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Admission and Discharge Criteria for Neuroscience ICU (2.1.26)

Admission and Discharge Criteria for Neuroscience ICU (2.1.26) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.26


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission and Discharge Criteria for Neuroscience ICU
Policy Number: 2.1.26
Category: UW Health
Type: Inpatient
Effective Date: July 17, 2017

I. PURPOSE

To ensure the use of a uniform policy when patients are admitted to and discharged from the Neuroscience
Intensive Care Unit (ICU).

II. POLICY ELEMENTS

A. Scope of Services - Intensive Care Unit. This neuroscience ICU serves critically ill adult patients who have
undergone major neurological procedures and/or sustained a traumatic injury. These patients require
frequent, detailed neurologic and other assessments coupled with technologic monitoring to quantify
physiologic parameters for early recognition and treatment of potentially life threatening events. Examples of
patients best admitted to this unit are:
ξ Post-op craniotomy
ξ Subarachnoid Hemorrhage
ξ Transsphenoidal/Transnasal hypophysectomy
ξ Anterior thoracic fusions requiring opening the pleural cavity
ξ Acute spinal cord injury
ξ Evacuation of subdural, epidural, intracranial hemorrhage
ξ New shunts
ξ Proximal shunt revisions
ξ Cerebral embolizations
ξ Cerebral coilings
ξ Status epilepticus
ξ Stereotaxic brain biopsy if greater than usual monitoring is required
ξ Decompression/removal spinal cord tumors
ξ Carotid endarterectomy
ξ Traumatic brain injury
ξ Guillain Barre with impending respiratory compromise
ξ Hemorrhagic and Non-hemorrhagic strokes
ξ Other diagnoses needing ICU or medical/surgical stabilization
B. Patients with a terminal disease or who have decided to be "Do Not Resuscitate" may be admitted to the
ICU for specific monitoring or intervention. The potential benefits to be accrued should be carefully
considered and discussed with family and caregivers before admission.
C. Medical Director. The medical director will be a designee of the department of neurosurgery. Neurosurgery
will be designee for triage for all patients in the F84 Neuro ICU.
III. PROCEDURE
A. Admission Criteria - Intensive Care.
i. Frequent, detailed neurologic and other assessments to detect neurological and/or respiratory
decompensation.
ii. Invasive monitoring which may include hemodynamic monitoring, arterial lines, Swan Ganz
catheters, central lines to measure CVP, ICP monitoring and ventriculostomy.
iii. Infusion of vasoactive medications used to maintain hemodynamic stability or maximize neurologic
function.
iv. Assisted mechanical ventilation to manage increased intracranial pressure or respiratory failure
related to acute neuromuscular disease.
v. Dysrhythmia requiring continuous monitoring of EKG or continuous antiarrhythmic drug infusions. If
the complexity of an arrhythmia outweighs the neurologic diagnosis, serious consideration will be
given to transferring the patient to a unit with primary cardiac goals and/or an intensive care unit.
vi. Monitoring for seizures when the intra-ictal events put patient at significant risk (such as surgically
implanted electrodes).



UW HEALTH CLINICAL POLICY 2
Policy Title: Admission and Discharge Criteria for Neuroscience ICU
Policy Number: 2.1.26

vii. Intravenous loading of seizure medications when the drug side effects necessitate cardiac
monitoring and/or the patient is in status epilepticus requiring short term intubation and
management.
viii. Observation and monitoring of parameters requiring frequent or continuous nursing observations
and interventions.
ix. ICU admissions will have orders written by the primary service.
x. If the patient is on the neurology service, critical care services will be notified and will assist
neurology with invasive monitoring, ventilator management, or unstable medical diagnoses.
B. Transfer Criteria - Intensive Care.
i. Discontinuation of invasive monitoring.
ii. Discontinuation of drug management (as defined in the admission criteria).
iii. Mechanical ventilation discontinued.
iv. Resolution of dysfunction previously indicating the need for admission.
v. Considered medically stable.
vi. In the event of significant deterioration or medical instability the patient will be transferred to the
appropriate intensive care unit.
C. Discharge.
i. Patients may be directly discharged from the ICU. When direct discharge from the F84 ICU is
appropriate, it will be completed according to current UW Health clinical policy #2.1.25, Discharge
Planning Process.
IV. CONFLICT RESOLUTION

Conflicts which arise regarding the admission, transfer and/or discharge of patients and placement priorities
than cannot be adequately resolved by the parties involved should be promptly referred to the Clinical Nurse
Manager, Nursing Coordinator, the Medical and Administrative Directors of the Access Center, and the
Neuroscience Director for resolution.

V. COORDINATION

Author: Clinical Nurse Manager, F84; Chair, Department of Neurological Surgery
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: none
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: June 19, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J.Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

UWHC policy #8.23, Do Not Resuscitate/No CPR Order
UW Health clinical policy #2.1.25, Discharge Planning Process

VIII. REVIEW DETAILS

Version: Revision



UW HEALTH CLINICAL POLICY 3
Policy Title: Admission and Discharge Criteria for Neuroscience ICU
Policy Number: 2.1.26

Last Full Review: July 17, 2017
Next Revision Due: July 2020
Formerly Known as: Hospital Administrative policy #7.48