Cardiothoracic Surgical Unit - CTSU Rundown
General
You will be assigned to 1-2 registrars and SMOs, but are routinely expected to help out with rounds and jobs for all the ward patients as a group. This is a heavily team based run where you rely on all your colleagues to share the load. When HOs are covering nights/are on leave they are generally not covered so you will have to share the care of the team they are assigned to. For continuity of care this works best if one person can cover the same team for a number of days. There should be a minimum of 4 HOs per day, less than this, you can claim cross cover.
Refer to the Orientation Booklet for protocols (there are many, and this will guide the majority of your day-to-day work).
Any deviation from the usual pathway/protocol should be discussed with a registrar.
There is a ward registrar always available and holding the phone from 7:30am-4pm on weekdays.
Warfarin charting is left for the ward registrar.
Congenital patients are rounded on by the Congenital team, but they are admitted and stepped down by the CTSU HOs (and you may be asked to see or do jobs for them).
Go to theatre if you are interested and the ward is under control.
Daily routine
0715-0730 ward round begins (round begins at 0745-0800 on Wednesdays)
0815 handover in the meeting room
0900-1000 is normally when first step down arrives.
1300 rapid rounds in the nursing station – each HO runs through their patient’s plans and progress with the co-ordinator and ward registrar
1400 pre-operative admissions normally begin to arrive.
Step-downs
the vast majority of post-ops go to CVICU, and are then stepped down to Ward 42.
All step-downs need to be seen, examined, have the step-down template completed and have their meds charted.
Discharge and step-down templates are in the ‘CTSU HO Backup’ folder (need to be logged-in with ward computer).
Check ‘expected arrivals’ on Whiteboard to check which CVICU patients may be coming.
In general, stick to the protocol and continue the plan from CVICU. If patient is unstable or if any doubt, discuss with ward registrar.
Admissions
Between 1-2pm, the ward clerk will print a list of patients being operated on the next day (who should be on the ward by that time, or will have already been admitted).
Patients admitted under CTSU need the ‘Surgical Pathway’ booklet filled in (will usually on 42 and sometimes 41).
Patients admitted under Cardiology (CCU and 31) will usually be admitted by the Cardio HO, but need a pre-op checklist (the ‘red sticker’) completed by CTSU.
In general, all patients need recent bloods, G+H, CXR, ECG and their medications charted.
All consenting is done by registrars.
On weekdays, patients can be sent with a lab form to Labplus (on Level 6) to have their bloods done (Labplus closes at 4pm).
On-call evenings
On weekday long days you cover CTSU - ward 42 only.
The CTSU registrar will be around in person until 20:00 at which point they will attend the CVICU round and then be on call at home.
If you have any problems they are very contactable.
Weekends
Two House officers on the weekend. One does a long day on Saturday, the other on Sunday.
Weekend rounds start later - at around 0800.
The Saturday ward round is done with the team registrar.
Find out which team is busiest and round with them, get handovers for the rest.
On Sunday the ward registrar and house officer will round on all patients. The Sunday short day house officer starts in the afternoon and their main job is to do the pre-admissions.
Nights
You cover CTSU, Cardiology, CCU and SDU.
Contact either the on call CTSU registrar (offsite) or the cardiology registrar (on site) during nights. If concerned you can also usually go to CVICU and talk to the registrar there too.
Teaching
CTSU House Officer teaching is on Wednesday 0900-0945. You will get a timetable of all the sessions emailed to you.