Clinical Services Training
Clinical Services training includes comprehensive experience in the Cardiac Intermediate Care Unit (CICU), Coronary Care Unit (CCU), the Consult Service, the Emergency Ward, the MetroWest Medical Center rotation, and Outpatient Care.
Cardiac Intermediate Care Unit. A 30-bed unit serving patients admitted to the Cardiology/Medicine Service at BIDMC, the Cardiac Intermediate Care Unit provides fellows with a wide range of clinical experience, including participation in rounds with the medical house staff, as well as extensive experience in the management of patients admitted for interventional procedures. The CICU also receives emergency room admissions for decompensated heart failure and suspected myocardial infarction (when critical care is not deemed necessary), as well as transfers from the Coronary Care Unit and patients scheduled for elective cardiac catheterization or routine angioplasties. Two medical junior residents and six medical interns cover this service. Also present on this unit is the Uncovered Interventional Cardiology Service. A third or fourth year interventional cardiology fellow and numerous nurse practitioners as well as an interventional faculty member staff this service.
Coronary Care Unit. The CCU specializes in the treatment of patients hospitalized with acute cardiovascular disorders. Under the supervision of Dr. Peter Zimetbaum, the unit admits in excess of 1,500 patients each year. The CCU rooms are equipped with computerized arrhythmia and ST segment monitoring, bedside hemodynamic monitoring, portable fluoroscopy, and capability for intra-aortic balloon counterpulsation, as well as facilities for hard copy hemodynamic recording and in-unit measurement of arterial and mixed venous oxygen saturation.
A team of medical house staff (three interns, one junior resident, and two senior residents), a cardiology fellow, and a cardiology attending provide patient care in the CCU. The teams are responsible for decisions in patient management, and for the performance of indicated diagnostic and therapeutic procedures. The CCU attendings are available on a 24-hour basis, and in conjunction with the fellows, follow CCU patients after transfer to the in-patient medical wards. Fellows have one to two CCU Service rotations in their first year, and one to two rotations in their second year.
In addition to providing intensive care for the cardiac patient, the CCU is an active center of cardiovascular research where studies have included hemodynamic investigations of new drugs and devices as well as medical care delivery strategies.