Building from the ground up

In envisioning the Neuromedicine ICU that is being created many aspects of care must be discussed and agreed upon. There will be an intensivist covering the unit with a combination of the neurology and neurosurgical residents and midlevel providers for 24 hour coverage of the unit. The unit will be managed by a nurse manager and three nurse leaders. The nurses will follow a nursing care model that involves the use of Licensed Practical Nurses (LPN) in conjunction with Registered nurses (RN). There will be a team of ancillary staff including but not limited to dieticians, physical and occupational therapists, speech pathologists, and social workers. Columbia University is well known for their state of the art Neuro critical care ICU. The nurse manager of the Neuromedicine ICU had the opportunity to tour and speak with the nurse manager at Columbia to gain more insight into building the best ICU possible.

A common question asked is why does a large university medical center need another ICU?   There are currently four that care for the critically ill patients currently. Not to mention the astronomical costs of building and staffing a new unit. Emory University did a wonderful job of explaining why their medical center chose to add another ICU within their facility. A study done in 2001 by Mirski, Chang, and Cowan compared patient’s length of stays and the cost of care between a neuroscience ICU and a generic Surgical/Medical ICU. The results showed a decrease in the length of stay, decrease in costs and a decrease in imagining tests ordered on patients with intracranial hemorrhages.  The decrease in laboratory test, imagining (such as MRI and CT scans) and pharmacy needs is related to specialized knowledge of the neurologist and neurosurgeon.  Another, older, study noted a decrease in length of stay in a neuromedicine ICU versus a surgical ICU. This study did not evaluate the costs in relation to the decrease length of stay.