SICU Patient Presentation Format Recommendations
The SBAR (Situation, Background, Assessment, Recommendation) format is strongly recommended for standardized patient presentations in the Surgical Intensive Care Unit (SICU), as it structures oral communication to be clear, concise, and exhaustive, improving teamwork and safety climate. 1
Core Elements of SICU Patient Presentation
1. Structured Communication Framework
The 2023 Anaesthesia guidelines emphasize that standardized communication in critical care settings significantly improves patient safety and reduces adverse events. The SBAR format (or its variations SAED/SCAR) structures oral communication to ensure critical information is consistently shared 1:
- Situation: Current patient status and immediate concerns
- Background: Relevant patient history and context
- Assessment: Clinical evaluation and interpretation of data
- Recommendation: Proposed actions and plan of care
This structured approach helps develop a shared mental model among team members, which is essential in high-stakes environments like the SICU.
2. Daily Goals Format
Daily rounds should incorporate a standardized daily goals format that includes 1:
- Patient identification and demographic information
- Current clinical status and vital signs
- Active problems listed in order of priority
- Interventions performed and patient's response
- Plan for the day with specific tasks assigned
- Potential safety risks and mitigation strategies
Research shows that implementing a daily goals sheet significantly improves interdisciplinary communication and reduces ICU length of stay from 2.2 days to 1.1 days 2.
3. Advanced Care Planning Documentation
Every SICU presentation should include 3:
- Identified surrogate decision maker (documented in the chart)
- Goals of care discussions
- CPR directives
- Patient values and preferences
Implementation of a standardized electronic medical record template for advanced care planning significantly increases documentation of surrogate decision makers and improves care alignment with patient preferences 3.
Key Components of Comprehensive SICU Presentation
Patient Assessment Section
- Chief complaint in patient's own words
- Duration of symptoms, onset, location, characteristics
- Relevant medical/surgical history
- Current medications and allergies
- Physical examination findings
- Laboratory and imaging results with interpretation
- Current hemodynamic parameters and ventilator settings (if applicable)
Medical Decision Making Section
The American College of Emergency Physicians and Critical Care Medicine guidelines recommend documenting 4:
- Differential diagnosis with supporting evidence
- Risk factors for serious conditions
- Rationale for diagnostic tests ordered
- Interventions performed and response to treatments
- Consultations obtained
Communication with Family Section
Critical Care Medicine guidelines emphasize the importance of 1:
- Assessing family's understanding of the situation
- Explaining the patient's medical condition and prognosis
- Addressing emotional needs of family members
- Documenting shared decision-making discussions
Plan and Next Steps
- Clear daily goals and tasks
- Anticipated clinical course
- Potential complications and monitoring plan
- Criteria for escalation/de-escalation of care
- Discharge planning considerations
Implementation Best Practices
Interdisciplinary Engagement
Research shows that standardizing communication and creating defined roles in formal processes promotes effective interdisciplinary care team communication by fostering psychological safety 5. Specific strategies include:
- Nurse participation during presentation of patient data and generation of daily plans
- Pharmacist input on medication management
- Respiratory therapist involvement in ventilation strategies
- Physical/occupational therapy recommendations for mobility and rehabilitation
Closed-Loop Communication
The 2023 Anaesthesia guidelines strongly recommend using closed-loop communication in which verbal repetition confirms that team members have correctly understood the message 1. This technique has been shown to improve team performance and reduce medical errors.
Enhanced Written Communication Tools
The European Society of Intensive Care Medicine guidelines recommend implementing enhanced written communication tools to complement standard oral communication 1:
- Brochures or leaflets designed for families
- Daily written summaries of care
- Electronic documentation templates
Common Pitfalls to Avoid
- Unstructured presentations that miss critical information
- Medical jargon that families cannot understand
- Failure to document surrogate decision makers
- Lack of clear daily goals
- Inadequate nurse participation in rounds and care planning
- Omitting emotional support for families of critically ill patients
By implementing this standardized SICU presentation format, healthcare teams can improve communication, reduce errors, enhance family satisfaction, and potentially decrease ICU length of stay while improving patient outcomes.