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The whole Neuro ICU program is led by two authorities in the fields of Neurocritical Care and Neurosurgical Critical Care: Rodney Bell, MD and Jack Jallo, MD, PhD. The clinical excellence, high volume, and quality of human resources have helped to attract more highly qualified professionals. Over the last 6 years, the program has grown to include a total of 9 neurointensivists that operate in a semi-closed model. Nine board-certified neurointensivists, two additional vascular neurologists, and two endovascular neurosurgeons support to the daily operation of the Neuro ICUs, providing a true multidisciplinary approach to the high complexity of neurological illness. Daily work rounds start at 6AM with house staff and fellows, and multidisciplinary rounds then take place between 9AM and 12PM. The Neuro ICU’s daily operation is also supported by the work of several nurse practitioners and the excellent Neurocritical care nursing staff (see above). Unique features to the practice of Neurocritical Care (NCC) at Thomas Jefferson University Hospitals (TJUH) are the use of modern technology applied to critical care such as: targeted temperature management, brain tissue oxygenation, point of care ultrasound, fiber optic bronchoscopy and laryngoscopy, and semi-invasive and non-invasive hemodynamic monitoring. Neuro ICUs at TJUH are backed-up by a 365, 24-hour, seven days a week, neurointensivist presence in all ICUs. Three neurointensivists provide 12-hour physical presence in all Neuro ICUs with a 12-hour tele-medicine robotic support during nights. The development of robotic tele-presence in the Neuro ICU allows the neurointensivists to provide a unique opportunity for identification of situations that require immediate attention. In addition, our NCC program extends the skills of general intensivists at our affiliates via our Tele-Neurocritical Care program. In addition to supporting the full NICU operation at TJUH and its affiliates, Jefferson neurointensivists also participate in the Jefferson Expert Teleconsulting (JET) program. JET is the first university-based mobile robotic tele-consulting system in the Delaware area, allowing Jefferson professionals evaluate time-sensitive Neurocritical diseases, like stroke, in real time, efficiently, and without delay. Over the last 6 years, Thomas Jefferson University has offered and sponsored CME activities in the field of NCC. Over 5 iterations of a yearly NCC Symposium have demonstrated the ongoing need for physician and nursing education in the field. Recently, the faculty at Jefferson Neurocritical Care organized the successful 6th International Hypothermia Symposium where world experts in the field of temperature management from 16 different countries converged to discuss the current state of TTM in the field (see below). A Neurocritical Care fellowship endorsed by the United Council of Neurological Subspecialties (UCNS) is currently available at TJUH. Every year, three positions are offered in combination with an ACGME accredited Vascular Neurology fellowship. Fellows are being trained in invasive procedures such as: central venous access, PAC insertion, airway and ventilator management; closed thoracostomies and thoracenthesis; management and interpretation of lumbar and ventricular drains, brain oxygen monitors; trans-cranial Doppler technology and Focused Cardiac Ultrasound (FOCUS®); fiber optic bronchoscopy and laryngoscopy; and non-invasive cardiac output monitoring; as well as interpretation of continuous EEG and conventional CT/MRI technologies. In addition to their expected time in the Neuro ICUs, fellows rotate in the CCU, MICU and SICU, and become experienced in the use of advanced sedation techniques. A fully functional simulation lab at TJU provides pre-clinical training in airway management, ACLS protocols, and bronchoscopy. Additional areas of training during the fellowship 30


eMag_264548_NCS Currents_December2016_3
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