Saint Michael’s Hospital
St. Michael’s Hospital has 3 separate ICU’s within the hospital (as well as a CCU).
The Medical/ Surgical ICU is a 24 bed unit. Two staff physicians from anesthesia, internal medicine, general surgery and respirology staff the unit each week. The case-mix comprises all medical admissions as well as vascular, general, orthopedic, urologic, plastic and ENT surgery. In addition we admit critically ill obstetric patients from our obstetric unit.
The MSICU provides conventional and non-conventional ventilatory support and CCRT. In addition this unit is the referral centre in the city / province for plasma exchange therapy for neurological disease. The MSICU is also a referral centre for the interventional gastroenterology service. Multidisciplinary daily bed-side rounds occur with a team comprising chaplain, nurses, nutritionist, two full time pharmacists, respiratory therapist and social worker. CCM residents who are not in their first months of training do backup junior staff call from home rather than in-house call.
Junior residents get seminars from 2-3 pm Tuesday – Friday covering a core curriculum. The Tuesday sessions are always given by allied health professionals.
An innovative hands-on half day resuscitation course has been introduced as part of the orientation for new junior residents.
CCM residents get separate weekly case-based seminars. In addition the CCM residents (as well as international fellows) present a weekly Journal Club under supervision by a staff person with formal clinical epidemiology training as part of weekly CCD grand rounds.
In addition to providing consultation in the hospital about 10% of the admissions for MSICU are from Criticall. We also provide consultation within the hospital with an out reach team.
The Cardiovascular/ surgical ICU is a 17 bed unit providing care to postoperative cardiovascular patients as well as vascular surgery patients. There is weekly seminar for fellows with a one year curriculum. In addition many of the attending staff from anesthesia are board certified in echocardiography and provide TEE seminars and hands-on training to the trainees in the CVICU. Trainees are exposed to temporary pacing techniques, PA catheters in almost all patients, Intra-aortic balloon pumps, and other rarer techniques such as ECMO.
The Trauma/ Neurosurgery ICU is a 17 bed unit caring for critically ill neurosurgical patients and interventional neuroradiology patients. We are also one of two Level one adult trauma centres serving the city. The TNICU specializes in teaching trainees advanced neuro-monitoring techniques such as Trans Cranial Doppler, Licox tissue P02 monitoring, Jugular venous monitoring and continuous bedside EEG monitoring. There is a weekly, year round seminar program for trauma, as well as separate seminars on neurosurgery ICU for the trainees.
The hospital has a number of ethicists as part of the ICU team. They attend weekly rounds reviewing all MSICU patients, are part of the multidisciplinary orientation on the first day, and provide seminars as part of the Tuesday –Friday core curriculum.
One of the attending MSICU staff heads the patient safety committee for the entire hospital and is in charge of rounds dealing with error as well as the Outreach team and M and M rounds.
Monthly, as part of grand rounds, we invite a renowned local, national or international speaker. In addition every 2 months for grand rounds we have combined critical care/ nephrology presentation and then also combined critical care/ gastroenterology rounds attended by staff from both disciplines.
All CCM trainees and international fellows are given academic days with no clinical duties, in order to pursue appropriate projects, either research or clinical. Those trainees with specific interests are paired up with appropriate staff for supervision. The trainees have their own room and computer in an area physically separate from the ICU environment.