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NCS Currents Sept 2016

FEATURED PROGRAM The Mayo Clinic Neuroscience ICU in Jacksonville, Florida By W. David Freeman, MD, Lauren Ng, MD, and Jose Diaz-Gomez, MD Mayo Clinic in Jacksonville, Florida is the top ranked hospital in Florida and is nationally ranked in several medical specialties. Mayo Clinic in Florida (MCF) is a growing, 340-physician practice with a national and international patient base in cooperation with the other Destination Medical Center campuses in Rochester, Minnesota and Scottsdale, Arizona. The MCF Neurosciences Intensive Care Unit (NSICU) was started in 2007 and led by founding neurointensivist W. David Freeman, MD, FNCS. The MCF NSICU is currently a 14-bed physical unit, which can scale up to 27 multimodality-monitoring-capable ICU beds. It is nested within a state-of-the-art 55-bed ICU and progressive care unit on the fourth floor of the Mayo Clinic Hospital, which is part of the 304-bed hospital that opened in April 2008. In addition, the MCF NSICU and surgical ICUs received the Beacon award of excellence in 2016 for exemplifying excellence in professional nursing practice, patient care, and outcomes. Neuroscience is also part of an enterprise specialty focus for Mayo Clinic. The MCF NSICU is also part of Florida’s first Joint Commission-accredited Comprehensive Stroke Center and functions as a closed Neuro ICU. The NSICU staff includes five multidisciplinary attending physicians with UCNS neurocritical care board certification (W. David Freeman, Jose Diaz-Gomez, Lauren Ng, Perry Bechtle, and Carla Venegas- Borsellino). This multiprofessional unit is also comprised of a team of advanced registered nurse practitioners (ARNPs) and physician assistants, neuroscience nursing staff, physical and occupational therapists, speech pathologists, case managers, pharmacists, nurse managers, and education and research coordinators. Educationally, the MCF NSICU offers a UCNS-accredited neurocritical care fellowship that began in 2013. Clinical fellows learn critical care management for postoperative neurosurgical/ neuroendovascular patients, acute stroke, cerebrovascular disease, endovascular thrombectomy of large vessel occlusive stroke, malignant cerebral edema, intracranial hemorrhage, subarachnoid hemorrhage, intraventricular hemorrhage, Guillain-Barre Syndrome, myasthenic crisis, complications after solid-organ transplantation, status epilepticus, and neurological prognostication after cardiac arrest. Fellows also learn primary management of all UCNS core competencies including airway/intubation, central line placement, bronchoscopy, EEG, transcranial Doppler, and percutaneous tracheostomy. Mayo Clinic also adheres to the ACGME policies for all of its fellows. In 2015, Mayo Clinic launched an enterprisewide Society of Neurologic Surgeons Committee of Advanced Subspecialty Training (CAST) fellowship in neurocritical care (https://www.societyns.org/fellowships/Neurocritical%20Care1. asp). MCF also offers a national/international NCS-supported observer program to facilitate world-wide education and to advance neurocritical care knowledge to international visitors to Mayo Clinic. The MCF NSICU is involved with multidisciplinary neuroscience research studies, both intramurally and extramurally funded (CLEAR III, MISTIE III, EDGE 1962), and considers the NSICU patient as central to future translational discoveries, including precision medicine and brain-injury biomarker studies, critical illness and stroke. Mayo Clinic is also part of the Neurocritical Care Research Network (NCRN) and is a future site for the SETPOINT tracheostomy trial. The Mayo NSICU participates in cutting-edge health care quality, cost, administrative, and outcomes research as part of its Mayo Clinic Kern Center for the Science of Health Care Delivery. We also have numerous intramurally and federally supported opportunities for young investigators and established investigators. Regarding educational outreach, Mayo Clinic endeavors to provide world class educational material to advance the knowledge of neurocritical care beyond its walls to help patients. We have established an annual comprehensive stroke and cerebrovascular review at the Ritz Carlton at Amelia Island (https://ce.mayo.edu/ neurology-and-neurologic-surgery/content/mayo-clinic-8th-annualstroke and-cerebrovascular-disease-review-2016). In collaboration with the NCS, we also provide a local Emergency Neurological Life Support (ENLS) course. Mayo Clinic also now offers an annual neurocritical care CME review and workshops with our Rochester colleagues Eelco Wijdicks, MD and Alejandro Rabinstein, MD along with other course co-directors in allied health including Suzanne Brown, BSN, RN, Christy Smith, ARNP, Jodi Hellickson, CNS, and Daniel Jackson, PharmD. The next Mayo neurocritical care CME meeting will be held at the Four Seasons in Orlando, from May 4-6, 2017. 28 Mayo Clinic Jacksonville Hospital Entrance


NCS Currents Sept 2016
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