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Neurocritical Care Fellowship: Facilities

Rotations on the Johns Hopkins Hospital NCCU

The Johns Hopkins Hospital Neurocritical Care Unit (NCCU) is an intensive care unit devoted to the care of patients with critical care needs associated with neurological disease such as stroke, epilepsy, trauma, subarachnoid hemorrhage or primary neurological cancer.

 The size of this 24-bed unit, acuity of patients’ conditions and rapid turn‐over offer high intensity, clinical experience, and faculty takes special care to acclimate fellows with a dedicated two-week clinical orientation as the first rotation block.

Three fellows are assigned to each rotation. Two NCCU teams, each led by a member of the neurosciences critical care division, round on patients and perform necessary critical care procedures. One team consists of an attending physician, a fellow and several residents from anesthesia and critical care medicine, neurology, and neurosurgery.

 The other team consists of an attending physician, a fellow and 2‐3 nurse practitioners. Fellows are responsible for leading rounds and providing support and guidance for residents on the team, with medical decisions and procedures directly supervised by the attending physician.

 A fellow and resident are assigned to the NCCU 24 hours a day. Fellows take call one in three nights, with clinical activities beginning at 6:30 a.m. with sign-out rounds, followed by morning rounds focused on teaching and clinical planning for the day. In the mid‐afternoon, teams reconvene for afternoon rounds and treatment planning for the night. Clinical responsibilities for the post‐call fellow end after sign-out rounds the next morning.

Rotations at the Bayview Medical Center NCCU

Rotations at this 14-bed unit provide the fellow with the experience of managing an NCCU more similar to those found in most academic centers in terms of patient turn‐over and acuity.

 This rotation also introduces effective practice of telemedicine, as fellows often provide guidance to residents from home using telephone, electronic medical records, and web conferencing.

 In contrast to the JHH NCCU, the BMC NCCU functions as an open unit, meaning that primary cross-cover and overnight patient care decisions are the responsibility of the primary neurology or neurosurgery service.

 The BMC NCCU is staffed by a member of the neurosciences critical care division who, in concert with the assigned Fellow, rounds on patients to set care plans and then performs critical care procedures as required. Medical decisions and procedures are supervised directly by the attending physician.

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