The ICP is a 12-bed unit on the 9 South ward at Boston Children’s that functions as a step-down unit and cares for patients who require more intensive nursing than can be provided on the floors. Commonly encountered disorders include diabetic ketoacidosis, severe status asthmaticus, complex medical patients requiring intensive respiratory monitoring or noninvasive ventilation, and significant electrolyte abnormalities (such as diabetes insipidus) requiring close monitoring and frequent blood analyses.
The service is split into two teams, each with one senior or late-year junior resident, one intern, and one nurse practitioner that covers half of the unit (six patients). Both teams share the same attending. Resident teams round independently from the attending on a large subset of patients, providing additional supervisory skills and autonomy for juniors and seniors. One junior resident and 1 intern staff the ICP at night. The nursing staff (who care for one or two patients each) and a dedicated respiratory therapist participate actively in morning and night rounds. An interdisciplinary approach is emphasized. Given the intimate structure of the team and the higher acuity on the unit, many formal and informal teaching opportunities arise. Daily didactics focus on topics such as management of DKA, airway obstruction and respiratory compromise.