Communication, Leadership, and Decision-Making in the Neuro-ICU.
The Neuro-ICU is a multidisciplinary location that presents peculiar challenges and opportunities for patients with life-threatening neurological disease. Communication skills are essential in supporting caregivers and other embedded providers (e.g., neurosurgeons, advanced practice providers, nurses, pharmacists), through leadership. Limitations to prognostication complicate how decisions are made on behalf of non-communicative patients. Cognitive dysfunction and durable reductions in health-related quality of life are difficult to predict, and the diagnosis of brain death may be challenging and confounded by medications and comorbidities. The Neuro-ICU team, as well as utilization of additional consultants, can be structured to optimize care. Future research should explore how to further improve the composition, communication and interactions of the Neuro-ICU team to maximize outcomes, minimize caregiver burden, and promote collegiality.
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA. Stephen.Trevick@northwestern.edu.
Stephen
S
Trevick
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
Minjee
M
Kim
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
Andrew
A
Naidech
D002493:Central Nervous System Diseases; D003142:Communication; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D007857:Leadership; D011788:Quality of Life
Communication; Leadership; Multidisciplinary teams; Neuro-ICU; Patient decision aids; Shared decision-making
J Palliat Med. 2013 Jul;16(7):745-51
23697816
Neurocrit Care. 2009 Dec;11(3):345-52
19430929
Healthc (Amst). 2015 Jun;3(2):97-101
26179730
Crit Care Med. 2014 Apr;42(4):934-42
24335446
Am J Respir Crit Care Med. 2005 May 1;171(9):987-94
15665319
Crit Care Med. 2015 May;43(5):1121-9
25654178
Neurocrit Care. 2009;11(1):45-9
19199079
Neurocrit Care. 2012 Feb;16(1):63-71
21847702
Neurology. 2013 Jul 9;81(2):107-12
23739227
J Palliat Med. 2013 Mar;16(3):243-9
23368978
Neurol Clin. 2004 May;22(2):viii-ix, 457-71
15062523
J Cardiovasc Thorac Res. 2015;7(2):43-8
26191390
Crit Care Med. 2001 Feb;29(2 Suppl):N26-33
11228570
Ann Intern Med. 2010 Aug 17;153(4):213-21
20713789
Crit Care Med. 2015 Oct;43(10):2147-54
26181222
Crit Care Med. 2013 Oct;41(10):2318-27
23939349
Acta Neurol Scand. 2016 Nov;134(5):352-359
26748540
Neurology. 2010 Apr 6;74(14):1096-101
20368630
Arch Intern Med. 1998 Nov 23;158(21):2389-95
9827791
Death Stud. 2010 Sep;34(8):673-98
24482845
Crit Care Med. 2003 Apr;31(4):1263-70
12682502
Stroke. 2015 Sep;46(9):2714-9
26243219
Continuum (Minneap Minn). 2012 Jun;18(3):655-8
22810254
Intensive Care Med. 2016 Jun;42(6):995-1002
26951427
Postgrad Med J. 2015 Jun;91(1076):343-54
26045562
Arch Intern Med. 2005 Sep 26;165(17):1970-5
16186466
Curr Opin Crit Care. 2014 Apr;20(2):161-7
24514100
Neurocrit Care. 2010 Aug;13(1):118-22
20182921
Neurocrit Care. 2015 Aug;23(1):127-30
25561435
Arch Intern Med. 2006 Mar 13;166(5):493-7
16534034
Am J Med. 2015 Sep;128(9):994-1000
25863148
Neurocrit Care. 2004;1(1):107-17
16174905
JAMA. 2016 Apr 12;315(14):1480-90
27115264
JAMA Surg. 2013 Jan;148(1):29-35
23324837
Crit Care Med. 2015 Sep;43(9):1964-77
26154929
Surg Clin North Am. 2006 Dec;86(6):1351-7
17116452
Crit Care Med. 2014 Aug;42(8):1797-803
24674928
Crit Care Med. 2004 Jul;32(7):1484-8
15241092
N Engl J Med. 2012 Mar 1;366(9):780-1
22375967
J Transpl Coord. 1997 Mar;7(1):14-21
9188394
Am J Med Qual. 2017 Jul/Aug;32(4):376-383
27329489
Chest. 2010 Feb;137(2):280-7
19762549
J Neurosci Nurs. 2014 Apr;46(2):E3-7
24556662
Neurocrit Care. 2014 Apr;20(2):311-8
24233814
Intensive Care Med. 2005 Sep;31(9):1215-21
16041519
JAMA. 2014 Nov 26;312(20):2146-55
25358122
Postgrad Med J. 1961 Jan;37:26-30
13767218
J Med Assoc Thai. 2009 Dec;92(12):1627-34
20043565
Stroke. 2004 May;35(5):1130-4
15044768
Neurol Clin Pract. 2016 Feb;6(1):40-48
26918202
Radiographics. 2015 Oct;35(6):1655-67
26466177
J Palliat Med. 2014 Feb;17(2):219-35
24517300
Crit Care. 2010;14(5):R168
20843344
Crit Care Med. 2006 Jan;34(1):211-8
16374176
Crit Care. 2016 Apr 09;20:97
27059989
Cochrane Database Syst Rev. 2014 Jan 28;(1):CD001431
24470076
J Cancer Educ. 2017 Dec;32(4):914-923
27041700
Health Expect. 2012 Mar;15(1):23-31
21323824
Neurology. 2013 Jul 30;81(5):448-55
23897872
Chest. 2013 Jan;143(1):214-221
23276844
Jt Comm J Qual Patient Saf. 2015 Nov;41(11):492-3
26484680
Qual Health Res. 2016 Jun;26(7):895-906
26481945
Crit Care Med. 2011 Jan;39(1):158-62
21037471
BMC Med Educ. 2014;14 Suppl 1:S16
25560954
JAMA. 2002 Nov 6;288(17):2151-62
12413375
Crit Care Med. 2012 Aug;40(8):2464-9
22809913
Crit Care. 2013 Dec 09;17(6):1021
24321182
Neurocrit Care. 2015 Dec;23 Suppl 2:S1-4
26438452
Surgery. 1995 Aug;118(2):294-8; discussion 298-9
7638746
J Eval Clin Pract. 2015 Jun;21(3):496-502
25833064
Stud Health Technol Inform. 2016;225:452-6
27332241
Soc Sci Med. 1997 Mar;44(5):681-92
9032835
BMJ Qual Saf. 2016 Aug;25(8):615-25
27334866
Am J Respir Crit Care Med. 2008 Aug 1;178(3):269-75
18480429
J Palliat Med. 2011 Sep;14(9):1051-7
21910612
BMJ. 2016 May 03;353:i2139
27143499
Am J Respir Crit Care Med. 2005 Apr 15;171(8):844-9
15640361
Am J Respir Crit Care Med. 2013 Oct 1;188(7):800-6
23992449