Critical Care Experience
Currently, the NICU Directorship is an open position with a search underway. The Neurosurgical Director is Murat Gunel. Additionally, an MICU and critical care fellow are assigned fulltime to the unit.
Residents assigned to the Clinical Neurosurgery Service round daily in the NICU (along with all the other residents on the clinical service). Additionally, Physician Assistants cover the NICU 16 hours per day to assist in patient care. Work rounds are run by the Chief Resident and involve a review and work plan for each patient in the NICU. Following rounds, the neurosurgery intern and junior residents are primarily in charge of the clinical care of patients in the NICU, including implementation of the work plan, assessment of diagnostic studies, and response to changes in medical and neurologic condition. A board certified critical care physician and a critical care fellow also round in the NICU on a daily basis. The junior neurosurgery house-staff participate in these rounds. The critical care fellow is available 24/7 for consultation. Fundamental clinical skills including management of ventilator, multisystem support, intracranial pressure, cerebral perfusion pressure, and postoperative care of critically ill patients are acquired and refined. There is special attention to the acute evaluation and emergent management of patients with acute ischemic and hemorrhagic stroke, comprising approximately half the admissions to our 14 bed NICU. By participating on rounds with the chief resident, the critical care attending the neurosurgery attending, knowledge based competencies are continually assessed and evaluated. During this time, the intern or junior resident is credentialed in the insertion of invasive lines. There are specific requirements of performance and a prescribed numbers of procedures under supervision (minimum of 5) before being allowed to perform these procedures independently. Invasive lines include arterial catheters, central venous catheters, Swan-Ganz pulmonary artery catheters, and parenchymal and ventricular intracranial catheters. A log of the credentialing procedures is maintained in the NICU. Skill-based competencies are met in the NICU with the outlined paradigm.
Similarly, for patients in the Pediatric Intensive care Unit and the Newborn Special Care Unit, the critical care attendings who are pediatric critical care or newborn special care specialists and their staffs, respectively, jointly manage those patients along with the neurosurgical attending and neurosurgery residents.
The neurosurgical physician assistant staff is made up of 5 PAs who are assigned to cover the neuro intensive care unit daily from 6am-4pm on a rotational basis. In order to optimize continuity of care, the rotations are 2 weeks in duration, and consecutive days are scheduled when possible. The PA is an integral part of the NICU team and rounds with the neurosurgical house staff and assists in implementing the plan of care as outlined by the Chief Resident on work rounds. The PA maintains a collaborative relationship with the neurosurgery intern and resident, is available to round with the neurosurgery attending and with the MICU consult team throughout the day. The PA serves as conduit, providing updates on events of the day, patient and staff education, and also helps to facilitate the exchange of information amongst the members of the team, attendings, families, and consultants.
Work rounds are conducted twice daily by the chief resident, and include the NICU PA, and neurosurgery house staff members who are available. An evening PA helps cover the NICU in collaboration with the on-call resident, and is available 2p-12 midnight Monday thru Friday. The NICU PA participates in a formal sign-out with the on-call resident at the conclusion of the workday.
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