Trinity Medical Center Opens Neurosurgical ICU

Trinity Medical Center now boasts an ICU that is dedicated to neurosurgical patients. It opened this fall and fulfilled a dream neurosurgeon Zen Hyrnkiw, MD, has had for over 20 years. “I saw a need for it because neurosurgery or head-injured patients or stroke-injured patients are very different from general surgical patients in terms of their needs,” Hyrnkiw said. “The hospital previously had a surgical intensive care unit where you have people with bowel surgery or chest surgery next to a neuro patient. The general surgery patients need very physiological evaluations and numbers, whereas a neurosurgery patient’s evaluations would be really more mental status and personality status, and it’s kind of hard to shift gears.” He continued, “A few years ago, multiple places like the Cleveland Clinic and Mayo Clinic started having their own neurosurgical intensive care units, and they were able to publish papers saying that the results of patients with neurospecialty problems did better if they were in specialized units. It makes sense.” Hyrnkiw says a Neuro ICU was a natural fit for Trinity, since they have historically offered full neurosurgery coverage 24 hours a day, seven days a week. In contrast, he explained, many hospitals have at most two neurosurgeons, so they are not able to keep one on call at all times. “The whole state is really lacking in neurosurgery coverage and historically I was very open to accepting trauma from all over the state, as was UAB,” he said. “But UAB has a problem with bed shortages, so they go on divert a lot. I developed a reputation, and a lot of my patients come from all over the state, so we started having more and more volume. We decided to go into the neurosurgical intensive care unit business, and the administration agreed to it.” While Trinity at one time had three neurosurgeons, Hyrnkiw is the only full-time neurosurgeon there now. He is still committed to maintaining full coverage for neurosurgical patients, however. When he isn’t at the hospital, patients are admitted directly to the unit under the care of a neurologist. “All the X-rays are on the PACS machine so I can see them in the office or my laptop at home. There are four neurologists full time who are accepting all the patients. As a surgeon, it has made my load a lot easier.” The Neuro ICU is equipped for video monitoring of the patients. “If we are worried about seizures, we are set up to watch the patient continuously during their sleep. All the beds are hooked up for intracranial pressure monitors, so we can do physiological monitoring of the brain from a central station. It’s a closed unit for brain and stroke and spinal cord injuries with a dedicated team and dedicated, trained nurses,” he said. UAB has a Neurosurgical ICU, but Hyrnkiw is unaware of any others in the state. While it is relatively new for Trinity, the unit is often full already, reflecting the need for the specialized care. He hopes for an even bigger unit when Trinity moves to its new building. Hyrnkiw said that they are expanding the teaching program because the skills for caring for neuro patients are so specialized. “We have basically two kinds of patients,” he explained. “A lot of patients are quick in and out. The head traumas that come in from all over the state who have a small bleed need to be observed and tested for a few hours. Their stay is usually overnight. Then we have another set of patients with a serious aneurysm bleed or a serious stroke who develop long-term complications. Those are the ones who stay in for a couple of weeks.” They try to keep beds available for the acute patients, as those are the ones needing the most care. The long-term patients are more stable and more easily cared for in other units if the Neuro ICU is full. Hyrnkiw says if other hospitals are interested in setting up their own Neuro ICU, it is worth looking into. “If you are actually doing brain neurosurgery or spinal cord work, and not just disk disease, I think the patients will get a better outcome and better service if they have a specialty unit taking care of their post-operative needs. I wholeheartedly encourage any place where they do active neurosurgery to develop a unit, and this would be a good model.” In the meantime? Hyrnkiw wants the local physicians to know that Trinity’s Neuro ICU is open for business. “If a physician in the region has a patient with a stroke or needs a close neurological evaluation, it should be really easy for them to be switched to this unit where their patients can get access to good care. We mean to be friendly to referring physicians, and it should be a seamless transition with minimal phone calls. We’d be happy to have their patients come.” December 2007