • Red resident team attending will round on EGS patients in the ICUs- focusing on their surgical issues. 
      • This also allows for continuity of care from ICU to floor. 
      • OK to use templated EGS progress note
  • Red resident EGS team attending will operate on Red resident EGS team patients.  While operating, the CWIT attending will see urgent consults.
  • Red Resident EGS team attending is required to round on all resident patients
  • Daily sign out to night trauma attending at 4 pm in faculty office

Red EGS team residents- days

  • Preview recorded orientation/problem based charting/patient pathways before rotation begins
  • Day shift is 6 am to 6 pm.
  • Red resident EGS team will include one APP Monday thru Friday.
  • Daily sign out from night resident or APP at 6 am in the resident room.
  • Assign self to patients in PerfectServe daily at 6 am per Epic assignments made by night team
  • Carries -0447 pager
  • Attends weekly ACS resident education on Tues at 7:30 am (this time is protected for both the Red trauma and EGS attendings, and residents- so Blue trauma APP attending responds to activations as needed.  Exception is OR.)
  • Preround on assigned patient from 6a-rounds
  • Daily check in with case managers and social work by 8:30 am via text for potential discharges and patient needs
  • Begin rounds on 9th fl low side at 8:30 am DAILY (except Weds, rounds start at 9 am), unless in OR.
  • As one person is presenting a patient- another provider should be putting in orders/pulling up images/finding answers, and updating the Hand Off
  • Residents and APPs should enter room with attending during rounds on all patients, so care for all patients is transparent.
  • Red EGS resident team will round on EGS patients in the ICUs- focusing on their surgical issues. 
      • This also allows for continuity of care from ICU to floor.
      • OK to use templated EGS progress note
  • Evaluates all EGS consults- includes patient evaluation, note and orders
  •  Afternoon talking rounds around 4 pm, update the hand off tool
  • ICU residents and APPs will place the Bed Request when a patient is ready for transfer out of the ICU.  The floor residents and APPs will write the orders, upon bed availability. 
      • ICU residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer, and AGAIN at time of physical transfer.
  • Daily sign out to night resident and APP at 6 pm in the resident room.

Red EGS team APP- days

  • MUST be an APP working a 12 hr shift, and who stays through 6 pm sign out
  • 1 day APP (Mon-Fri)
  • The day APP is responsible for:
      • Rounding on patients when the Red Resident EGS team census exceeds 15 patients
      • Cover consults when number of concurrent consults exceed 2 at any one time
      • Ensures Daily check in with case managers and social work by 8:30 am via text for potential discharges and patient needs
      • Will hold the Red Resident EGS team pager only when all residents are scrubbed or in education.  This should be minimal, as residents should divide the pager duty as applicable.
          • Residents need to UNASSIGN themselves from their patients BEFORE OR or education, where PerfectServe will force patient calls to the appropriate pager. 
          • Residents must communicate this to the APP before UNASSIGNING themselves.
      • Assist with patient discharges
      • Attend EGS clinic

Red EGS team clinic

·         2 residents and one APP will attend the EGS elective clinic Thurs am and EGS follow up clinic on Thurs pm

Red EGS team residents- night

  • Lower level residents will each do 2 weeks of night float, 6p-6a, with one night off
  • Carries EGS pager
  • Evaluates all new consults, writes notes and orders
  • No night EGS APP on nights when a resident is covering

Red EGS team night APP and APPs on APP-only nights

  • One night per week, night EGS resident is off.  Night APP will cover EGS pager/new consults that night.
  • New consults and patient concerns staffed with the night attending, in conjunction with senior resident night float

Chest Wall Injury Team Attending

  • Attends weekly ACS resident education on Tues at 7:30 am (this time is protected for both the Red trauma and EGS attendings, and residents- so Blue trauma APP attending responds to activations as needed.  Exception is OR.)
  • Supports the Red EGS attending and acts as a “flex” to ICU, trauma and EGS
      • Scrubs case which are not covered by a resident
  • Daily sign out to night trauma attending at 4 pm in faculty office, as applicable
  • Maintains CWIT list in Epic
  • Reviews trauma list daily to identify potential patients, move patients to CWIT list in Epic
  • Writes note daily on CWIT patients
  • Pre ops patients- obtains consent, provide pre op patient written material, books case in OR, discusses with trauma residents
  • Operates on CWI patients
  • If available, as needed, for questions from ICU and trauma teams regarding CWI patients
  • CWI patients remain on the respective ICU, Red Resident and Blue APP teams- are managed by those respective teams.  Care of the chest wall injury should not be deferred to the CWI attending.

Weekdays flow- Monday thru Friday

  • 7 am- night attending sign out to day attending in Chairman’s conference room
      • ALL day/night rounding faculty should attend- serves as our sounding board
      • Any additional faculty are encouraged to attend
      • Night ICU to day 8th fl ICU attending and non-8th fl ICU attending
      • Night EGS/Trauma to day EGS attending and day Trauma attending
  • 7:30am-8:30am Tuesdays- RESIDENT EDUCATION in Chairman’s conference room.  ALL ACS faculty will attend, as available.  Educating the residents will be a group effort.
  • Green and yellow rounds start at 8:30 am all week in their respective units
  • Red trauma rounds start at 8:30 am in the Chairman’s conference room for talking rounds with the CTN and SW (M-F).  This will be followed by walking rounds at 9 am.   On Sat/Sun, walking rounds start at 8:30 am.
  • Blue trauma rounds will start by 10 am- continue to check in with the APPs that morning for optimal time to meet.
  • EGS rounds start at 8:30 am.
  • On Weds with Grand Rounds, rounds pushed back to 9 am, with walking rounds at 9:30 am for Red Trauma
  • Fellow education scheduled for Tuesdays at 12 noon
      • ALL ACS faculty will attend, as available.  Educating the fellows will be a group effort.
  • 4 pm-day attending sign out to night attending in individual faculty offices
      • Day ICU to and non-8th fl ICU attending to night 8th fl ICU attending
      • Day EGS attending and day Trauma attending to night EGS/trauma attending
  • No formal 6 pm sign out.  EGS, trauma and ICU teams will sign out independently.

 

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