EPA: Perioperative Care of Critically Ill Surgical Patient

EPA: Perioperative Care of Critically Ill Surgical Patient

Includes Sepsis and Hemmorhage

Evaluatee Name (Last, First)*

Enter resident starting with last name. Once a form has been submitted, the resident will receive a copy of the evaluation.

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Evaluator Name (Last, First)*

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Date of Assessment*

Rotation*

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Phase of Care: ICU*

UPDATE! You can only select one phase of care. Complete an assessment for each phase of case separately.

Resuscitation

Procedures

Post-resuscitation

Resuscitation: Medical Knowledge

Demonstrates limited understanding of the pathophysiology of critical illness

Demonstrates understanding of the pathophysiology of critical illness and NORMAL physiologic response

Demonstrates understanding of the pathophysiology of critical illness and NORMAL/ABNORMAL physiologic responses

Resuscitation: Evaluation*

Obtains an H&P inclusive of reviewing medical records and available testing with cultural humility; develops a differential for a patient’s primary surgical problem. Reports new data and other endpoints of resuscitation.

Evaluates a critically ill patient and ORDERS AND INTERPRETS DIAGNOSTIC TESTING WITH ASSISTANCE to discern underlying etiology. Reports new data and other endpoints of resuscitation and begins to formulate a management plan in response.

Considers effect of comorbidities. MONITORS SOME BUT NOT ALL ENDPOINTS of resuscitation; reassesses to identify if additional resuscitation or specialist consultation is indicated. Identifies whether an operation is indicated but NOT IN A TIMELY WAY.

Synthesizes all information to identify a patient’s illness severity and initiate management. Monitors endpoints of resuscitation and adapts management as indicated, including making timely decisions regarding operative intervention.

Resuscitation: Evidence-based management

Identifies but cannot yet apply evidence-based guidelines.

Demonstrates superficial knowledge of evidence-based guidelines for managing a critically ill patient.

Resuscitates a patient based on available evidence-based guidelines with some supervision

Resuscitates a patient in accordance with evidence-based guidelines

Resuscitation: Communication with other providers*

Reports information received from referring/consulting teams

Identifies indicated referring/consulting teams, reports information received, and asks follow-up questions

Communicates with referring/consulting teams, including centers offering higher levels of care, but NEEDS SUPERVISION to ensure all essential points have been relayed

Communicates with referring/consulting teams, including centers offering higher levels of care, ensuring all essential points have been relayed to expedite resuscitation

Not applicable/not observed

Consent

Communicates the elements of an informed consent discussion for bedside procedures but OMITS some elements when documenting the discussion

Initiates informed consent for bedside procedures and, if indicated, an operation; REQUIRES HELP TO COMPLETE CONSENT, address best- and worst-case scenarios for the short, medium, and long term, and ensure patient/caregiver comprehension.

Obtains informed consent for bedside procedures and, if indicated, an operation; addresses best- and worst-case scenarios but DOES NOT ALWAYS ENSURE PATIENT/CAREGIVER COMPREHENSION by using applicable language services and audio/visual aids.

Obtains informed consent for bedside procedures and, if indicated, an operation; addresses best- and worst-case scenarios; uses applicable language services and audio/visual aids to ensure patient/caregiver comprehension.

Not applicable/not observed

Procedures (bedside)

Arterial and venous line placement, tube thoracostomy, surgical airways, POCUS, thoracentesis, and bronchoscopy

Demonstrates SUPERFICIAL knowledge of indications, steps, and basic skills (knot tying, suturing). LIMITED understanding of execution, confirmatory testing, and associated risks of bedside procedures.

Demonstrates COMPREHENSIVE knowledge of indications, steps, and basic skills (knot tying, suturing). SOLID understanding of execution, confirmatory testing, and associated risks of bedside procedures.

PERFORMS procedures. Identifies associated risks. Calls for help if unable to accomplish procedure, modifies approach when initially unsuccessful. REQUIRES ASSISTANCE to make decision regarding treatment approach and time sensitivity of a procedure.

PERFORMS procedures. INDEPENDENTLY makes patient-specific decisions regarding approach, admitting disposition, and time sensitivity

Post-resuscitation: Evaluation

Requires prompting to reassess a patient in early postop/post-resuscitation course and adjust treatment based on new information. Evaluates an ICU patient for periop complications.

Reassesses a patient in early postop/post-resuscitation course but NEEDS ASSISTANCE to adjust management. Identifies periop complications but NEEDS ASSISTANCE to manage them .

Use data from interventions performed; considers additional resus, interventions, or specialist consult, including palliative care or ethics. Evaluates postop complications in light of comorbid (bleeding with coagulopathy, infxn in immunosuppression).

Performs above AND INDEPENDENTLY identifies when additional information is required or management needs to be modified. Identifies/manages periop complications using a systems-based approach and available evidence-based guidelines

Not applicable/not observed

Post-resuscitation: Evidence-based Management

Identifies evidence-based critical care guidelines that apply to perioperative complications or management of a critically ill patient

Elicits patient/caregiver input regarding management to inform evidence-based care

Applies evidence-based critical care guidelines applicable to perioperative problems/complications or management of a critically ill patient

Critically appraises and applies evidence to a critically ill patient and adapts the plan of care when the patient does not respond

Not applicable/not observed

Post-resuscitation: Communication with other providers

Reports an updated plan of care to other involved specialist teams

Considers a subspecialty consultation, including palliative care or ethics. Demonstrates understanding of the importance of primary palliative care but cannot reliably provide or adjust it as needed

Provides primary palliative care in communication, symptom management, and goal concordance in an ongoing plan of care. Adjusts a goal-concordant plan when there are unanticipated changes and communicates any changes to all involved teams

Not applicable/not observed

Post-resuscitation: Communication with patient

Reports an updated plan of care to a patient/caregiver(s) in a timely way

Communicates an updated plan of care to a patient/caregiver(s) without reliably considering if they can carry it out within their psychosocioeconomic context

Communicates an updated plan of care to a patient/caregiver(s) with consideration of some, but not all, patient factors (eg, illness severity, prognosis, additional treatment, feasibility of carrying out plan within psychosocioeconomic context)

Communicates an updated plan of care to a patient/caregiver(s), considering illness severity, prognosis, additional treatment, and feasibility of carrying out the plan within their psychosocioeconomic context

Not applicable/not observed

Post-resuscitation: Documentation

Documents a goals-of-care discussion with a patient/caregiver(s) but omits some elements, particularly nuances

Documents patient/caregiver goals and goal-concordant plan of care in the EMR with few, if any, omissions

Promptly documents changes to a patient’s/caregiver’s goals and goal-concordant plan of care in the EMR

Reviews and gives feedback on documentation in the EMR regarding changes to a patient’s/caregivers’ goals and goal-concordant plan of care

Not applicable/not observed

Post-resuscitation: End of life discussions

Needs assistance to recognize a patient at the end of life and incorporate patient/caregiver preferences into the plan of care

Identifies a patient at the end of life and seeks to incorporate patient/caregiver preferences into the plan of care

Identifies end-of-life stage of care, prioritizing comfort and symptom-directed therapy as indicated with assistance. Reflects on the experience of having been involved in a patient’s care and uses strategies to process the experience

Reflects on the experience of having been involved in a patient’s care; uses multiple strategies to process the experience both in and outside of the hospital in ways that support physical, mental, emotional, and spiritual well-being

Not applicable/not observed

Overall Performance*

Based on your observation, what level of autonomy would you trust the resident to perform this task at the next encounter?

Limited Participation: Learner has basic knowledge and skills, attending does show and tell

Direct Supervision: Attending provides active help

Indirect Supervision: Attending provides passive help

Practice Ready: Attending is available but is not needed for routine cases/presentations, but input may be needed for complex cases

Comment*

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