1. Neurocritical care (NCC) service oversight by physician, nursing, and hospital executive leadership
|
R
|
R
|
R
|
2. Delineation of physician and non-physician privileges
|
R
|
R
|
R
|
3. Distinct administrative unit
|
R
|
R
|
O
|
4. Leadership meet regularly to evaluate service needs
|
R
|
R
|
R
|
5. NCC Committee
|
R
|
R
|
O
|
6. Standing committee, interdisciplinary representation
|
R
|
R
|
O
|
Policies / Guidelines
|
|
|
|
1. Admit/Discharge
|
R
|
R
|
R
|
2. Determination of death by neurologic criteria
|
R
|
R
|
R
|
3. Disease specific protocols
|
R
|
R
|
R
|
4. Equipment and procedures related to NCC
|
R
|
R
|
O
|
5. Equipment maintenance
|
R
|
R
|
R
|
6. Essential equipment list
|
R
|
R
|
R
|
7. Nosocomial infection
|
R
|
R
|
R
|
8. Patient isolation
|
R
|
R
|
R
|
9. Patient monitoring
|
R
|
R
|
R
|
10. Periodic review of morbidity / mortality
|
R
|
R
|
R
|
11. Quality
|
R
|
R
|
R
|
12. Safety
|
R
|
R
|
R
|
13. System record keeping
|
R
|
R
|
R
|
14. Traffic control
|
R
|
R
|
R
|
15. Transfer
|
R
|
R
|
R
|
16. Visitation and family/surrogate – integrated care
|
R
|
R
|
R
|
Medical Director
|
|
|
|
1. Appointment by appropriate hospital authority
|
R
|
R
|
R
|
2. Acknowledge in writing
|
R
|
R
|
R
|
3. Name qualified physician to fulfil duties when unavailable, communicated to interdisciplinary team
|
R
|
R
|
R
|
4. Written documentation of responsibilities
|
R
|
R
|
R
|
Medical Director Qualifications
|
|
|
|
1. Neurocritical Care Subspeciality (Board) certified or eligible
|
R
|
NC
|
O
|
2. Assure policy implementation
|
R
|
R
|
R
|
3. Coordinate research
|
R
|
R
|
O
|
4. Ensure staff education
|
R
|
R
|
R
|
5. Maintain database or vital statistics
|
R
|
R
|
R
|
6. Participate in budget preparation
|
R
|
R
|
R
|
7. Participate in development, review and implementation of policies
|
R
|
R
|
R
|
8. Quality oversight of any NCC patient
|
R
|
R
|
R
|
9. Supervise quality improvement (QI) and quality assurance (QA) activities
|
R
|
R
|
R
|
10. Supervise resuscitation techniques
|
R
|
R
|
R
|
Physician staff or licensed Independent Practitioners (LIP)
|
|
|
|
Certified Neurointensivists or LIP or postgraduate year 2 above with NCC expertise and neurointensivist support
|
|
|
|
1. Available –n-house 24 h a day
|
R
|
NC
|
O
|
2. Available at bedside within 5 min 24 h a day
|
R
|
R
|
O
|
3. Available by telemedicine or telephone
|
R
|
R
|
R
|
4. All physicians should have subspeciality certification in NCC
|
R
|
O
|
O
|
5. Physicians should have subspeciality training in NCC
|
R
|
O
|
O
|
6. All medical staff undergo ongoing professional practice evaluation (OPPE) case review in NCC (or equivalent)
|
R
|
R
|
O
|
7. Additional privileges in NCC determined by organization
|
R
|
R
|
O
|
8. Neurointensivist on-site 24/7. May be delegated to another in-house provider (Trainee, advanced practice provider)
|
R
|
R
|
O
|
9. When off-site, neurointensivist must return calls within 5 min, at bedside within 5 min
|
R
|
R
|
O
|
Available in less than 30 minutes
|
|
|
|
1. Neurointerventionalist
|
R
|
NC
|
O
|
2. Neurosurgeon
|
R
|
R
|
O
|
3. Radiologist
|
R
|
R
|
O
|
Available in less than an hour
|
|
|
|
1. Neurointerventionalist
|
R
|
R
|
O
|
2. Neurosurgeon
|
R
|
R
|
O
|
Available for consultation
|
|
|
|
1. Anesthesiologist
|
R
|
R
|
R
|
2. Cardiologist
|
R
|
R
|
O
|
3. Cardiothoracic and vascular surgeon
|
R
|
R
|
O
|
4. Endocrinologist
|
R
|
O
|
O
|
5. Epileptologist
|
R
|
O
|
O
|
6. Ethics
|
R
|
O
|
O
|
7. Gastroenterologist
|
R
|
O
|
O
|
8. General surgeon
|
R
|
R
|
R
|
9. Hematologist/oncologist
|
R
|
O
|
O
|
10. Infectious disease
|
R
|
O
|
O
|
11. Nephrologist
|
R
|
R
|
O
|
12. Palliative care/supportive care medicine
|
R
|
O
|
O
|
13. Pathologist
|
R
|
O
|
O
|
14. Psychiatrist / psychologist
|
R
|
NC
|
O
|
15. Pulmonologist
|
R
|
R
|
O
|
16. Radiologist
|
R
|
R
|
O
|
Nursing staff
|
|
|
|
1. Director/Manager with NCC experience
|
R
|
R
|
N/A
|
2. Nurse to patient ratio 2:1, criteria for 1:1
|
R
|
R
|
N/A
|
3. % Nurses with speciality certification
|
R
|
O
|
O
|
4. All nurses offered initial orientation, ongoing education, annual performance evaluation, ongoing competency assessment
|
R
|
R
|
R
|
5. BLS, ACLS for all nurses
|
R
|
R
|
R
|
6. ENLS certification or equivalent
|
R
|
R
|
O
|
7. Knowledge and education should reflect general critical care and neurocritical care concepts
|
R
|
R
|
R
|
8. Manager has master’s degree or higher or subspeciality certification
|
R
|
O
|
O
|
9. Neurocritical care competencies (including ED staff)
|
R
|
R
|
O
|
10. Nurse-sensitive quality indicators should be monitored
|
R
|
R
|
R
|
11. Nursing policies and procedure
|
R
|
R
|
R
|
12. Orientation to ICU, NCC
|
R
|
R
|
N/A
|
Advanced Practice Provider (APP)
|
|
|
|
1. Additional training in NCC completed and documented
|
R
|
O
|
O
|
2. Involved in rounding with NCC team
|
R
|
O
|
O
|
3. NCC Quality/education focused APP
|
R
|
O
|
O
|
Nursing skills
|
|
|
|
1. Management of external ventricular drains and lumbar drains
|
R
|
R
|
R
|
2. Address psychological needs of family
|
R
|
R
|
R
|
3. Administer drugs
|
R
|
R
|
R
|
4. Administer fluids
|
R
|
R
|
R
|
5. Management of available advanced neurological monitoring
|
R
|
R
|
O
|
6. Management, troubleshooting patient monitors
|
R
|
R
|
R
|
7. Recognize, interpret, record physiologic parameters
|
R
|
R
|
R
|
8. Respiratory care techniques (including mechanical ventilation)
|
R
|
R
|
R
|
9. Resuscitation, including ENLS certification or equivalent
|
R
|
R
|
NC
|
10. Wound care of cranial and spinal postoperative patients
|
R
|
R
|
R
|
Pharmacists
|
|
|
|
1. Pharmacist dedicated to NCC unit/team
|
R
|
O
|
O
|
2. Pharmacist with expertise in NCC
|
R
|
O
|
O
|
3. Pharmacist with residency training or equivalent in high-acuity area
|
R
|
O
|
O
|
4. Doctorate degree in pharmacy
|
O
|
O
|
O
|
5. Board certified critical care pharmacists (BCCCP) (preferred) or board certified pharmacotherapy specialist (BCPS) certification
|
R
|
O
|
O
|
6. Attend in-hospital neurocritical care emergencies
|
R
|
O
|
O
|
7. Engaged in clinical rounding with team, daily medication review
|
R
|
R
|
O
|
8. Involved in hospital committees, quality improvement
|
R
|
NC
|
O
|
9. Provide neuropharmacology training to other caregivers
|
R
|
O
|
O
|
Respiratory therapy
|
|
|
|
1. Supervisor responsible for training RT staff, maintenance of equipment, and quality control/review
|
R
|
R
|
O
|
2. RT department supervise training
|
R
|
O
|
O
|
3. Therapist in-house 24 h day
|
R
|
O
|
O
|
4. Therapist in-house with NCC expertise
|
R
|
O
|
O
|
Other team members
|
|
|
|
1. Biomedical technician
|
R
|
R
|
O
|
2. Occupational therapist (OT) with expertise in neurologic patient population
|
R
|
O
|
O
|
3. Physical therapist (PT) with expertise in neurologic patient population
|
R
|
R
|
O
|
4. PT/OT/ Speech therapist (ST) available 7 days a week
|
R
|
O
|
O
|
5. PT/OT/ST establish response time for new consultation
|
R
|
R
|
O
|
6. PT/OT/ST with special expertise in NCC
|
R
|
O
|
O
|
7. Radiology technician
|
R
|
R
|
O
|
8. Registered dietician or certified nutrition support clinician
|
R
|
R
|
O
|
9. Social worker and case manager with expertise in care of neurologic patient population
|
R
|
O
|
O
|
10. Spiritual care support
|
R
|
O
|
O
|
11. ST with expertise in neurologic patient population
|
R
|
O
|
O
|
12. Unit clerk
|
R
|
R
|
O
|
Hospital facilities and services
|
|
|
|
Emergency department
|
|
|
|
1. Staffed by physician 24 h day
|
R
|
R
|
R
|
2. Helipad
|
R
|
O
|
O
|
3. Resuscitation area – capable of managing 2 patients at once
|
R
|
R
|
O
|
4. Resuscitation area – capable of managing at least 1 patient
|
R
|
R
|
R
|
5. Comprehensive blood bank, all components
|
R
|
R
|
O
|
6. Type and screen, cross match within 1 h
|
R
|
R
|
R
|
Radiology/diagnostic (perform/interpret)
|
|
|
|
1. Angiography capabilities 24 h day
|
R
|
NC
|
O
|
2. Continuous EEG
|
R
|
O
|
O
|
3. CT scan available 24 h day
|
R
|
R
|
R
|
4. ECG
|
R
|
R
|
R
|
5. Fluoroscopy
|
R
|
R
|
O
|
6. Diagnostic and therapeutic endoscopy
|
R
|
O
|
O
|
7. MRI available 24 h day
|
R
|
R
|
O
|
8. Nuclear scanning
|
R
|
O
|
O
|
9. Portable radiograph
|
R
|
R
|
R
|
10. Radiation therapy
|
R
|
O
|
O
|
11. STAT EEG
|
R
|
O
|
O
|
12. Transcranial doppler
|
R
|
NC
|
O
|
13. Transesophageal echocardiogram
|
R
|
O
|
O
|
14. Transthoracic echocardiogram
|
R
|
R
|
O
|
15. Ultrasonography
|
R
|
R
|
R
|
Laboratory
|
|
|
|
1. ABG available within 15 minutes
|
R
|
R
|
R
|
2. Available labs within 1 h
|
|
|
|
a. CBC, platelets, differential count
|
R
|
R
|
R
|
b. Chemistry
|
R
|
R
|
R
|
c. Clotting studies
|
R
|
R
|
R
|
d. CSF cell count
|
R
|
R
|
O
|
e. Platelet function test
|
R
|
R
|
O
|
f. UA
|
R
|
R
|
R
|
3. Labs within 3 h
|
|
|
|
a. Ammonia
|
R
|
R
|
O
|
b. Magnesium, phosphorus
|
R
|
R
|
O
|
c. Osmolality
|
R
|
R
|
O
|
d. Tox screen
|
R
|
R
|
O
|
4. Labs available 24 h day
|
|
|
|
a. Culture and gram stain
|
R
|
R
|
O
|
5. Operating room
|
|
|
|
a. Available within 30 min, 24 h day
|
R
|
R
|
O
|
b. Available within 60 min, 24 h day
|
R
|
R
|
NC
|
c. Second OR available within 45 min, 24 h day
|
R
|
NC
|
O
|
d. Renal replacement therapy including intermittent hemodialysis and continuous renal replacement therapy
|
R
|
R
|
O
|
Pharmacy
|
|
|
|
1. 24 h day for all requests
|
R
|
R
|
R
|
2. Bedside urgent drug list
|
R
|
R
|
R
|
Neurorehabilitation internal or affiliated
|
|
|
|
Physical facility (unit)
|
|
|
|
1. Dedicated beds
|
R
|
R
|
O
|
Separate rooms
|
|
|
|
1. Conference room
|
R
|
NC
|
O
|
2. Family counselling room
|
R
|
R
|
O
|
3. Leadership office space
|
R
|
R
|
O
|
4. On call room
|
R
|
R
|
R
|
5. Patients’ personal effects storage (may be internal)
|
R
|
R
|
O
|
6. Staff locker room
|
R
|
R
|
R
|
7. Staff lounge
|
R
|
R
|
O
|
8. Unit rooms, unit makeup
|
R
|
O
|
O
|
9. Clean utility room
|
R
|
R
|
R
|
10. Clocks
|
R
|
R
|
R
|
11. Computerized laboratory reporting or efficient equivalent
|
R
|
R
|
O
|
12. Counter, cabinet space
|
R
|
R
|
R
|
13. Easy, rapid access to head of bed
|
R
|
R
|
R
|
14. Emergency equipment storage
|
R
|
R
|
R
|
15. Handwashing facility
|
R
|
R
|
R
|
16. Isolation capacity
|
R
|
R
|
NC
|
17. Medication station with drug refrigerator and locked narcotics cabinet
|
R
|
R
|
R
|
18. Nourishment station
|
R
|
R
|
O
|
19. Patient privacy provision
|
R
|
R
|
R
|
20. Patient toilet
|
R
|
R
|
R
|
21. Soiled utility room
|
R
|
R
|
R
|
22. Staff toilet
|
R
|
R
|
R
|
23. Television, radios
|
R
|
R
|
O
|
24. Two or more compressed air outlets/bed
|
R
|
R
|
O
|
25. Two oxygen outlets/bed
|
R
|
R
|
R
|
26. Two vacuum outlets/bed
|
R
|
R
|
O
|
27. Building code or federal code conforming
|
|
|
|
a. Heating, ventilation, air conditioning
|
R
|
R
|
R
|
b. Fire safety
|
R
|
R
|
R
|
c. Electrical safety
|
R
|
R
|
R
|
d. Plumbing
|
R
|
R
|
R
|
e. Illumination
|
R
|
R
|
R
|
Portable equipment
|
|
|
|
1. Automated bed scale
|
R
|
O
|
O
|
2. Automated blood pressure and monitoring technology
|
R
|
R
|
R
|
3. Blood warmer
|
R
|
R
|
O
|
4. Defibrillator/Cardioverter
|
R
|
R
|
R
|
5. Difficult airway management equipment
|
R
|
R
|
R
|
6. Doppler ultrasonography
|
R
|
R
|
O
|
7. ECG machine
|
R
|
R
|
R
|
8. EEG machine
|
R
|
R
|
O
|
9. Emergency cart
|
R
|
R
|
R
|
10. Emergency surgical airway equipment
|
R
|
R
|
R
|
11. Endotracheal intubation equipment
|
R
|
R
|
R
|
12. Equipment from intracranial access, external ventricular drain placement and intraparenchymal pressure monitoring
|
R
|
R
|
O
|
13. Heating/cooling blankets
|
R
|
R
|
R
|
14. Infusion pumps
|
R
|
R
|
R
|
15. Intraosseous access and/or emergency cut down trays
|
R
|
R
|
R
|
16. Isolation cart
|
R
|
R
|
R
|
17. Oral/nasal airways
|
R
|
R
|
R
|
18. Oto-ophthalmoscope
|
R
|
R
|
R
|
19. Point-of-care ultrasonography
|
R
|
R
|
R
|
20. Procedure lamp (if adequate in room lighting not available)
|
R
|
R
|
R
|
21. Suction machine (in addition to bedside)
|
R
|
R
|
R
|
22. Thermometers
|
R
|
R
|
R
|
23. Transport monitors
|
R
|
R
|
R
|
24. Vascular access equipment
|
R
|
R
|
R
|
25. Bronchoscope
|
R
|
NC
|
O
|
26. Emergency drugs
|
R
|
R
|
R
|
Respiratory support equipment
|
|
|
|
1. Air compressor
|
R
|
R
|
R
|
2. Air-oxygen blenders
|
R
|
R
|
NC
|
3. Bag-valve-mask resuscitation devices
|
R
|
R
|
R
|
4. Chest physiotherapy and suctioning
|
R
|
R
|
R
|
5. Continuous oxygen analyzers with alarms
|
R
|
R
|
R
|
6. Mechanical ventilator
|
R
|
R
|
R
|
7. MRI compatible ventilator
|
R
|
O
|
O
|
8. Non-invasive mechanical ventilator
|
R
|
R
|
R
|
9. Oxygen tanks
|
R
|
R
|
R
|
10. Respired gas humidifiers
|
R
|
R
|
R
|
11. Spirometers
|
R
|
R
|
R
|
Continuous monitoring equipment
|
|
|
|
1. ECG, heart rate
|
R
|
R
|
R
|
2. Advanced hemodynamics: invasive or non-invasive including cardiac output
|
R
|
R
|
O
|
3. Arrhythmia detection/alarm
|
R
|
R
|
R
|
4. Brain tissue oxygen monitoring
|
R
|
O
|
O
|
5. Cerebral blood flow
|
R
|
O
|
O
|
6. Esophageal pressure
|
O
|
O
|
O
|
7. ETCO2 monitor
|
R
|
R
|
NC
|
8. Intracranial pressure
|
R
|
R
|
O
|
9. Microdialysis
|
O
|
O
|
O
|
10. O2 monitors
|
R
|
R
|
R
|
11. Respirators
|
R
|
R
|
R
|
12. Systemic arterial pressure
|
R
|
R
|
R
|
13. Temperature
|
R
|
R
|
R
|
Research and training
|
|
|
|
Physician training
|
|
|
|
1. Units/beds in facility with accredited neurology residency programme
|
R
|
O
|
N/A
|
2. Unit provides clinical rotation for neurocritical care
|
R
|
O
|
N/A
|
3. Fellowship programme in NCC
|
R
|
O
|
N/A
|
4. BLS/ACLS certification or equivalent
|
R
|
R
|
R
|
5. Programme participates in regional / national meetings related to NCC
|
R
|
R
|
O
|
6. ENLS certification or equivalent
|
R
|
R
|
O
|
Unit personnel training
|
|
|
|
1. BLS training for nurses, respiratory therapists
|
R
|
R
|
R
|
2. ENLS certification or equivalent for nurses
|
R
|
R
|
O
|
3. Ongoing continuing education related to NCC
|
R
|
R
|
O
|
Regional education
|
|
|
|
1. Provide regional / local NCC education
|
R
|
R
|
O
|
2. Provide NCC educational outreach to public
|
R
|
O
|
O
|
Prehospital care and interfacility transport
|
|
|
|
1. Educational programmes in stabilization and transportation for EMS personnel
|
R
|
R
|
R
|
2. Integration / communication with EMS
|
R
|
R
|
R
|
3. Periodic review of EMS/transport protocols for NCC diseases
|
R
|
R
|
R
|
4. Transfer arrangement with level 1 NCC unit
|
N/A
|
R
|
R
|
5. Transfer arrangements with referral hospitals
|
R
|
R
|
R
|
Quality assessment
|
|
|
|
1. Discharge planning
|
R
|
R
|
R
|
2. Monitor quality metrics
|
R
|
R
|
R
|
3. Morbidity / mortality review
|
R
|
R
|
R
|
4. Safety review
|
R
|
R
|
R
|
5. Utilization review
|
R
|
R
|
R
|