By Darsie Marin, MD, Tarula Erick, MD, and Medow Joshua, MD,MSc
The University of Wisconsin School of Medicine and Public Health is situated on a large medical campus on the west end of the University of Wisconsin – Madison. Located in the state’s capital, UW Hospital is a tertiary care center receiving referrals from the majority of the state of Wisconsin, the Upper Peninsula of Michigan, Northern Illinois, Eastern Iowa and parts of Minnesota. We provide service for between 1,200 and 1,400 neurocritically ill patients per year, and the patient load is steadily growing. A single state-of-the-art neurocritical care unit plumbed for multimodality monitoring capability and eICU cameras allows for observation of patients on-site and off. The program is now in its 10th year and is upgrading from its current 16 bed footprint to a new state-of-the-art unit with 24-bed capability and an adjacent 256 slice CT scanner. This new neurocritical care unit will allow the vast majority of neurocritical care patients to be housed in a single space where the entire team of physicians, nurses, pharmacists and therapists can be present to care for neurologically debilitated patients in a more consistent, multidisciplinary manner.
The neurocritical care program is led by Joshua Medow, MD, MS, FAANS, FACS, FNCS, FAHA, FCCM, a tenured associate professor of neurosurgery, pathology and biomedical engineering, board certified in neurosurgery and neurocritical care by ABNS, UCNS, CAST and by ABPA for clinical informatics. Key neurocritical care faculty include Erick Tarula, MD, MS, a Harvard trained neurologist who holds UCNS and CAST credentials and an emergency medicine faculty Marin Darsie, MD, who has UCNS credentials. UW Hospital has JCAHO Stroke Certification. There are six vascular neurologists, three endovascular faculty as well as four open vascular faculty who round out the stroke service. The UW epileptologists provide 24/7 video EEG monitoring of all ICU beds in the hospital, which is important given the significant number of neurocritical care patients that overflow to other ICUs within the hospital footprint. UW Health provides telestroke stroke services for many of our referring hospitals and telemedicine options both within our neurocritical care unit and throughout many of our referral network facilities.
The neurocritical care program is involved in basic, translational and clinical research. There is a platform for the education of students of many disciplines and levels of training. Rounds typically includes medical students, pharmacy students, and biomedical engineering students along with residents and fellows. These teaching rounds occur in addition to team multidisciplinary team rounds, which include nurses, physician staff, pharmacists and therapists. This approach drastically improved the quality and quantity of teaching and also significantly improved neurocritical care outcomes. Results of our success were presented at the American Association of Neurological Surgeons as a platform presentation. Our team has subsequently published 11 papers in peer-reviewed journals with students and residents that have rotated through the neurocritical care program, and we’ve had 30 national presentations on 25 quality improvement projects that are running in the neurocritical care unit at any given time.
The work from the neurocritical care engineering lab has laid the foundation for both private and federal funding, which helps support research in the ICU and in biomedical engineering. UW Health is also a StrokeNet hospital with $1.8 million in active funding from the NIH.
The University of Wisconsin School of Medicine and Public Health and the Wisconsin Institute for Medical Research are attached to the hospital and the schools of nursing and pharmacy. The direct connection makes for easy access to clinical and basic/translational research resources, improving research collaborations. The ICTR grant allows our fellows the ability to leverage their neurocritical care training toward either a capstone certificate or a master’s of science in clinical investigation, population science or public health. The adjacent UW campus provides for further degree options. Skills training occurs mostly at the bedside, but training opportunities also occur in the robust simulation center where procedural training and courses are offered. Neurocritical care fellows are expected to complete BLS, ACLS, ATLS and ENLS courses prior to their graduation from the program.
Neurocritical care fellows at the University of Wisconsin are fortunate to have a complete educational experience. Faculty mentoring ensures the cultivation of creative and innovative talents, critical thinking skills, and communication abilities. Vast opportunities for bedside clinical training, training in the classroom and in the simulation center along with research and advanced degree training afford neurocritical care fellows a well-rounded skillset that will prepare them for success in caring for neurocritically ill patients.
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