Neurology Patients Requiring Care in the Neuro-ICU
The neuro-ICU will be a closed unit with the neuro-intensivist on-call assuming primary
responsibility for the neurology patients cared for in the ICU. The inpatient neurology team will
function as a consulting service. As these patients will be discharged from the ICU to the
inpatient neurology service when they are floor status, the inpatient neurology team should see
the patient regularly (typically daily,) to ensure a smooth transition of care.
For neurology patients in the UMHS ED or inpatients requiring a neuro-ICU bed, including floor
patients who decline:
 These patients should be seen by the appropriate neurology resident and then staffed the
appropriate neurology attending. If the patient in the ED is obviously going to the ICU,
please staff with the neuro-ICU attending. The neuro-ICU staff need to hear about all of
the patients going to the NICU, even if the Neurology attending has staffed the patient.
The neuro-ICU attending should also be informed and given the option to staff the patient
instead of the neurology attending, as appropriate.
o The neurology resident is responsible for ensuring there is a neuro-ICU bed (by
talking with the neurosurgery resident on-call,) writing the H&P and entering
admission orders.
For inpatients at an outside hospital who require transfer to the neurology service and ICU level
of care:
 These patients should be accepted by the neuro-intensivist, NOT general neurology
attending, as the intensivist will be responsible for the patient’s care.
o If the neurology attending receives a transfer call for a patient who requires ICU
level care, he or she should direct the call to the intensivist.
o Please refer MLine Calls regarding critical care patients to the NICU attending.
o For patients who are in ICUs at outside hospitals to be transferred to Neurology,
inform the NICU attending as the patients will need to come to the NICU.
 The neurology resident on-call for transfers will be responsible for examining the patient,
writing the H&P, entering admission orders and staffing with the ICU attending.
For neurology patients in the ICU:
 The ICU team will write orders, call consultants, and write the daily progress note.
 The inpatient neurology team (NOT consult service) will provide consultative expertise
and manage the patient when he or she leaves the ICU or becomes floor status.
o The inpatient neurology team will provide written sign-out regarding the ICUs
patients they are following to dayfloat and nightfloat.
o The decision for a patient to become floor status will be made jointly with ICU
team and general care team.
 For patients discharged directly from the ICU, the inpatient neurology team will assist the
ICU team in arranging outpatient follow-up and ensuring appropriate documentation is in
the discharge summary for Joint Commission stroke center requirements and CMS core
measures.
 The neurology on-call resident will assist in managing neurology patients in the ICU, if
needed, in the evenings, overnight, and on the weekends. This will be in case of
emergency only. Routine issues will be handled by the ICU attending or fellow.
Updated: May 14, 2013