By Jamil R. Dibu, MD, Section Head, Neurologic Critical Care Unit, Cleveland Clinic Abu Dhabi, United Arab Emirates
Why is Cleveland Clinic in Abu Dhabi?
As a direct expansion of the Cleveland Clinic model of care, Cleveland Clinic Abu Dhabi builds on almost 100 years of excellence at Cleveland Clinic, aligning its services to meet the specific needs of the United Arab Emirates population.
The hospital is the result of an agreement signed in 2006 between Mubadala Investment Company and U.S.-based Cleveland Clinic, in support of the Abu Dhabi government’s Economic Vision 2030 to develop a robust healthcare sector in the emirate. Its mission is to offer patients in the UAE and the wider region access to world-class care, close to home.
What are the standards and the staffing model of CCAD’s Neurologic Critical Care Unit?
CCAD’s Neurologic Critical Care Unit (NCCU) is a state-of-the-art, 24-bed intensive care unit, staffed 24 hours a day by intensivists and nurse practitioners with various training backgrounds (neurology, anesthesia and internal medicine-medical ICU) of which three UCNS neurocritical care board certified neurointensivists. We follow a closed ICU model of care whereby we ensure discussing the plan and rounding jointly on our patients daily with consulting teams.
Meeting the level 1 NCCU standards, our neuro-ICU multidisciplinary team includes more than 80 nursing staff coming from over 15 different backgrounds and nationalities as well a dedicated neuro-ICU pharmacist, respiratory therapist, social worker, case manager, dietitian, physical therapist/occupational and speech therapists rounding together jointly and daily on our patients.
What resources and services does CCAD’s NCCU have?
We are fully resourced with an in-unit portable CT scanner, 24 hours a day access to CTs (including CT perfusion with RAPID software) and MRIs covered by three neuroradiologists, transcranial doppler (in-unit) and daily TCCDi capability, 24/7 portable video EEG monitoring availability covered by four epileptologists.
Our neurosurgeons cover all-spectrum services from open cerebrovascular surgeries, to pituitary, epilepsy and tumor surgeries, readily available for any emergency procedures such as ICP insertion and decompressive craniectomies. Five neuro-interventionalists provide 24/7 coverage of all emergency interventional cases such as mechanical thrombectomy and securing ruptured aneurysms within 24 hours of admission.
What is the average patient census, demographics and predominant diseases population in the NCCU?
Mentioning Abu Dhabi’s population demographics is important to understand the unique patients population we admit to our unit. Our stroke program’s primary target population consists of the Emirate of Abu Dhabi. In mid-2016, this was estimated close to 2.8 million, 500,000 United Arab Emirates (UAE) nationals (of whom 2/3 are under age of 30) and 2,300,000 non-nationals. In 2012, it was reported that 1,500 strokes were admitted across the Emirate of Abu Dhabi, and it has been reported that 8,000 strokes happen per year across the whole of the UAE.
CCAD’s stroke program was designated as the Center of Excellence for Stroke Emergencies in Abu Dhabi Island and the western regions in October 2015 by the ministry of health, given our unique setup of providing standard of care 24/7 for ischemic and hemorrhagic strokes. Also, we have just successfully passed the Joint Commission International Accreditation Survey for stroke center designation after meeting all key metrics of a comprehensive stroke center, to be the second accredited center in the UAE, and only the third in the Middle East region.
Since CCAD went operational in May 2015, our average yearly admissions for stroke patients have been rising, receiving overall 392 stroke patients in 2017 with the following breakdown: 257 ischemic strokes (of which 33 received t-PA and 46 underwent mechanical thrombectomy), 57 subarachnoid hemorrhages and 78 intracerebral hemorrhages. Thus, our patient’s population is predominantly cerebrovascular and young (i.e., average age for hemorrhagic strokes is 48 years); however, we also see the entire spectrum of neuro-ICU diseases such as subdural hematomas, status and super refractory status epilepticus, neuromuscular emergencies, post-operative tumor resections and meningo-encephalitis.
Cleveland Clinic Abu Dhabi is composed of 14 institutes, including the following centers of excellence: Heart & Vascular, Neurological, Digestive Diseases, Eye, Critical Care and Respiratory. The hospital is designated and licensed by the Abu Dhabi Department of Health as a research and teaching facility and is working to become a pioneering academic medical center for the region. Cleveland Clinic Abu Dhabi employs 330 physicians, and around 25 percent have trained or worked at Cleveland Clinic in the U.S.
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