Surgical Trauma Intensive Care Unit (STICU) Admission Policy

Original Date: 10/2025
Purpose: Delineate admitting practices, clinical responsibilities, and communication expectations for patients within STICU

Purpose
To standardize admission practices, delineate responsibilities for admitting services, and establish order entry expectations for patients admitted within the closed-unit model of the STICU.

Scope
This protocol applies to all patients admitted to the STICU at Memorial Hermann Hospital – TMC, including those from all surgical and non-surgical specialties.

Closed Unit Model:
The STICU operates as a closed intensive care unit, where all patients are managed by the STICU team under the direction of an intensivist. This model of care remains in effect until the patient has physically transferred out of the STICU.

Role of the Intensivist:
The intensivist-led STICU team will assume primary responsibility for the patient care while in the STICU and coordinate all multi-disciplinary care with consulting services.

Service Assignment:

  • Patients admitted to the STICU require an admitting physician to be assigned and for surgical patients this is the primary surgical service (i.e., Trauma Surgery, ENT, Plastic Surgery, OMFS, Orthopedics, Spine, OB, Moody). For patients admitted from hospitalist services, admitting faculty will be the intensivist. This practice applies to admissions from the Emergency Department, OR/PACU, IMU, and floor.
  • Direct admissions to the STICU from an outside hospital (i.e. ICU-to-ICU transfers) require an accepting admitting service and notification/approval by the STICU faculty.
  • Upon downgrade from the STICU, patients will be transferred to the admitting service unless otherwise prearranged by admitting service (i.e. a prearranged agreement between surgical service and hospitalist).
  • For patients who are discharged directly to home, all discharge requirements (orders, DC summary, prescriptions, etc) will be performed by admitting service.

Order Entry:

  • All medical orders, including medications, labs, imaging, ventilator settings, and hemodynamic management, will be entered and managed exclusively by the STICU team in collaboration with admitting and consulting teams. The intent of this policy is to ensure the critical care team is able to effectively coordinate multi-disciplinary care and avoid conflicting or duplication of orders.
  • All order requests will be addressed in a timely fashion by the STICU team. In the event of delays or differences of opinion regarding order entry requests, escalation to the STICU fellow and/or faculty will be completed in a timely fashion to avoid delays in patient care.

Communication Expectations and Delineation of Responsibilities:

Admitting and consulting services are responsible for:

  • Documenting their clinical plans and desired post-operative orders and communicating these plans with the STICU team.
  • Providing timely responses to the STICU team for service-specific questions or concerns related to the ongoing care of patients.
  • Coordinating all operations to be performed by their service, including scheduling cases and obtaining surgical consent.

The STICU team is responsible for:

  • Notifying admitting services of planned family meetings and goals of care conversations prior to occurrence. Admitting services are strongly encouraged to attend/provide representation whenever possible.
  • Coordinating with the admitting service to determine when the patient is appropriate for downgrade. Once agreed upon, STICU team will place transfer order and notification will again occur once patient physically leaves STICU
  • Following existing escalation and notification policies in the event of significant changes in patient conditions (STICU Escalation Policy).

Clinical Documentation:

  • The STICU team will write detailed, system-based daily progress notes that include updated plans of consulting services The admitting service is responsible for documenting updated recommendations and surgical plans in the medical record and providing the STICU team with regular updates. This is essential for the effective coordination of care by the STICU team.
  • Upon downgrade and transfer from the STICU, the STICU team will document a detailed transfer summary of patient’s ICU course.