DeliveringNeuro-CriticalCareinaPublicHospitalAGeneral.pptVIP

Delivering Neuro-Critical Care in a Public Hospital:A General Intensivist Experience Raghu S. Loganathan, MD, FCCP Director, Medical ICU Stroke Center Today’s Talk You are NOT going hear ground breaking stuff Background of neurocritical care Describe an incremental implementation of NC at a public hospital University affiliated teaching hospital Level-1 Trauma center ~37 critical care beds MICU and SICU 24/ 7 intensivist coverage ~ 1500 discharges per month BackgroundEvidence For Neurointensivist Care Intracerebral hemorrhage higher mortality in general medical-surgical ICU compared to a neuroscience unit OR 3.4, 95% CI 1.65–7.6 Economic benefit Diringer etc al. Crit Care Med 2001; 29:635–640 Mirski MA, Chang CW. J Neurosurg Anesthesiol 2001; 13:83–92 Traumatic brain injury Patel HC Intensive Care Med 2002; 28:547–553 Varelas PN J Neurosurg 2006; 104:713–719 Positive impact with Ischemic strokes Bershad EM Neurocrit Care Varelas PN. Neurocritical Care Subarachnoid hemorrhage decreased LOS and mortality Jose Suarez. Crit Care Med 2004; 32:2311–2317 BackgroundCurrent Neurocritical Care Work Force Evolution of Neuro critical fellowships Accredited by UCNS First Board exam in 2007 195 diplomates graduated so far Neurocritical Care Society 127 members ~ 50 dedicated Neurointensive units in US Trend towards regionalization of care Critical care work force shortageIs evolution of Neurointensive Care Making It Worse? Huge gap between supply and demand Growing shortage of general intensivists Drawing CC physicians into a specialized areas Fragmentation of critical care training: Surgical critical care Neurointensive care Cardiothoracic care Reality: 80% of critically ill patients are cared for in multidisciplinary units by general intensivists Neurointensivists: Part of the problem or part of the solution? Chang Krell. Crit Care Med 2008 Vol. 36, No. 10 Krell K: Critical care workforce. Crit Care Med 2008; 36:1350–1353 Delivering Ne