May 1, 2014

Number of neurointensivists grows nationally and at VUMC

Vanderbilt anesthesiologists who recently received board certification as neurointensivists include (from left) Nahel Saied, M.D., Roy Neeley, M.D., and Christopher Hughes, M.D. Not pictured are Nathan Ashby, M.D., John Barwise, M.D., Stuart McGrane, M.D., Tracy McGrane, M.D., and Sheena Weaver, M.D. (Photo by Steve Green)

After eight Department of Anesthesiology faculty members recently passed neurocritical care board exams offered by the United Council for Neurologic Subspecialties, Vanderbilt University Medical Center (VUMC) now boasts one of the largest contingents of practicing neurointensivists in the United States.

A neurointensivist is a physician who cares for patients in the Neurological ICU. The neurointensivist works closely with neurosurgeons, neuroradiologists, neurologists, emergency medicine physicians and palliative care physicians, as well as with acute care nurse practitioners, bedside nurses, pharmacists, respiratory therapists, rehabilitation therapists and other providers in a multi-disciplinary collaboration. Several studies have shown that specialized care in a neurological/neurosurgical ICU led by a neurointensivist is associated with improved outcomes, lower mortality rates, shorter length of stay and lower cost of care compared with a general ICU setting.

“Neurointensivists offer a unique perspective on the care of this patient population because we have expertise not only in critical care medicine, but also in recognizing and treating neurologic emergencies,” said Avinash Kumar, M.D., associate professor of Anesthesiology Critical Care Medicine and medical director of the Neurological ICU, who received his neurointensivist certification in 2008. “Most other ICU physicians who work in other units don’t have an opportunity to see extensive neurospecific pathology on a regular basis, except for perhaps neurotrauma.”

Vanderbilt is especially suited for this approach because the ICUs already operate on a multidisciplinary team model, said Kumar. And, of most recent note, the nursing staff of the Neurological ICU at Vanderbilt University Hospital was awarded the Beacon Award for Critical Care Excellence, one of the highest markers of nursing care.

“We have a great working relationship with Neurology and Neurosurgery, and the level of nursing care here is exceptional,” said Kumar. “We all work very well together, and everyone has the common purpose of providing the best possible care. It really makes a difference in patient outcomes.”

Neurocritical care is a relatively new medical specialty that developed in the late 1970s, and specialists in this field are increasing in number as neurointensive care units become more common across the nation. Neurointensivists are certified by UCNS, and, while previously a physicians’ career path could qualify them to sit for the board exam, now a UCNS-accredited neurocritical care fellowship is a prerequisite. It is expected that such a fellowship will be up and running at Vanderbilt within a year’s time, the result of a partnership among the departments of Anesthesiology, Neurosurgery and Neurology. Plans are to have two fellows every two years, with one fellow with a background in anesthesiology training and one with a background in neurological training.

“The development of a multidisciplinary fellowship in neurocritical care will significantly strengthen patient care and clinical neurosciences at Vanderbilt,” said David Charles, M.D., vice-chairman of Neurology and Chief Medical Officer, Neuroscience Institute.

“You have to have a minimum of four people who are neurocritical care-certified in order to have a core faculty for the fellowship, and we have twice that number now,” said Kumar, who is leading efforts to establish the fellowship. “Working in partnership with Neurology, our fellows will have access to specialized training like EEG, transcranial Doppler ultrasound and intraoperative neuro-monitoring. Close alignment with the current critical care fellowship structure will allow excellent opportunity for echocardiography and ultrasound training as well. We think it will be a very attractive fellowship.”

“Dr. Kumar is to be commended for outstanding leadership of our Neurocritical Care Unit and in setting the stage for VUMC to offer an accredited fellowship in neurocritical care,” said Robert Macdonald, M.D., Ph.D., chair of Neurology.

Anesthesiologists from the Division of Anesthesiology Critical Care Medicine receiving UCNS-accredited neurocritical care certification include Nathan Ashby, M.D.; John Barwise, M.D., Christopher Hughes, M.D., Stuart McGrane, M.D., Tracy McGrane, M.D., Roy Neeley, M.D., Nahel Saied, M.D.; and Sheena Weaver, M.D.