The time is 1859 and pagers throughout the ICU begin to chirp. It’s time: Tube O’clock. This simple and easy protocol was designed to ensure each patient is tubed NO SOONER than five minutes before death or one hour after end of Nursing shift. All pending intubations will now take place at 0700 & 1900:

– 1900: Intern to approach nurse beginning shift report and state, “We are intubating patient right now”. Should nurse have questions, redirect to resident.

– 1903: Resident to answer on 8th call from nurse. Redirect nurse to Fellow should nurse have questions.

– 1904: Fellow to answer nurse’s call and immediately ask why Respiratory isn’t in room. Nurse may have questions about which meds to draw up or if you’re in the patient’s room. Give your first round of orders now, while briskly walking away from patient’s room and out of plain sight.

High Yield: Make sure you have a second round of orders to give when the team is gowned and in patient’s room.

– 1920: For fun, try intubating patient in ascending order of provider experience.

High Yield: Time is on your side!

– 1945: Page anesthesia overhead

– 1950: Patient intubated by anesthesia. Promptly depart to opposite side of unit; DO NOT replace your depleted phone battery until you have located graham crackers & peanut butter as your reward.

– 2000: Code 7/19 Complete! Make sure to ask the nurse you’ve been working with all day if he’s on Nights now, while he furiously charts said Code 7/19.

– 2001: Mentally prepare to be uninvited from next week’s potluck and for multiple pages requesting Tylenol orders.