aann 2016, neurocritical care without limits- an alternative nccu model
TRANSCRIPT
Neurocritical Care Without LimitsAn Alternative NCCU Model
By Troy Gideon RN, BSN, MBA
Director Emergency Services and Programmatic IntegrationSt. Jude Medical Center
Karen Bartolone, RN, BSNManager CCU/SDU
St. Jude Medical Center
DisclosureThere are no relevant relationships with
industry
NCCU Without Limits
What makes a NCCUCCU Model comparison
Steps to build a Global NCCU
What makes a NCCU Clinical Team
Equipment
Education
What makes an NCCUClinical Team
• NCCU Medical Director• Neurointensivist’s • Neurologist’s• Neurosurgeon’s• Neurointerventional Radiologist’s• Neuro Recourse RN’s• Advanced Practice Neuro RN’s
What makes an NCCUEducation
Diagnostics• CT/CTa/CTp/MRI• TCD• EEG/cEEG• Labs• Neuro Exam
What makes an NCCUEducation
Interventions and Treatments• Neurointerventional Radiology• Neurosurgery• Medical Management• EVD placement• Targeted Temperature Management• Rehabilitation Therapies
What makes an NCCUEquipment
CCU ModelsGlobal Specialty
Specialty CCUBenefits
• Increased expertise• Provide more focused care• Decreased mortality• Decreased LOS• Increased D/C to home and
to SNF’s
Limitations• Less experience in other
systemic complications• Patients admitted
inappropriately• Physical space• Increased costs
Global CCUBenefits
• Patients often have multiple comorbid conditions and rarely admitted with single organ dysfunction
• Reduced mortality rates• Cost reduced and
efficiencies increased
Limitations• Decrease expertise• Worsening outcomes• Increased LOS
Steps to a Global NCCU
Steps to a Global NCCU• Intensivists board certified in Neurocritical
Care• Dedicated Neuro Recourse RN Team• Interdisciplinary Teams• Standardized Evidence Based Processes• Education• Administrative Support
Steps to a Global NCCUNeurocritical Care Intensivist’s
• Started with 2 Intensivists certified in Neurocritical Care
• Has grown to 9 Intensivists, 2 ED physicians and 2 Hospitalists certified in Neurocritical Care
Steps to a Global NCCUDedicated Neuro Recourse RN Team
• Started with a small group of previously experienced Neurocritical Care RN’s with one lead.
• Grew to a large team that extends beyond the NCCU, to include all areas (ED, CCU, OR, Cath Lab, SDU, NMSU, Rehab)
• FunctionSuper User Decision MakersEducator EBM ImplementationMentor Teamwork
Steps to a Global NCCUInterdisciplinary Members
• Rehab (OT, ST, PT)
• Dietary• Laboratory• Pharmacy• Respiratory
Therapy• Radiology
• Physicians• Stroke
Coordinator • APN’s in Neuro• Neuro Resource
RN’s• Case
Management• Palliative Care
• Clinical Research• Clinical
Excellence• Paramedic
Services
Steps to a Global NCCUInterdisciplinary Teams
Stroke Review Neuro Excellence
Neuro RN Resource Team
Neuro Case Review
Neurosciences Steering
Committee
Steps to a Global NCCUInterdisciplinary Teams
• Metrics • Case Studies• Strategic Goals• PI Plans
• Order Sets• Guidelines• Standard Work• Policies
Program Development
Steps to a Global NCCUStandardized Evidence Based Processes
• Practice Guidelines (AHA/ASA, NCS, AANS, SNIS) • Order Sets (CVA, ICH, SAH, Craniotomy, NIR, TTM)• Standard Work & Algorithms of Care (CVA, ICH, SAH,
NIR)• Reference Tools (CVA, ICH, SAH, NIR, Craniotomy, TTM)
Steps to a Global NCCUEducation
Formal Lectures ConferencesComputer Modules Daily RoundsObserved Validation Just in TimeSimulation Laboratory Case Reviews
Steps to a Global NCCUAdministrative Support
• Education- Conferences- Simulation Laboratory- Train the Trainers
- Certification Reimbursement• Equipment• Neurospecialty Goal Setting
Global NCCU Success
Global NCCU Success
Comprehensive Stroke Certification2015
Stroke Honor Roll Elite Plus 2015
Gold Achievement and Gold Plus Award2010, 2011, 2012, 2013, 2014, 2015
Target Stroke Honor Roll 2011, 2013, 2014, 2015
Global NCCU SuccessTeamwork
References1. Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 2001; 29:635-640.2. Lott JP, Iwashyna TJ, Christie JD, Asch DA, Kramer AA, Kahn JM. Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med 2209; 179:676-683.3. Peelen L, de Keizer NF, Peek N, Scheffer GJ, van der Voort PH, de Jonge E. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study. Crit Care. 2007; 11:R40.4. Vaara ST, Reinikainen M, Kaukonen KM, Pettila V. Association of ICU size and annual case volume of renal replacement therapy patients with mortality. Acta Anaesthesiol Scand 2012; 56:1175-1182.5. Katz JN, Shah BR, Volz EM, Horton JR, Shaw LK, Newby LK, Granger CB, Mark DB, Califf RM, Becker RC. Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes. Crit Care Med 2010; 38:375-381.6. Treggiari MM, Martin DP, Yanez ND, Caldwell E, Hudson LD, Rubenfeld GD. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. Am J Respir Crit Care Med . 2007; 176:685-690.
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