Birmingham VA Medical Center CCU Teaching Service


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The Cardiology Service at the Birmingham Veterans Affairs Medical Center (BVAMC) is part of the Division of Cardiovascular Disease of the UAB Medical Center and Department of Medicine. Here Cardiology Fellows have more direct interaction with patients & families, and more direct patient care responsibilities than at UAB Hospital. Fellows are responsible for organizing the patient care in the Critical Care Unit (CCU) at the BVAMC for seriously ill veterans with a full scope of cardiovascular disease.


 

Attendings

Massoud Leesar, MD
Gilbert Perry, MD (Director)
José Tallaj, MD


Duration of Rotation

Fellows will be assigned to the BVAMC CCU for several months during their clinical training. 

Clinical
Responsibilities

  • Triage beds in the CCU.
  • Evaluate cardiology patients admitted to the CCU or MICU beds.
  • Organize the patient care activities of patients admitted to this service under the direct supervision of an assigned Attending.
  • Write an admission note on all new admissions to the CCU and daily progress notes on all critically ill patients in the CCU. These notes should reflect the history and exam as obtained by the Cardiology Fellow – cutting and pasting of housestaff notes is inappropriate.
  • Review all invasive and non-invasive tests (old cath films, echocardiograms, nuclear studies, etc.) which are relevant to the decision making process.
  • Continue follow-up of patients after they leave the intensive care unit.

Teaching
Responsibilities

Supervise and assist the Medicine Residents in the performance of procedures* such as

  • Swan Ganz catheter placement
  • placement of temporary pacemakers
  • ventilator management 


Conduct work rounds with residents and give several formal talks to the residents each month.

*The CCU attending is responsible for assuring that the CCU Cardiology Fellow is competent to perform these procedures.


Rounds

The housestaff assigned to CCU and MICU form a single team, but round separately with the Cardiology and Pulmonary attendings.

Cardiology Fellows round with the CCU attending physician and the housestaff CCU team for approximately 1.5 hours every morning (at which time the attending sees and examines all cardiology patients in the CCU and MICU).

Call

Cardiology Fellows are called for new admissions to the VA CCU and any patient care questions that arise after hours to:
  • See new admissions in a timely fashion
  • Evaluate established CCU patients who become unstable.

Protocols
  • Non-emergent questions can be handled over the phone.
  • A VA cardiology attending is available 24/7.
  • Off-service consults are seen by a medicine resident on call for the consult service and staffed with the VA attending.

Nights: The Cardiology Fellow is to be called for new admissions to the VA CCU
and any patient care questions that arise after hours.

Weekends
: Cardiology Fellows will round in the BVAMC CCU on 2 weekends per month, and then have the remaining 2 weekends off, according to ACGME regulations.

Emergency Department 
Consults

  • See consults in the Emergency Department (ED) and on floors when requested by the ED physician or admitting resident.
  • Consult on all acute myocardial infarctions and unstable cardiac patients in the ED.

NOTE:
Cardiology Fellows and attendings are not responsible for non-cardiology admissions (MICU overflow) to the CCU.

Essential Skills

Cardiology Fellows successfully completing this teaching service will be proficient in:

  • Cardiac catheterization
  • Cardioversion
  • Communicating with referring physicians and support personnel.
  • Coordinating specific procedures and therapies according to the needs of the patient
  • Coronary Intervention
  • Echocardiography
  • Participating actively in the teaching of Internal Medicine Residents and Medical Students on the consultation team
  • Performing literature searches on topics pertaining to specific patient care situations.
  • Perfusion Imaging
  • Stress Testing