NeuroProgressive Care Unit offers alternative to ICU

Nursing Progress Notes - Fall-Winter 2008

Not all postoperative neurosurgery patients need to go to the ICU. And in some cases, it’s best if they don’t.

M. D. Anderson now has a NeuroProgressive Care Unit that caters to the recovery of patients who undergo straightforward, uncomplicated brain surgeries. The new unit allows patients to go from surgery to a post anesthesia care unit and then to a private room where they are monitored by specially-trained nurses, bypassing the ICU altogether.

For years the neurosurgeons have wanted such a unit. It was their answer to the need for a postoperative environment that was conducive to quick recoveries for simpler procedures - not to mention, a way to reduce the ICU’s patient load.

“And finally the stars aligned,” says Franco DeMonte, M.D., professor and vice chairman of Neurosurgery. DeMonte says one of the biggest and brightest stars was the Division of Nursing and the role its leadership played in the development of the unit.

“It’s a well known fact that you can’t get most things done clinically unless you have nursing behind you,” DeMonte says. “When it comes to any patient effort, you need nursing’s support, and we definitely had it in this endeavor.”

Knowledge is power

Rose Moore, clinical resource nurse, P8

A long with the support of the division, the neurosurgeons also had Nicole Harrison, who at the time was serving as associate director of clinical nursing on the neurosurgery unit. She had significant experience in neurosurgical ICU care, and was in the right place at the right time to champion the program.

The unit opened in January 2008 and the results have been encouraging. Not only has the ICU been relieved, but NPCU patients are recovering quicker, with shorter hospital stays — up to a day and a half faster. “This is partly because they are in an area that allows them to become mobile sooner,” says Bob Massey, Ph.D., director of clinical nursing. “It’s the interdisciplinary practice between nursing and neurosurgery that has made the NPCU a success.” According to Massey, without the support of Raymond Sawaya, M.D., chairman of Neurosurgery, DeMonte, and the neurosurgeons who entrust them to send their patients to NPCU, the program would not be possible.

Massey added that not only the environment, but also the training and education of the NPCU nurses, is a huge benefit to the patients’ recovery. Once trained, these nurses have the knowledge and skills necessary to care for this patient population like no other nurses can.

And according to DeMonte, knowledge and skill can never be underestimated when it comes to these patients.

“In the case of other recoveries, nurses can rely more on the monitors to determine what is happening with the patient. But there is not a monitor for the brain,” he says. “So the nurses’ ability to recognize specific changes in the patient is critical. By the time changes in other vital signs begin to show on monitors, the patient is dying.”

In addition to specialized care, Harrison added that the cost of staying on a floor unit, such as the NPCU, is much less for patients compared to the cost of staying in the ICU. And for every bed that is not taken up by one of these patients, it opens up a bed for someone who truly needs the acute care that the ICU provides,” she adds.

The NPCU currently has four beds. The hope is that two additional beds will be added by next spring. Approximately 270 patients have been seen at a rate of about 30 per month, according to Jason Wall, associate director of clinical nursing on P8. “The unit has done so well that only one patient has had to return to the ICU, which was due to a medical related issue,” Wall says.

To further study the success of the unit, Wall is developing ways to measure, track and compare NPCU data as the unit grows in size and scope.

NeuroProgressive Care Unit clinical nurses Yolanda Straughter (left) and Mayla Garcia