Definition of a Critical Care Laptop Admission

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  • The GENERAL RULE is that a patient becomes a Critical Care Laptop patient at the date/time that the ICU team takes over being their primary care team -- regardless of their physical location, even if it is a Boarding Loc such as ED or PACU. Thus, this relates to the first relevant Service tmp entry.
    • We define the ICU takes over being their primary care team as occurring when there is clear indication (usually a progress note) to this effect. That note may be by the ward team or by the ICU team.
  • There are a small number of tricky situations (not really exceptions) for this general rule:
    1. HSC SICU: As SICU patients remain under the primary care of the surgical service, the general rule is modified such that the patient becomes a Critical Care Laptop patient at the date/time that the ICU team agrees to take the patient into SICU (or equivalent SICU boarding location such as ER or PACU). This is thus a "partial exception" in that the only difference with the general rule is that the ICU team isn't officially the primary care team of SICU patients.
    2. Some Cardiac Surgery patients are tricky in regards to this, even though as per the general rule, the patient becomes a Critical Care laptop patient at the date/time when he/she transitions to be under the care of the CICU team. The tricky issue here is related to the fact that there are cardiac surgeons who are CICU attendings, cardiac surgery ward attendings, and operating surgeons guiding care in PACU. Thus it can sometimes be tricky to figure out which cardiac surgery service is caring for the patient before they actually arrive in CICU (or equivalent boarding location).
    3. Pts in ICU for procedures only who are never actually under the ICU service: These patients are, by definition, not ICU patients, and clearly DO fall under the general rule. But they may be tricky if it is not recognized that they were never under the care of the ICU team.
  • Note that the ICU team DOES NOT take over care DURING a code on the ward. When the ICU team runs a ward code, they are just performing a procedure (ACLS) for the ward team. We only consider the ICU team as taking over care IF once the patient has survived the code (or possibly in between arrests), the ICU team has agreed to do so. So, this is not automatic. The main way this will be noted is that the Medicine ward resident will almost certainly write a note indicating this.

Additional info

  • In the past we talked about Arrive DtTm and Accept DtTm. But in 2020 we transitioned to a different way of keeping track (separately) of the patient's physical location (i.e. Boarding Loc tmp entry) and the service they are under (Service tmp entry). See the relevant pages for more info.

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