By Ryan Hakimi, DO, MS, FNCS, NVS
With the support of Fredy J. Revilla, MD, and Charles Kanos, MD, the Chiefs of Neurology and Neurosurgery, respectively, a unified Neuro ICU Service was started at Prisma Health–Upstate's Greenville Memorial Hospital (GMH), the principal teaching hospital of the University of South Carolina School of Medicine's Greenville campus in 2018.
Initially, Ryan Hakimi, DO, MS, FNCS, NVS, was recruited to start a neurology-based neuro ICU in 2016, after having done the same at the University of Oklahoma. At the time, neurology and neurosurgery had two separate neuro ICU teams. In 2017, Hakimi was joined by Sanjeev Sivakumar, MD. Together, Hakimi and Sivakumar helped open the region's only dedicated neuro ICU, which unified the neurology and neurosurgery patients under one team.
This tertiary medical center is located in Greenville, South Carolina (the fourth fastest growing city in the United States). GMH serves as the hub for Prisma Health–Upstate’s six other satellite hospitals, with a catchment area of approximately 1.5 million.
Hakimi and Sivakumar led the expansion of the neuro ICU team in this closed-model neuro ICU by becoming the primary admitting service for essentially all non-traumatic neurological and neurosurgical patients, except for elective neurosurgical post-operative patients.
Further expansion came in 2018, with the recruitment of a well-published neuro endovascular team comprised of three full professors (Imran Chaudry, MBBS; Aquilla Turk, MD; and Raymond Turner, MD) and their fellow at the time (Jan Vargas, MD). Vargas has since joined the faculty and, together, the four neuro endovascular specialists have a neurocritical care-trained neurologist (Anand Venkatraman, MD) as their current neuro endovascular fellow.
Partnering with the neuro endovascular team, the neuro ICU team now admits approximately 15-25 post-mechanical thrombectomy patients per month and more than 100 subarachnoid hemorrhages annually, in addition to standard neuro ICU diagnoses. The 16-bed, state-of-the art neuro ICU is also hardwired for continuous video-EEG monitoring. However, the neuro ICU Team routinely occupies the trauma ICU as well, due to its average daily census of 20-25.
Recently, Hakimi recruited two new neurointensivists, Josh VanderWerf, MD and Andres Ruiz, MD, who comprise the four current attending neurointensivists. The neuro ICU team has been vitally dependent on advanced practice providers to achieve its expansion. Currently, the neuro ICU team has five such providers: Priscilla Massey, AGACNP-BC, Melissa Vorpahl, AGACNP-BC, Sarah Hierholzer, ACNP–BC, Kathleen Ward, AGACNP-BC and Sparkle Toland, AGACNP-BC. Together, with resident physicians, a neurocritical care pharmacist (Michael Wagner, PharmD, BCCCP) speech therapists, occupational therapists, physical therapists, respiratory therapists, dietitians and neurology-trained nurses, the neuro ICU functions as a true multidisciplinary team.
Neuro ICU Team Members (from left to right): Front row: Sarah Hierholzer, ACNP-BC, Priscilla Massey, AGACNP-BC, Melissa Vorpahl, AGACNP-BC. Back Row: Andres Ruiz, MD; Ryan Hakimi, DO, MS, FNCS, NVS; and Josh VanderWerf, MD.
Recently, Hakimi partnered with the GMH Vascular Lab to train six registered vascular technologists (RVT) to perform transcranial doppler ultrasound. The service is provided seven days a week and continues to grow with the addition of seventh RVT. The other neurointensivists are also pursuing board certification in neurosonology to grow the team to five interpreting physicians with the ultimate goal of achieving IAC accreditation.
GMH TCD Sonography Team (From left to right): Tracy Roberson, RVT, Crystal Walker, RVT, Amanda Phillips, RVT, Donna Serna, RVT, Lindsay Highhouse, RVT, Marissa Bowman, RVT.
One additional neurointensivist, Naresh Mullaguri, MD, will be joining the team from the Cleveland Clinic following completion of his fellowship in July 2020. In addition, two more APPs, Ashley Alexander, AGACNP-BC and Melissa Bouassaba, CNS-BC, will be joining the team later this year. By next year, the neuro ICU team will have five neurointensivists, seven neuro ICU APPs and seven RVTs.