ACS Roles & Responsibilities (2025-2026)

Acute Care Surgery - Roles and Responsibilities

2025-2026

Purpose:  The purpose of this document is to outline the roles and responsibilities for each team member providing patient managementcare 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.

8^th 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 8^th 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-8^th fl ICU attending
• Daily sign out to night ICU attending at 4 pm in faculty office
• Carries trauma phone on night call
• Covers 8^th fl and non-8^th fl ICUs at night
• In PerfectServe, all ICU pages/questions will go to the 8^th floor ICU attending/APPs/residents
• 8^th 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.
    • 8^th floor ICU attending will do bedside procedures (perc trach, PEGs, wound care, etc)

8^th 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 8^th 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

8^th 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 8^th 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 8^th 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.

8^th 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 8^th 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 8^th 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 8^th fl ICU and non-8^th 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-8^th 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 5^th fl SDCC at 8:30 am DAILY (except Weds, rounds start at 9 am)
• Supports the 8^th 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-8^th 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-8^th 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 8^th 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 8^th 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.

8^th 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 8^th fl work room
  • • Pertinent points, “watchers”, follow up items in Hand Off tool
• Evenly splits all 8^th fl and non 8^th 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 8^th fl work room

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

• Daily verbal sign out to night resident and APP at 6 pm in the 8^th 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 8^th fl and non 8^th 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 8^th 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 9^th 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 4^th 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 9^th 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 4^th 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 9^th 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 9^th 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 4^th 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 9^th 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 4^th floor resident conference room

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                  ICU Presentations Format……………………………………………………………………………14

  
  

  Trauma Team Roles…………………………………………………………………………………………….15

                  Red Team Attending……………………………………………………………………………………15

                  Red Team Residents……………………………………………………………………………………15

                                  Red Team residents – days…………………………………………………………………15

                                  Red Team residents – nights………………………………………………………..…….17

                  Red Team APP……………………………………………………………………………………………19

                  Blue Team Attending…………………………………………………………………………………..20

                  Blue Team APPs…………………………………………………………………………………………20

                  Trauma Clinic Coverage………………………………………………………………………………21

                  Chest Wall Injury Attending………………………………………………………………………….21

  
  

  
  

  Nights APPs……………………………………………………………………………………………………….22

  Night CCS APPs…………………………………………………………………………………………22

  Night trauma red APP, trauma blue APP………………………………………………………...22

  
  

  EGS………………………………………………………………………………….………………………..………25

                  EGS team attending………………………………………………………………………….………..25

                  EGS team APP-days…………………………………………………………………………..……….26

                  EGS team clinic………………………………………………………………………………..………..26

                  EGS team residents-days…………………………………………………………………………….27

                  EGS residents-night……………………………………………………………………………..…….27

  Faculty Commitments

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• 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 orprovide the Redhighest 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 continuityquality of care fromcompassionately ICUdelivered for the traumatically injured, critically ill and emergency surgical patients, to floor.
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    • Usetomorrow’s “short progress note” to document assessmentsurgeons, 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 byadvance 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 endfield of tableacute rounds,care makingsurgery phonethrough calls,research callingand 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

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• 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/Suncore of upall towe 1:20do.
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    • If both censuses exceed thresholds, please notify Dr. Evans and Christina Boje by text and email to discuss additional coverage.

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• 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 ortrain the Rednext 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 continuitygeneration of caresurgeons.
      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

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  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 4^th 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.

TraumaBaseline ClinicProfessional 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 9^th 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 4^th 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 4^th fl APP area.

Roles and Responsibilities during Trauma activationsObligations:

·         SeeMaintain separateall documentclinical requirements- including but not limited to: bedside rounding on all resident patients, bedside rounding on all ICU patients, FCOTS, other aspects as described in Roles and Responsibilities documents

Red·         EGSMaintain Teamall Attendingnonclinical requirements- including but not limited to ATLS instruction, attendance at M and M (division and departmental), Grand Rounds and weekly faculty meetings, division resident and fellow lectures

·        

• DailyOutlook signemail outand fromOutlook nightcalendar traumaas attendinga atprimary form of communication, including schedules, updates, announcements.

  ·         Complete compliance training by due date

  ·         Attend faculty meetings >50%

  ·         3-day documentation goal of 95% or greater

  ·         Complete yearly ADIS evaluations by due date

  ·         Be on time for 7 am inand Chairman’s4 conferencepm room

faculty
• sign outs

  ·         AttendsAssigned PI charts are completed within 2 weeks of assignment.  Charts will be assigned on the 1^st of each month. 

  o   If a vacation or personal time falls within these two weeks, please notify PI and Dr Evans and give a completion date

  ·         Attend weekly ACSand monthly PI/PIPS > 50%

  ·         Division chief will provide faculty scheduling 2 months in advance.  In order to maintain ongoing schedules, faculty will:

  o   Email vacation and non clinical requests to division chief, lead administrative assistant, and personal assistant by 1^st of month according to schedule

  o   Once approved, the request will be placed on the master calendar and faculty’s personal calendar.

  o   Errors made in scheduling will be corrected by division chief.

  o   Once a schedule is deemed final, it is the faculty’s responsibility to find their own replacement, except in cases of personal emergencies, where the division chief will assist.

  ·         Requests to attend meetings will be prioritized according to those with: podium presentations, committee obligations, poster presentations followed by those wishing to go for educational purposes

  ·         Requests for vacation/time off will be on a first come, first served basis

  ·         Non-clinical days (days where you are not assigned rounding or clinic or call) are administrative days, created to allow time for education, research, administrative work, further contribution to the division/department/university/hospital. 

  o   Available for meetings in person or via zoom, with response within 2 hrs to request

  o   If you are not available administratively on a nonclinical day, that day should be taken as Paid Time Off.

  §  To ensure adequate time off, place Out of Office automatic reply on email with other contact information

  §  Recruit a partner to cover your Epic inbox while away

  §  Complete all required tasks PRIOR to leaving on vacation

  ·         Act as an ATLS instructor or director twice per year

  ·         Contribute two fellow lectures per year

  ·         Contribute to the creation or editing of 2 patient pathways per year.

  ·         Baseline medical student and resident education onobligations, Tuesset atby 7:30the am

department.
• Begin

  Acute roundsCare Surgery faculty members must meet the baseline professional expectations outlined by Nebraska Medicine, the Department of Surgery, and the Division of Acute Care Surgery to be eligible for the Value Based Incentive Payment based on 9^ththe flCorporate lowScorecard sidemetrics atand 8:30metrics amlisted above.

  ACS Residents

  DAILYACS (exceptResidents

  Weds,

  Residents roundsare startan atintegral 9part am),of unlessall inacute OR.care

surgery
• Roundsservice withlines, Redand EGSnone residentsof 7our daysservices acan week.
function
• Supportswithout resident support. The educational goal for all ACS service lines is to learn how to take care of some of 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 EGSsickest patients in the ICUs-hospital, 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 pmboth 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 9^th 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.operating room. TheSuccess flooron ACS services requires the ability to triage, as we frequently have long lists, multiple operating rooms, and multiple admissions. In general, the expectation of residents andon APPsall willservices writeinclude: 

  ·         Review orientation materials prior to starting on service 

  ·         Obtain signout on the orders,service 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 infrom the resident room.
you’re

replacing; this should include information about the structure of the service as well as the specific patients  

Red·         EGSObtain teammorning APP-signout daysand give evening signout 

·        

• MUSTRound on your assigned patients, but be anfamiliar APPwith workingall patients on the service. We work as a 12 hr shift,team, and who stays through 6 pm sign out
• 1 day APP (Mon-Fri)
• The day APPeveryone is responsibleexpected for:to
  be
  • able
    to
    • Roundingprovide oncare patientsfor whenany the Red Resident EGS team census exceeds 15 patients
    • Cover consults when number of concurrent consults exceed 2patient at any onetime.  time

    • ·         EnsuresEnsure Dailyall checkoperative cases are covered by an appropriate level resident  

      ·         Run the list and round with the attending  

      ·         Communicate with all consultants and/or primary services 

      ·         Complete all notes in a timely manner 

      ·         Be familiar with caseACS managerspathways and socialapply workthem bywhen 8:30indicated am

      via

      ·         textAttend required education for potentialyour dischargesresidency andprogram/department patient

      needs

    ·        

    • WillAttend holdscheduled theACS Rededucational Residentconferences  EGS

      ·         Work collaboratively on a multidisciplinary team pager

      only

      ·         whenRead allabout residentsrelevant arepathology scrubbedduring oryour time on service. Resources to consider reading include: Marino’s ICU Book, Trauma (the red book), Top Knife (for trauma intraoperative decision making), 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 callsaddition to the appropriategeneral pager.surgical textbook
        of
        • Residentsyour mustchoice communicatesuch thisas toCameron’s/Schwartz/Sabiston’s.  the
          APP
          before

          Weekday UNASSIGNINGFlow themselves.
        -
        Monday
      thru
    • Assist with patient discharges
    • Attend EGS clinic

Friday

RedWeekdays EGSflow- teamMonday clinicthru Friday

·         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

  o   

  • • ALL day/night rounding faculty should attend- serves as our sounding board

    • o    Any additional faculty are encouraged to attend

    • ·         Night ICU to day 8^th fl ICU attending and non-8^th 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 am9:00am 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, all 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-8^th fl ICU attending to night 8^th 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. 
  CCS Provider Team Roles & Responsibilities

  CCS Provider Team Roles and Responsibilities

   

  CCS Attendings (Green and Yellow) 

  • CCS Green Attending - Responsible for all patients on the CCS service located on the 8^th floor of Clarkson Tower 
  • CCS Yellow Attending - Responsible for all patients on the CCS service located in locations outside the 8^th floor of Clarkson Tower 
  • Attend daily morning sign-out from night CCS attending in Chairman’s conference room 
  • Attends weekly ACS Resident and CCS Fellow education 
  • CCS rounds begin by 9:00 am daily. Deviations from this time should be limited, but if done, the time should be clearly communicated to the rounding team.   
  • The CCS Attending facilitates and encourages good communication regarding daily plans and clinical status changes to the primary surgical services. 
  • The CCS Attending is responsible for seeing all new admissions on the CCS service in a timely manner. 
  • The CCS Attending is responsible for communicating with members of the CCS team anytime a patient transitions out of the operating room.  If the patient is unstable, physical presence at bedside to facilitate appropriate transition of care is appropriate. 
  • If a patient on the CCS service is undergoing evaluation for organ donation, the CCS attending is responsible for facilitating and encouraging good communication with the OPO team.
  • The CCS Attending is responsible for mediating any conflict that arises while on service and elevating any problems to the CCS medical director or ACS division chief and/or the SICU Nurse Manager if necessary.  
  • Each CCS attending (Green and Yellow) supports and provides back up for each other if needed 
  • CCS attending should afternoon round prior to 4pm sign-out
  • Afternoon sign-out to night CCS attending at 4 pm daily. The night CCS Attending covers both CCS services (Green and Yellow).
  • The night CCS Attending carries the ACS transfer phone and is responsible for communicating any transfer requests to the surgical service as appropriate. 

  o    The CCS ICU attendings are expected to be physically present, as needed, in the ICU.  To support this: 

  o    The CCS attending will not operate in OR, unless needed. 

  o    The CCS attending will be responsible for all bedside procedures (percutaneous trach, PEGs, central lines, etc.) 

  o    Bedside exploratory laparotomies will be performed by the respective surgical service attending with the assistance of the surgical intensivist.  

   

  CCS Fellows 

  ·         The CCS Fellow should take leadership in all aspects of the critical care team. The CCS attending will be present and provide support as needed. 

  ·         Attend daily sign out from night CCS Attending at 7 am in Chairman’s conference room. Daily sign out to night CCS attending occurs at 4 pm in faculty office 

  ·         Attend weekly CCS Fellow education. 

  ·         Prepare for and lead monthly CCS M&M  

  ·         The CCS Fellow facilitates and encourages good communication regarding daily plans and clinical status changes to the primary surgical services. 

  ·         The CCS Fellow is responsible for seeing all new admissions on the CCS service in a timely manner. 

  ·         The CCS Fellow is responsible for communicating with members of the CCS team anytime a patient transitions out of the operating room and be present at bedside when the patient arrives.  

  ·         If a patient on the CCS service is undergoing evaluation for organ donation, the CCS Fellow is responsible for facilitating and encouraging good communication with the OPO team.  

  ·         The CCS Fellow is responsible for mediating any conflict that arises while on service and elevating any problems to the CCS Attending, CCS Medical Director or ACS Division Chief and/or the SICU Nurse Manager if necessary.  

  ·         The CCS fellow’s primary responsibility is for the CCS team they are assigned to (yellow or green) but will provide support and back up if needed for all patients on the CCS service.   

  ·         The CCS Fellow will supervise APPs and Residents during all bedside procedures.

  ·         CCS fellows to provide support as needed to cover resident patients while residents are absent for required education days.  

  ·         The CCS Fellow is to attend monthly ICU leadership meetings with CCS Medical Director.  

  CCS Residents 

  ·         Attend daily sign out from night resident and APP at 6 am in the SICU provider work room. 

  ·         Assign self to PerfectServe daily at 6 am at start of shift. The CCS Resident will be primarily assigned to patients on the CCS green team. If needed, the CCS resident will provide patient care support to patients on the yellow service based on census, acuity and APP coverage needs.  

  ·         Preround on assigned patient prior to formal CCS rounds at approximately 9:00 am. 

  ·         CCS rounds begin at 9:00 am daily. Patients will be presented in a systems-based format.  See the template below.  

  ·         The CCS resident will provide support to other residents and APPs while not presenting by putting in orders/pulling up images/finding answers and updating the hand off tool. 

  ·         Complete ACP note on new CCS admissions within the first 24 hours of admission. Mark as completed on the handoff tool  

  ·         Pay attention during rounds. The overall expectation is that everyone on the team knows pertinent details about every patient.  

  ·         The CCS resident will complete the daily progress note documentation using the CCS note template.  It is the responsibility of the CCS Resident to document a unique note daily to ensure an accurate clinical narrative and promote effective communication. Along with documentation of the daily note, the resident should also update the problem list and rounding tab accordingly.  

  ·         Responsibility for new CCS consults should be shared between CCS residents and APPs, no matter if the patient is going to be admitted to yellow or green.  

  o    A CCS Resident or APP should attend all FULL trauma activations. 

  ·         Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed. 

  ·         The CCS Resident facilitates and encourages good communication regarding daily plans and clinical status changes to the primary surgical services. 

  ·         The CCS Resident is responsible for seeing any new admissions in a timely manner along with presentation of that patient to the fellow/attending.  

  ·         The CCS Resident is responsible for communicating with members of the CCS team anytime a patient transitions out of the operating room and should be present at bedside when the patient arrives for handoff.  

  ·         The CCS resident is responsible for communicating any change in patients’ status to the CCS fellow and/or the CCS attending in a timely manner, especially if the patient has a change in neurologic/respiratory status and/or becomes hemodynamically unstable. 

  ·         It is the responsibility of the CCS resident to document any significant patient event or status change in the medical record as appropriate via the progress note or short progress note.  

  ·         The CCS resident is responsible for performing bedside procedures under the supervision of the CCS Attending and/or CCS Fellow.  The CCS Attending and Fellow should be informed about any bedside procedure being performed.  The CCS Attending/Fellow will be present and supervising as appropriate.   

  o    Carries the CCS Green pager (0282) 

  o    Consults will be called through the pager or PerfectServe 

  o    The person who is carrying the pager is not solely responsible for all consults. 

  ·         Consults should be delegated based on workload and availability. 

  o    Daily sign out to night resident and APP is at 6 pm in the SICU provider work room.   

  o    If a night CCS resident is present, they will be assigned to patients on the CCS Green team.   

  ·         Pertinent points, “watchers”, follow up items should be documented in the Hand Off tool 

  ·         Attends weekly ACS Resident and CCS Fellow education 

  o    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 reconcile the orders, upon bed transfer.   

  o    CCS residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer to floor status to provide updates/handoff on that patient 

  o    Identify FLOOR STATUS on the handoff and remove CCS from the handoff tool as well. MUST go in and transition primary team to trauma red/blue/EGS, whatever applies to that patient.  

  ·         Transfer to floor status on non-ACS patients should be a joint discussion with primary team (such as CRS, MIS, Urology, etc.) 

  o    Residents are required to attend their respective departments education. 

  o    CCS Resident is still responsible to be present at both hand off at 6AM and 6PM even on education days.  

  o    On assigned education days, CCS Resident should still pre-round and see their patients prior to leaving for education. They should hand off to another Resident, APP, or Fellow system-based rounding with pertinent information for rounds on all patients while they are gone.  

  CCS Advanced Practice Providers (APP) 

  ·         Attend daily sign out from night resident and APP at 6 am in the SICU provider work room. 

  ·         Assign self to PerfectServe daily at 6 am at start of shift.  The CCS APP will be assigned to patients on both the CCS yellow and CCS green teams. 

  ·         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 SICU provider work room 

  ·         Preround on assigned patient prior to formal CCS rounds at approximately 9:00 am  

  ·         CCS rounds begin at 9:00 am daily. Patients will be presented in a systems-based format.  See the template below.  

  ·         The CCS APP will provide support to other residents and APPs while not presenting by putting in orders/pulling up images/finding answers and updating the hand off tool. 

  ·         Complete ACP note on new CCS admissions within the first 24 hours of admission. Mark as completed on the handoff tool  

  ·         Pay attention during rounds. The overall expectation is that everyone on the team knows pertinent details about every patient.  

  ·         The CCS APP will complete the daily progress note documentation using the CCS note template.  It is the responsibility of the CCS APP to document a unique note daily to ensure an accurate clinical narrative and promote effective communication. Along with documentation of the daily note, the APP should also update the problem list and rounding tab accordingly.  

  ·         Responsibility for new CCS consults should be shared between CCS residents and APPs, no matter if the patient is going to be admitted to yellow or green.     

  o    A CCS Resident or APP should attend all FULL trauma activations. 

  ·         Role of the ICU resident or APP is to gather information about the patient, provide procedural support in case where help is needed. 

  ·         The CCS APP facilitates and encourages good communication regarding daily plans and clinical status changes to the primary surgical services. 

  ·         The CCS APP is responsible for seeing any new admissions in a timely manner along with presentation of that patient to the fellow/attending.  

  ·         The CCS APP is responsible for communicating with members of the CCS team anytime a patient transitions out of the operating room and should be present at bedside when the patient arrives for handoff.  

  ·         The CCS APP is responsible for communicating any change in patients’ status to the CCS fellow and/or the CCS attending in a timely manner, especially if the patient has a change in neurologic/respiratory status and/or becomes hemodynamically unstable. 

  ·         It is the responsibility of the CCS resident to document any significant patient event or status change in the medical record as appropriate via the progress note or short progress note.  

  ·         The CCS APP is responsible for performing bedside procedures under the supervision of the CCS Attending and/or CCS Fellow.  The CCS Attending and Fellow should be informed about any bedside procedure being performed.  The CCS Attending/Fellow will be present and supervising as appropriate.   

  o    Carries –0335 yellow pager 

  o    Consults will be called through the pager or PerfectServe 

  o    The person who is carrying the pager is not solely responsible for all consults. 

  ·         Consults should be delegated based on workload and availability. 

  ·         Attendance to weekly CCS Fellow education highly recommended 

  ·         Assist with covering resident patients and round presentations when residents are at required education days  

  o    Daily sign out to night resident and APP is at 6 pm in the SICU provider work room.   

  o    If a night CCS resident is present, they will be assigned to patients on the CCS Green team.  

  o    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. 

  ·         Pertinent points, “watchers”, follow up items should be documented in the Hand Off tool 

  o    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 reconcile the orders, upon bed transfer.   

  o    CCS residents and APPs will CALL (text message is not sufficient) the floor resident or APP at time of decision to transfer to floor status to provide updates/handoff on that patient 

  o    Identify FLOOR STATUS on the handoff and remove CCS from the handoff tool as well. MUST go in and transition primary team to trauma red/blue/EGS, whatever applies to that patient.  

  o    Transfer to floor status on non-ACS patients should be a joint discussion with primary team (such as CRS, MIS, Urology, etc.)