The ICP is a 24-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 3 teams, two of which are staffed by residents and one staffed by nurse practitioners. Each resident team is comprised of a senior and intern, allowing for dedicated teaching and mentoring. Resident teams share the same attending and thus round independently from attendings on a large subset of patients, providing additional autonomy for seniors.
One junior resident and 1 intern staff the resident teams in 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.