The Trauma Section presents a spotlight on Dr. S. Alan Hoffer, associate professor of neurosurgery and neurology, director of the Traumatic Brain Injury Center and co-director of the Neurocritical Care Center at University Hospitals of Cleveland and Case Western Reserve University.
What is your practice model and how is your effort distributed between clinical practice, administrative duties, research, teaching, other?
I practice at an academic teaching hospital where 90% of my time is spent on clinical practice. I interact with residents, fellows and medical students on a daily basis. The other 10% is administrative and teaching.
Are you actively involved in the neurocritical care of patients?
A quarter of my time is spent as the attending neurointensivist in our neuroscience-ICU. Our medical center is a level 1 trauma center, a JHACO comprehensive stroke center and the hub of a 15-hospital system. Because of this, I treat patients with a wide array of neurological disorders. Our ICU is a closed unit for neurology patients (the ICU team is the primary team) and an open unit for neurosurgery patients (the ICU team consults for the critical care issues of patients). In this setting, cooperation between the ICU team and the neurosurgery, stroke and general neurology teams is essential.
Are you involved in research?
Our ICU and neurosurgery service have been involved with several multicenter trials, such as ICES and CLEAR III. We were very excited to participate in these trials because they allow us to stay on the cutting edge of patient treatment.
What do you think is the biggest unanswered question in neurotrauma/neurocritical care?
I think the biggest question in the care of patients with severe neurological insults is the role of multimodal monitoring. To date, there are many tools available, such as brain tissue oxygen monitoring, cerebral blood flow monitoring, continuous EEG, microdialysis, etc., to help us understand the physiology of the injured brain. However, we do not yet know which of these are the most helpful and can be used in real time to optimally manage our patients.
What is your biggest challenge during your day-to-day work?
My biggest challenge is budgeting time between the operating room, my clinics, the ICU and my office.
What advice can you give to young neurosurgeons who are contemplating or just starting a career in neurotrauma/neurocritical care?
Get involved in Joint Section activities early in your career. It is very easy to become active in the Joint Section on Neurotrauma and Critical Care. If you’re interested in research, education, guidelines or policy, there are roles for you, whether you’re a medical student, resident, fellow or attending.
What, if any, has been your involvement in the treatment of COVID+ patients during this pandemic?
The neuroscience-ICU unit and staff are part of the hospital’s plan for the anticipated surge in critically ill patients with COVID-19. Hearing that neurosurgeons were being asked to provide general critical care for COVID patients, I created the “Neurosurgeon’s Guide to Pulmonary Critical Care for COVID-19,” a resource for neurosurgeons that was endorsed by the AANS and CNS.