From Tulane University School of Medicine (A.S.C.), New Orleans, LA; Department of Neurology (S.I.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (M.A.K.), University of Pennsylvania, Philadelphia; Department of Public Health Sciences (C.J.J.), Loyola University, Chicago, IL; Departments of Neurology and Neurotherapeutics (S.A.F., C.E.H.) and Anesthesiology, Neurology, and Neurosurgery (D.L.M.), UT Southwestern, Dallas, TX; Department of Neurology (M.B.M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Neurology (D.P.L.), Lahey Clinic, Burlington, MA; Departments of Neurology and Neurosurgery (P.M.V.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Critical Care Medicine, Neurology & Neurosurgery (L.A.S.), University of Pittsburgh School of Medicine/UPMC, PA; and Department of Neurology (E.S.R.), Massachusetts General Hospital, Boston.
Neurology. 2018 Jun 12;90(24):1117-1122. doi: 10.1212/WNL.0000000000005682.
To define expectations for neurocritical care (NCC) core competencies vs competencies considered within the domain of other subspecialists.
An electronic survey was disseminated nationally to NCC nurses, physicians, fellows, and neurology residents through Accreditation Council for Graduate Medical Education neurology residency program directors, United Council for Neurologic Subspecialties neurocritical care fellowship program directors, and members of the Neurocritical Care Society.
A total of 268 neurocritical care providers and neurology residents from 30 institutions responded. Overall, >90% supported NCC graduates independently interpreting and managing systemic and cerebral hemodynamic data, or performing brain death determination, neurovascular ultrasound, vascular access, and airway management. Over 75% endorsed that NCC graduates should independently interpret EEG and perform bronchoscopies. Fewer but substantial respondents supported graduates being independent performing intracranial bolt (45.8%), ventriculostomy (39.0%), tracheostomy (39.8%), or gastrostomy (19.1%) procedures. Trainees differed from physicians and program directors, respectively, by advocating independence in EEG interpretation (92.8%, 61.8%, and 65.3%) and PEG placement (29.3%, 9.1%, and 8.5%).
Broad support exists across NCC role groups for wide-ranging NCC competencies including skills often performed by other neurology and non-neurology subspecialties. Variations highlight natural divergences in expectations among trainee, physician, and nurse role groups. These results establish expectations for core competencies within NCC and initiate dialogue across subspecialties about best practice standards for the spectrum of critically ill patients requiring neurologic care.
定义神经危重症护理（NCC）的核心能力预期，与其他亚专科领域内的能力进行区分。
通过美国毕业后医学教育认证委员会神经病学住院医师项目主任、联合神经病学专科委员会神经危重症护理研究员项目主任以及神经危重症护理学会成员，向全国的 NCC 护士、医生、研究员和神经科住院医师发放了一份电子调查问卷。
共有来自 30 家机构的 268 名神经危重症护理人员和神经科住院医师做出了回应。总体而言，超过 90%的受访者支持 NCC 毕业生独立解读和管理全身和脑血流动力学数据，或进行脑死亡判定、神经血管超声、血管通路和气道管理。超过 75%的受访者认为 NCC 毕业生应独立解读脑电图并进行支气管镜检查。但仍有相当一部分受访者支持毕业生独立进行颅内螺丝（45.8%）、脑室造口术（39.0%）、气管切开术（39.8%）或胃造口术（19.1%）。与医生和项目主任相比，住院医师分别主张独立进行脑电图解读（92.8%、61.8%和 65.3%）和 PEG 放置（29.3%、9.1%和 8.5%）。
NCC 各角色群体广泛支持广泛的 NCC 能力，包括许多由其他神经科和非神经科亚专科执行的技能。这些差异突出了受训者、医生和护士角色群体之间期望的自然差异。这些结果确定了 NCC 核心能力的预期，并在各亚专科之间发起了关于需要神经科护理的危重症患者最佳实践标准的对话。
