NEWS FROM THE NEUROSCIENCE PROGRAM Fall 2010
Emergency Center collaborative treatment creates ideal flow for urgent neurotrauma, stroke With Beaumont Hospital, Royal Oak being the only Level 1 trauma center in Oakland and Macomb counties, it comes as no surprise that the Emergency Center sees more than 116,000 visits per year, sometimes up to 400 per day. Under the direction of Jedd Roe, M.D., the EC has 111 beds and an Currently, Beaumont, Royal Oak’s observation unit that varies from 21 to 32 beds, based on caseload. Emergency Center is the busiest in
IN THIS ISSUE
A volume and bed capacity this high has led the EC to be the nation’s leader in emergency observation Dr. Roe, Chair, medicine. Royal Oak’s observation Emergency Center unit is the site for workup of many transient ischemic attack, or TIA, patients. In fact, Beaumont was one of the first trauma centers to have a TIA treatment protocol that has subsequently been published in the Annals of Emergency Medicine.
Michigan and one of top 15 busiest centers in the country.
The EC has approximately 40 faculty physicians, all of whom are board-certified emergency medicine specialists. They work in conjunction with 20 urgent care physician assistants, 42 emergency medicine residents, and an entire EC staff trained for trauma to provide the best care possible. In addition, the EC has expertise in pediatric emergency medicine with a separate pediatric EC that sees anywhere from 25,000 to 30,000 patients per year. Beaumont’s EC is distinct in that it has in-department CT with angiography capabilities, eliminating scheduling and transfer delays. The EC is extremely productive and advanced in research topics including resuscitation science, pre-hospital care, cardiac emergencies and emergency medicine education and operations. Royal Oak’s emergency medicine department is constantly striving to improve flow process within the department, and these improvements are often translated to a hospital-wide initiative for system enhancement. The EC is one of the most EC doctors Roe and collaborative Ditkoff treating a departments patient in Royal Oak’s trauma bay.
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Quick access and comprehensive treatment for neurosurgical trauma care made the difference Inpatient Neuro Rehab Think N.E.U.R.O. First Motor Speech Neurorehabilitation and Parkinson’s Disease Long-distance patients get VIP treatment with new guest services program Direct Access Center facilitates quick and efficient patient transfer
Message from the Chief The delivery of health care and its financial implications to a hospital and medical center is of great concern to the Neuroscience Center at Beaumont Hospitals. We strive to provide the optimal provision of care in neuroscience in a cost effective manner, maximizing the utilization of available resources and limiting the expense in the use of material, time and personnel. To provide effective delivery of health care, we implemented measures to maximize our efforts. A dedicated Neuro ICU works in collaboration with Surgical Critical Care enhancing implementation of care pathways for patients with traumatic head and spinal cord injury, cerebral aneurysms and subarachnoid hemorrhage, brain tumor patients with intracranial pressure problems and a coordinated program for patients with acute stroke. A unique program has also been developed with Pediatric Critical Care for the care of children with acute neurological problems in the Pediatric ICU. The neurosurgical operating suites have been upgraded to provide cutting edge technology as well. Beaumont has become a recognized minimally invasive neurosurgical center with procedures that maximize patient care while decreasing the trauma caused by surgery. We also have neuro-specific anesthesia teams with a dedicated anesthesiologist and certified nurse anesthetists that have developed standardized anesthesia care protocols. Furthermore, Six Sigma standards are implemented in the neurosurgical operating rooms to decrease turnover times, minimize resource utilization and decrease cost of materials and instrumentation used while maintaining ideal patient care.
The neuroscience patient floor has been expanded to include 20 progressive nursing care beds dedicated to the care of the neuroscience patient. Courses in neuroscience nursing are being taught to our personnel, support materials are being provided, and the neuroscience nurses have the opportunity to participate in local, regional and national neuroscience educational meetings. The neuroscience nurse practitioners, physician assistants and all nurses are encouraged to become involved in these learning opportunities through the use of hospital and departmental financial support. The quality of care and length of stay are being further improved by the addition of a dedicated neurorehabilitation unit on the neurosurgery patient floor, including eight dedicated initially; this will eventually be expanded to 14. The addition of these units directly to the patient floor will facilitate immediate rehabilitation treatment for our patients. Appropriate therapies will begin the day of admission and will progress in a coordinated and structured manner with the support of the departments of Physical Medicine and Rehabilitation and Discharge Planning. The delivery of the best patient care possible is the primary concern to the Neuroscience Center at Beaumont Hospitals, where we believe that you should always Think Neuro First!
Fernando G. Diaz, M.D., Ph.D. Chief, Neurological Surgery, Beaumont Hospital, Royal Oak
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in the hospital, and the staff interfaces with virtually every department in every specialty. This method of collaboration plays into the department’s mission and allows for direct access transfers, ER to ER transfers and weekly arrivals from patients who come from more than 50 miles away. In addition to being the chair of the EC, Dr. Roe is also the medical director for Beaumont Transportation, which is a joint venture with ambulatory services. Beaumont Hospital partners with Community EMS to provide essential pre-hospital care for the incoming trauma patient via Beaumont Medical Transport. Beaumont’s EC is a large contributor to the Oakland County Medical Control Authority to establish protocols to improve and to expedite pre-hospital care of patients en route. 2 • Neuroscience Update • FALL 2010
Emergency Center Stroke Care Jeff Ditkoff, M.D., is the assistant medical director of operations for EC, and, along with his team, strives to provide optimal care of the stroke patient. The EC stroke team offers a comprehensive array of services, in conjunction with their neurosurgical, neurological and interventional colleagues. Treatment of acute CVA patients begins in the pre-hospital setting; medical direction is provided to local paramedics as well as education regarding stroke identification. Patients presenting to the EC with acute CVA symptoms are triaged immediately to a high acuity area where an emergency physician is waiting at the bedside. If CVA is suspected, the stroke team is activated and the patient has an immediate CT of the brain. Once CT is completed, a decision is made regarding further imaging or treatments, which include tPA, interventional options and surgical options. The entire staff in the Emergency department is dedicated to care of the stroke patient and makes every effort to provide world-class care for these patients. Beaumont, Royal Oak’s Emergency Center is committed to the treatment of neurotrauma patients with many time sensitive conditions, such as stroke and head trauma (see article on Marion Strada, pg 3). If you would like more information on the level one trauma center at Beaumont, Royal Oak, please call 248-898-5925.
Quick access and comprehensive treatment for neurosurgical trauma care made the difference August 25 was a normal afternoon for Kate Strada. Her children were playing as usual, when Marion, her 10-month-old daughter curiously approached an open door. Before Kate could reach her, Marion fell down a flight of uncarpeted stairs into the basement. Kate saw Marion crying at the base of the stairs, picked her up and began checking for broken bones. Other than shock, Marion appeared to be fine. Kate called her husband at work to tell him what happened. He told her he was coming home, and she should take Marion to the Emergency Center just to be certain, advice that undoubtedly saved her life. But while they were waiting for Kate’s mother to come watch the other three children, Marion vomited. Kate immediately called 911 for ambulance transport to take them to Beaumont Hospital, Royal Oak. In route to the hospital, emergency medicine technicians immediately started pre-hospital care on CT scan showing Marion’s epidural Marion. After assessing her condition, the EMTs called hematoma from fall (circled). in a pediatric trauma to the EC to get the trauma team in place. “I was amazed at how many people were waiting for us when we arrived,” says Kate. “Marion’s care started before we were even in the door.” Although she had become a little lethargic in the ambulance, Marion’s arrival at Beaumont sparked some activity, and she regained a little color. Despite her apparently improved condition, the EC doctors and staff ordered a head CT scan as precaution. “At this point, I thought we would get negative CT results, they would watch Marion for a few hours, and we’d be taking her home,” explains Kate. “We had no idea what was about to happen.” After Marion’s CT was completed, she vomited again. The results showed an acute epidural hematoma compressing her brain and an associated skull fracture with midline shift. These critical findings were immediately called into Casey Roche, M.D., by the radiologist. “As they wheeled us back to the Pediatric EC, the transporters broke out into a sprint, and I could hear a trauma being announced over the PA system needing continued on page 5
Dr. Gilmer checking Marion’s incision site at her first post-op visit.
When to bring your child to the Emergency Center Daniel B. Michael, M.D., Ph.D.
A simple bump on the head is pretty common for children. Even concussions, a more severe blow, are all too common with about 1.25 million in the United States per year. So how do you know when to bring your child to the Emergency Center after he or she has sustained a head injury? Consider the following:
The kind of injury the child has sustained Brain damage is proportionate to the force applied to the head and energy imparted to the brain; this can be mitigated by protective gear. A helmeted child who trips, falls and hits his or her head is far less likely to have sustained a serious brain injury than those not wearing head protection. Level of consciousness Any loss of consciousness, or LOC, in a child, no matter how brief, should trigger an evaluation by a pediatrician or visit to the EC. LOC is the hallmark of concussion in most but not all cases. If a child cannot recall the incident or fall, this can also suggest a concussion diagnosis. After a brief LOC, a child may awaken and later become very drowsy, sometimes within minutes. This should be taken very seriously, and any child exhibiting a “lucid interval” should be brought to the EC promptly. Physical and emotional symptoms Following head injury, a child may be irritable, unsteady, vomit and complain of headache or visual/hearing problems. Following a head injury, any of these signs should be evaluated without delay by a doctor. Also, any scalp laceration which does not stop bleeding after application of direct pressure should be examined. continued on page 5
FALL 2010 • Neuroscience Update • 3
Inpatient Neuro Rehab Ronald Taylor, M.D., Chief, Physical Medicine and Rehabilitation In concordance with the Neuroscience Program, the department of Physical Medicine and Rehabilitation is developing a program to provide early evaluation and intervention for all patients admitted to the 8 South Neuroscience Unit. A team concept will be implemented to improve patient recovery and satisfaction as well as decrease the length of stay. The program will treat patients with traumatic brain injuries, spinal cord injury, stroke, Parkinson’s disease, multiple sclerosis, aneurysm, as well as central nervous system and spinal tumors and other neurologic diseases. This unit is the first of its kind in Michigan and allows us to align ourselves with health care reform and to provide the most efficient care for our patients. These patient care goals will be accomplished through the coordinated efforts of the departments of Neurosurgery, Neurology and Physical Medicine and Rehabilitation, utilizing a team approach unique to each patient’s needs. Every patient will be seen by the appropriate physicians, nurses, midlevel providers, Physical Therapy and, if necessary, Occupational Therapy, Speech Therapy, Continuing Care and Social Work. This concept 4 • Neuroscience Update • FALL 2010
has proven very effective on inpatient rehabilitation units and provides prompt, appropriate care and placement for all patients. As part of this program, an eight-bed dedicated inpatient rehabilitation unit will be opened on 8 South’s Neuroscience Unit in close proximity to the other patients in the program, thus maximizing team coordination. The program also includes an emphasis on post-acute disposition, like inpatient
rehabilitation, subacute rehabilitation or home, with appropriate outpatient followup. This particular aspect of the program will minimize long-term disability and readmissions to the hospital. Thus far, the program and its development have shown support and excellent collaborative teamwork in ensuring a timely and appropriate start to our services. We hope to begin implementation in the first quarter of 2011.
Neuro Trauma Rehab Program Sherry Viola, M.D., Medical Director, NTRP
Located in the Beaumont Health Center, the Neuro Trauma Rehab Program, or NTRP, is a specially designed outpatient program created solely for patients recovering from neuro-related trauma. The NTRP provides comprehensive rehabilitation assessment and service for impairments of communicative, cognitive, physical and social-emotional abilities secondary to neurological injury. Patients with severe and debilitating conditions including traumatic brain injury, TBI, spinal cord injury, stroke, aneurysms, Parkinsons’s disease and central nervous system tumors receive intensive therapies. Following discharge from the hospital, patients with neurologic challenges may continue to receive rehabilitation services provided by staff that specializes in the unique care required for optimal recovery. These therapists have had specialized training to support a patient and his or her family’s recovery as they tackle everyday challenges that ensue when returning to normal activities like school, work and driving. Program components include: • Vision Rehabilitation • Day Rehabilitation • Vestibular Rehabilitation • Driver Rehabilitation • Neuropsychological testing • Workability • Aquatics • Speech, language and cognitive communication groups Dr. Sherry Viola and Vanessa Gentry, PT, assist a patient status post cervical trauma.
Neurosurgical trauma care continued from page 3 people to respond,” explains mom. “Immediately, we knew it was for Marion.” When they returned to the Peds EC, another full team of people were waiting for Marion, including Amanda Griffith, a Neurosurgery nurse practitioner who had been paged to attend to Marion’s newly diagnosed condition. Despite her earlier improvements, Marion was now lethargic and her heart rate was dropping. The EC doctors explained they had found a bleed on her brain, and she would have to be intubated because she was losing consciousness and showing no signs of fight as they inserted her intravenous line. Kate says, “When the head of Marion’s EC team came to me, he held my hand and said, ‘I will not sugar coat this – this is extremely serious. She has a significant amount of blood (in her brain) and we need to get her into emergency surgery.’” Amanda Griffith, N.P., knew that Holly Gilmer, M.D., chief of Pediatric Neurosurgery, was already in the operating room with another patient at that exact time. “I called into the OR where Dr. Gilmer was operating, she looked at the CT scans and told me to transport Marion to the OR immediately, and she would meet me there,” recalls Amanda. Amanda and the EC team transported Marion to the OR while Megan Clippard, another Neurosurgery nurse practitioner, boarded the case and got everything in the operating room coordinated. Dr. Gilmer came out and briefly spoke with Kate, letting her know that the surgery should take one to two hours and that she would need to remove part of Marion’s skull to remove the blood from her brain.
“Within that first hour of waiting while Marion was in surgery, we honestly thought we were going to lose her,” says mom. She soon learned that Marion was out of surgery, off the ventilator and on her way to recovery. Marion arrived in the Pediatric Intensive Care Unit less than three hours after her initial arrival to the EC. Amanda followed up with Marion the next day in the PICU and couldn’t believe she was sitting up, alert and moving around. Mom and dad attribute Marion’s flawless treatment and recovery to the emergent care she received by everyone they came in contact with and the fortunate presence of Dr. Gilmer at the time of Marion’s arrival. However, everyone involved in Marion’s treatment agrees that the quick action of her parents to get her to the EC is the real reason this happy, now 11-month old, baby has fully recovered. “Everyone who sees her is amazed at how well she’s doing and can’t believe how quickly she’s bounced back after such a terrible accident,” says Marion’s parents. “We can’t thank Beaumont Hospital, the EC’s amazing trauma team, Dr. Gilmer and the pediatric ICU nurses enough for all that they did to help treat Marion.”
Dr. Gilmer and Marion with Amanda Griffith, N.P., (top left) and Marion’s mom, Kate Strada (top right).
Mom and dad attribute Marion’s flawless treatment and recovery to the emergent care she received by everyone they
Kids and the EC continued from page 3
came in contact with and
Better safe than sorry It’s important for parents and guardians to remember that no doctor or nurse knows your child better than you. If a child just doesn’t seem right after head injury, even without LOC, bring the child to medical attention immediately. Brain injuries are treatable and good outcomes are possible and prevalent. The sooner a brain injury diagnosis is made, the better recovery chance a child will have.
the fortunate presence of Dr. Gilmer at the time of Marion’s arrival.
FALL 2010 • Neuroscience Update • 5
Neurosurgery Education and Understanding, Royal Oak
Think N.E.U.R.O. First
Pre-operative spine education classes for patients Holly Weissman, N.P., Chief, Neurosurgery Physician Extender
Starting in February 2011, patients will have the opportunity to attend a free educational seminar regarding their upcoming neuro-spine surgery scheduled at Beaumont Royal Oak. Think N.E.U.R.O. First classes will cover cervical, thoracic and lumbar surgery, both minimally-invasive and complex in nature. The classes are designed to answer patient and family questions and reduce concerns before surgery as well as better prepare them for post-op recovery and hospital stay. Procedures and diagnoses discussed will include: • cervical fusion • disc herniation • corpectomy • spinal stenosis • laminectomy/discectomy • compression fracture • lumbar fusion, including XLIF • spondylolisthesis • vertebroplasty • degenerative disc disease In addition to explaining the type of surgery the patients will have, in depth instruction will also take place regarding pre- and post-operative care in the hospital as well as at-home recovery tools. Patients will receive interactive education from a number of departments, including anesthesia, discharge planning and physical medicine and rehabilitation. Topics covered will include: • parking/registration • pre-op and anesthesia • post-op and PACU • admission to Neurosurgery floor • post-op expectations • pain management • average length of stay • discharge planning • inpatient and outpatient rehabilitation • recovery prognosis
6 • Neuroscience Update • FALL 2010
After the educational curriculum is presented, patients and their family will have the opportunity to ask personalized questions and receive comprehensive answers from our multidisciplinary team. Patients will also be provided with an educational folder containing a variety of information handouts pertaining to their upcoming surgery. The Neuroscience Program is currently constructing surgery and diagnosisspecific educational handouts for all major neurosurgical conditions. These handouts will be made available to participants in this class specific to their individual surgery as well as general hospital information and an orientation DVD about their neuro-spine surgery. Furthermore, literature will be provided for Beaumont’s outpatient rehabilitation locations, after care facilities and home medical equipment.
The classes are designed to answer patient and family questions and reduce concerns before surgery as well as better prepare them for post-op recovery and hospital stay.
Outpatient neurosurgical clinics will be in-serviced and provided with the class flyer and registration information for patient sign-up. In addition, all patients scheduled for spine surgery within the neurosurgery department will be contacted regarding their interest in attending the class preoperatively for increased surgical awareness.
All classes are free but do require an RSVP as space for each class is limited. Sign-up for the inaugural seminar begins mid-December. Think N.E.U.R.O. First will take place the second Monday of every month from 5 – 7 p.m. For more information, please contact Neurosurgery Administration at 248-551-2300.
Motor Speech Neurorehabilitation and Parkinson’s Disease Richard M. Merson, Ph.D., CCC-SLP, Department of Speech-Language Pathology
Motor speech disorders, or dysarthrias, are common in neuropathology and can often require speech-voice assessment and rehabilitation. Dysarthrias requiring motor speech therapy include: • Parkinson’s disease • multiple sclerosis • amyotrophic lateral sclerosis • myasthenia gravis • Huntington’s disease • Wilson’s disease • dystonia movement disorders • essential tremor • cerebral palsy Also, patients undergoing other neurosurgical procedures like seizure disorder treatment, tumor resections or cervical neck surgery may also require pre-surgical assessment and post-surgical treatment for motor speech and/or swallowing disorders. Parkinson’s disease is one of the more common neuropathologies requiring this motor speech intervention. PD is a degenerative disorder of the central nervous system characterized by muscle rigidity, tremor and slowing of physical movement, known as bradykinesis. These
symptoms are the result of a decreased or insufficient supply of the neurotransmitter, dopamine. Dopamine depletion is identified as a malfunction of the neurons in the substantia nigra. The etiology of PD can be related to genetics, toxins or head trauma. The mean age of individuals with PD is 60 years, and it is estimated that there are one million patients with PD in North America. Approximately one percent of the population over the age of 65 years has PD. The prevalence is reported between 120 to180 cases per 100,000 people in North America and Europe. The prevalence in China,
Neurorehabilitation, along with surgical intervention and neuropharmaceuticals, is a critical part of PD management and allows patients to live out all or most of their expected lifespan despite their condition.
Japan and Nigeria is significantly less. Motor deficits of PD include: • tremor • rigidity • slowness Sensory and psychogenic deficits include: • cognition • behavior • mood • dementia The most widely used treatment approach is to stimulate dopamine production or slowing it’s uptake in the brain. The drug management of PD is not a simple or uniform approach. Neurosurgical approaches to managing some of the movement disorder in PD are becoming more popular. Deep-brain stimulation and implantation, a technique offered at Beaumont, has proven very effective. Neurorehabilitation, along with surgical intervention and neuropharmaceuticals, is a critical part of PD management and allows patients to live out all or most of their expected life-span despite their condition. There is evidence that motor speech, swallowing, physical and occupational therapy can help maintain a good quality of life for most PD patients. The Parkinson Rehabilitation Program at Beaumont Hospital has been providing all the efficacious treatment programs in a multidisciplinary setting for many years. Motor speech and voice rehabilitation is available at all three campuses in the speech-language pathology department. For more information, please call 248-551-2100.
Angee Ludwa, PT, Justin Riutta, M.D., Joyce Gibbs, OT, Pat Hayduk, R.N., Richard Merson, Ph.D., Paige Silence, PT and Jenny Maurer, SLP, work collaboratively to develop the most comprehensive treatment plan for one of their Parkinson’s patients. FALL 2010 • Neuroscience Update • 7
Long-distance patients get VIP treatment with new guest services program Preparing for surgery can be stressful enough but adding a long distance trip to a hospital can add to that. In an effort to ease some of the worry of Beaumont’s patients who travel from outside of the tri-county area for care, Guest Services at Royal Oak launched a Patient and Family Hospitality program. The patient-focused program began as a pilot project with Orthopedic Surgery and eventually expanded to serve patients in Neurological Surgery. The program is designed to provide patient and family liaison services to all elective surgical patients and their families traveling further than 30 miles.
flights and make hotel accommodations for families visiting a loved one having surgery, even accommodating some family members through the Patient and Family Housing near the hospital. Upon a patient’s arrival to Beaumont, a hospitality assistant meets and greets them and directs them to the proper registration
contact the proper personnel. Although some patients may be longdistance, they have family close by and don’t need the extent of services that the program can provide. “However, every patient takes advantage of at least one of the services the program has to offer,” says Heather, one of the program’s hospitality assistants. “About
On a daily basis, a hospitality assistant checks the surgery boarding list for Neurosurgery and Orthopedics and contacts all of the long-distance patients scheduled for surgery. On first contact, the program’s hospitality assistant answers all of the patient’s questions about the time they will spend at Beaumont Royal Oak, assists with directions and coordinates housing and travel arrangements, if needed. The best part is that the service of the patient liaison extends to family as well; the program has helped families coordinate
The program has helped families coordinate flights and make hotel accommodations for families visiting a loved one having surgery.
Guest Services manager, Devin Lippert, supervisor, Steve Barber and patient family liaison, Heather Slanda, contact patients and coordinate services for their family at the Guest Services Business Center in the South Tower Concourse.
and waiting areas for their procedure. As the patient’s personal liaison, they continue to provide services and support throughout their stay, following them post-operatively to ensure that all needs continue to be met. Anytime a patient has an issue or needs assistance, they either provide it directly or
Neuroscience achievements Fernando G. Diaz, M.D., Ph.D., chief of Neurosurgery at Beaumont Hospital, Royal Oak, was nominated as an American Association of Neurological Surgeons Continental Representative to the World Federation of Neurosurgery. Mick J. Perez-Cruet, M.D., MS, vice-chief of Neurosurgery at Beaumont Hospital, Royal Oak, received the North American Spine Society’s 2010 Translational Research Grant Award, a $50,000 prize, for his work entitled “In-Vivo Intervertebral Disc Regeneration Using Human Umbilical Cord Blood Stem Cell Derived Chondroprogenitors.” 8 • Neuroscience Update • FALL 2010
half of the patients we help use the full spectrum of services available.” Many of Heather’s most grateful patients are elderly and are either scared about their upcoming surgery or unsure of the surroundings at Beaumont and are looking for assistance. “A lot of the patients who call me to thank me tell me they were grateful to have the name of a person to call if they had a question or complaint,” says Heather. “Often, that’s all it takes to ease their minds about surgery.” Guest Services is working towards adding the liver transplant patients to the program. As the success of the project continues, additional service lines will be added. For more information about the program, please contact a hospitality assistant in Guest Services at 248-898-2285.
Nancy Jinyang Cao, M.D., Ph.D. Department of Neurology Nancy Cao, M.D., Ph.D., is a boardcertified general neurologist with subspecialty in epilepsy and neuromuscular diseases. Dr. Cao obtained her medical degree in China and her doctorate from Wayne State University, which is also where she did her neurology residency training and an additional fellowship in clinical neurophysiology. She was chief resident of Neurology and published several clinical and research papers throughout her training. Dr. Cao practices general neurology and has a subspecialty in Clinical Neurophysiology, treating disorders like epilepsy, neuromuscular diseases, sleep
disorders and multiple sclerosis. She is also a member of Royal Oak’s stroke call team, offering round the clock stroke coverage and treatment, which helps Beaumont maintain its primary stroke center certification. She supports Beaumont’s teaching program as an attending neurologist at the resident’s Neurology Clinic, lecturing medical students rotating in Neurology and having them shadow her in the office. Dr. Cao treats epilepsy, neuromuscular diseases, stroke, sleep and movement disorders and MS. Patients are always Dr. Cao’s number one priority, and her office provides efficient,
effective, quality and compassionate care. Her office’s extremely high patient and customer satisfaction rating is a result of her team’s thorough and benevolent service. For more information on Dr. Cao or the neurologic services she offers, please contact the Physician Referral Line at 800-633-7377.
8 South Neuro Staff Beaumont Hospital, Royal Oak’s neuroscience progressive floor on 8 South has 58 beds treating post-operative spinal, cranial, stroke and aneurysm patients as well as two Epilepsy Monitoring Unit beds for 24-hour video EEG and seizure surveillance. The floor also will expand to include eight neuro rehab beds for efficient patient flow and in-house therapy. Most patients on 8 South are either post-operative or are step-down from the Neuro ICU and care is facilitated by the dedicated nursing team on the floor. The staff on 8 South is described as very close-knit by Michelle Boiani, R.N., one of
the assistant nurse managers on the unit. “Many of our nurses have been here more than 10 years,” says Michelle. “Those who are just starting join the team and immediately fit right in.” Peggy Magary, R.N., the floor’s other assistant nurse manager, says the nursing staff teams with the physician extenders and neurosurgeons to provide the most advanced and compassionate care to the patients and their families. Recently, 8 South welcomed Lorna PostPowell, R.N., as the new administrative
manager. Lorna has been with Beaumont Hospital for a number of years, but explains that she has always been interested in neuroscience and felt that 8 South was a perfect place for her. “I am looking forward to using the ideas and systems that 8 South already has in place and taking them to the next level,” says Lorna. Many of the nurses on 8 South are undergoing their neuroscience certification training. The 8 South nursing team continues to grow and develop with the expanding neuroscience program. Members of the 8 South neuro team
FALL 2010 • Neuroscience Update • 9
Direct Access Center facilitates quick and efficient patient transfer to Beaumont Royal Oak Holly Bair, MSN, N.P., Director, Beaumont Direct Access Center
The Direct Access Center at Royal Oak was established to facilitate the process of referring patients to Beaumont for treatment. The center serves as a central point of access to facilitate the placement of new patient admissions, intra-hospital and inter-hospital transfers at Royal Oak. Additionally, the center provides around-the-clock coverage with specially trained registered nurses and bed coordinators. Beaumont’s Direct Access Center • provides a single point of entry for all patients, including direct admits from doctors’ offices • centralizes all bed management functions, inpatient transfers, direct admits and EC admits • facilitates physician-to-physician communication for all inpatient transfers • keeps referring physicians informed while their patient is at Royal Oak • uses Midwest Med Flight for immediate air transport, if necessary The center’s goals are to: • coordinate the transfer of a patient to Royal Oak for diagnostic or interventional services • connect physicians and patients with the most appropriate Beaumont specialist • confirmed that appropriate insurance approvals and authorizations are arranged • when applicable, coordinate transportation, including ground ambulances and aeromedical support • facilitate the follow-up and return of patients to the primary sending physician. This service is available to all patients with any condition, from simple to complex. For more information, please contact the Direct Access Center at 866-858-8483. 10 • Neuroscience Update • FALL 2010
Karol Zakalik, M.D.
Department of Neurosurgery Karol Zakalik, M.D., is a board-certified neurosurgeon at Royal Oak who subspecializes in pediatric neurosurgery and is a Fellow of the American College of Surgeons. Dr. Zakalik attended medical school at the University of Michigan and started his residency at the University of Vermont. He completed his neurosurgical residency training at the University of Colorado in Denver and then continued his training with a pediatric neurosurgery fellowship at the Hospital for Sick Children in Toronto. Although Dr. Zakalik is formally trained in the care of pediatric neurosurgery, the practice scope in his Royal Oak office spans across the board to all patients, both child and adult.
Dr. Zakalik and members of his OR team, Irish Bolukh, R.N., and Shelly Dowden, R.N.
His adult practice includes all general neurosurgery, including large brain tumors, spinal cord tumors and spine surgery, especially in the cervical region. Dr. Zakalik has a moderate approach to spine surgery, which his patients and referring physicians appreciate. He rules out all non-surgical therapies before proceeding with surgical intervention by trying physical therapy or epidural steroid injections to alleviate a patient’s pain. If surgery is the most appropriate option, he avoids multi-level procedures whenever possible. His practice has seen better long-term outcomes with more conservative spine surgery. Dr. Zakalik also specializes in pediatric epilepsy surgery with cortical mapping and resections of the temporal lobe, amygdala and other seizing areas. He often works closely with Narayan Verma, M.D., and Gary Trock, M.D., in treating patients in Royal Oak’s Epilepsy Monitoring Unit. “We’ve had great results in the EMU without complications,” says Dr. Zakalik. “The EMU’s technology allows for better seizure mapping to ascertain the most logical surgical intervention for treatment.” For more information on Dr. Zakalik’s practice and patient referral, please contact the Physician Referral Line at 800-633-7377.
Neuroscience program overview Traumatic Brain and Spinal Cord Injuries – When an accident results in brain or spinal cord injury, treatment often begins at one of Beaumont’s Emergency Centers. Our EC’s offer leading edge imaging and advanced telemetry for fast, accurate diagnosis of injuries. Our multidisciplinary team of ER staff, trauma surgeons, neurosurgeons and rehab specialists work together to begin immediate treatment, which is essential for best outcomes. Gamma Knife® – Beaumont’s Gamma Knife® treats brain tumors and neurological conditions with pinpoint accuracy. Gamma Knife® delivers a highly therapeutic dose of radiation to the brain accurately and without the risks of open surgery like general anesthesia, infection and bleeding. Only the target tissue receives a significant radiation dose and no incision is required. Recovery is quick and treatment is generally done on an outpatient basis. In addition to tumors, Gamma Knife® can be used for arteriovenous malformations, trigeminal neuralgia, Parkinson’s disease, essential tremors, epilepsy and obsessivecompulsive disorder. Neuro Oncology – Our specialists diagnose and treat malignant brain and spine tumors in children and adults using neuroimaging techniques like positron emission tomography, magnetic resonance spectroscopy imaging, Gamma Knife® and spinal radiosurgery. The team includes neuro oncologists, neurosurgeons, radiation therapists and neuroradiologists. Cranio-Facial and Skull Base – Beaumont’s Cranio-Facial program brings together specialists to provide integrated care for children with a range of craniofacial disorders, such as cleft lip or palate. The multidisciplinary team includes plastic surgeons, otolaryngologists, maxillo facial surgeons and neurosurgeons.
Pediatric Neurosurgery – At Beaumont Children’s Hospital, pediatric neurologists, neurosurgeons and interventional neuroradiologists are available to treat a variety of neurological conditions in infants and children. Our experts are skilled and equipped to handle the most severe head and spine trauma issues in children. As the only hospital in SE Michigan providing pediatric interventional treatment of brain aneurysms, arteriovenous malformations and vascular tumors, we reduce or eliminate the need for traditional surgery methods. Epilepsy and Movement Disorders – Our team treats a broad grouping of neurological conditions like epilepsy, Parkinson’s disease, dystonia, spasticity, Huntington’s disease and movement disorders caused by brain injury. An Epilepsy Monitoring Unit opened at Beaumont Royal Oak as a specialized inpatient unit designed to evaluate, diagnose and treat children and adults with seizures. The EMU offers leading diagnostic capabilities and physician consultation. Beaumont is also a leader in using deep brain stimulation (DBS) to treat various neurological and movement disorders like Parkinson’s disease, essential tremor, dystonia, tremor due to multiple sclerosis and chronic pain. Pain Management – Safe and effective pain management is an integral part of treatment. Beaumont’s neuroscience team works in conjunction with anesthesiologists on a variety of treatments and procedures. Physicians have innovative options for treating pain including dorsal column stimulators that can be adjusted for varying levels of pain as well as an implantable intrathecal drug pump. Beaumont’s advanced radiosurgery equipment is helpful in treating focal pain conditions because it’s less invasive than surgery and can be repeated if symptoms recur.
Spine – Our team performs minimally invasive surgeries on complex spinal conditions including spinal trauma, spinal deformities, and spinal oncology. This approach significantly improves patient outcomes with less blood loss, less pain, lower infection rates and shorter hospital stays. Interventional Neuroradiology and Stroke – Beaumont Royal Oak is designated a Primary Stroke Center by the Joint Commission affirming the success of our comprehensive stroke care. Our team includes specially trained and certified nursing staff, more interventional stroke specialists than any other hospital in Michigan, dedicated ICU beds for stroke patients, interventional neurosurgeons and neuroradiologists who can administer intraarterial TPA and remove blood clots from the brain, and a dedicated neuroscience unit with 66 beds and 9 monitored critical care beds. A minimally-invasive approach is provided by our team to treat vascular diseases of the central nervous system and spine including aneurysms, vascular malformations, arterial/ venous stenosis, and tumors of the brain, head and neck requiring surgical intervention. Intraoperative Monitoring – Intraoperative monitoring allows surgeons to check the functionality and integrity of the nervous system during surgery. The use of electrophysiological methods measures brain, nerve and spinal cord activity and has shown to improve patient safety and surgical outcomes. Beaumont’s IOM team has training and experience exceeding many programs in the nation in the surgical areas of neurosurgery, orthopedics, otolaryngology/head and neck and urology.
FALL 2010 • Neuroscience Update • 11
3711 Thirteen Mile Road Royal Oak, Michigan 48073
is published quarterly in support of the Neuroscience Program at Beaumont Hospitals. For comments or suggestions, please call Rachael Wade at 248-551-2300
NeuroscienceFaculty and Staff Neurosurgery
Fernando G. Diaz, M.D., Chief, Neurosurgery Mick J. Perez-Cruet, M.D., M.S.¥ Vice-Chief, Neurosurgery Holly S. Gilmer, M.D.¥£ Chief, Pediatric Neurosurgery Daniel B. Michael, M.D., Ph.D.§¥ Chief, Neurotrauma Ryan J. Barrett, D.O.¥ Stephen E. Boodin, M.D.¥ Chaim Ben-Joseph Colen, M.D., Ph.D.§ Konstantin V. Elisevich, M.D., Ph.D.¥ Phillip Friedman, M.D.¥ Mark L. Goldberger, D.O.§ Murali Guthikonda, M.D.¥ Bradley T. Hall, D.O.¥£ Steven D. Ham, D.O.¥ Robert R. Johnson, M.D.¥ Fredrick S. Junn, M.D.¥ Steven N. Kalkanis, M.D.¥£ Ghaus M. Malik, M.D.¥ Todd Y. Nida, M.D.¥£ Manouchehr Nikpour, M.D.§ Rick E. Olson, M.D.¥£ Daniel R. Pieper, M.D.¥ Omar M. Qahwash, D.O.¥ Jack P. Rock, M.D.¥ Mark L. Rosenblum, M.D.¥ Teck M. Soo, M.D.¥ Sandeep Sood, M.D.¥ Karol Zakalik, M.D.¥ Lucia J. Zamorano, M.D.¥ß John L. Zinkel, M.D., Ph.D.§ Stroke Program Susan Catto, M.D.¥ Medical Stroke Director
Physician Extenders Holly Weissman, N.P. Chief Kim Cameron, P.A. Megan Clippard, N.P. Becky Doherty, N.P. Amanda Griffith, N.P. Lauren Gurski, P.A. Justin Hugelier, P.A. Jennifer Jehle, N.P. Megan Keiser, N.P. Rosie Mannina, N.P. Kristen McGrath, N.P. Jamie Peysakhov, P.A. Hospital Administration Charles Shanley, M.D. Senior VP and Chair, Surgery Victoria Hollingsworth-Schuler, M.S., M.S.A. Administrative Director, Neuroscience Dorothy Bernard, B.S.N., M.S.A Director, Specialty Nursing Neuroscience Administration Lori Sheridan Administrative Manager Rachael Wade Administrative Assistant Administrative Office 248-551-2300
Amer G. Aboukasm, M.D.§ Gyula Acsadi, M.D.§ Mazen M. Al-Hakim, M.D.¥£ Kheir M. Al-Zouhayli, M.D.¥£ Malaz Almsaddi, M.D.£ Steven S. Beall, M.D.§ Martin I. Belkin, D.O.¥£
William D. Boudouris, D.O.¥ Julie A Burnham, D.O.£ Norman M. Burns, M.D.¥ Nancy Jingyang Cao, M.D. Ph.D.¥£ Paul A. Cullis, M.D.§ Sarih Salati, M.D.§ Lawrence M. Eilender, M.D.¥ Mitchell L. Elkiss, D.O.¥ Aaron L. Ellenbogen, D.O.¥£ Anthony A. Emmer, D.O.¥ Raina M. Ernstoff, M.D.¥£ Jonathan Fellows, D.O.¥£ Sonia G. Fernando, M.D.¥ Martha Frankowski, M.D.£ Michelle L. Furmaga, M.D.¥ Jodi A. Ganley, D.O.¥ Thomas Giancarlo, M.D.§ Neil J. Gilbert, M.D.¥ Shaila Gowda, M.D.¥ Rashmi Gupta, M.D.¥ Cesar D. Hidalgo, M.D.£ Matthew Holtzman, D.O.¥ Agnes Jani-Acsadi, M.D.§ Nancy K. Juopperi, D.O.§ Mark A. Kachadurian, D.O.¥ Brian N. Kirschner, M.D.¥ Muhammad A. Khan, M.D.£ Shelley R. Knowles, M.D.¥ Lawrence W. Konst, D.O.§ Boris J. Leheta, M.D.§ Elizabeth A. Leleszi, M.D.¥ William Leuchter, M.D.¥ Zef Lucaj, M.D. Ph.D.¥£ Alicia G. Lumley, M.D.§ John Manica, M.D.¥£ M. Eileen McCormick, D.O.¥ Tracey T. Morson, M.D.§ Shyam S. Moudgil, M.D.§ Sami Mounayer, M.D.¥£ Steven E. Newman, M.D.¥ Thomas J O’Neil, M.D.£
Haranath Policherla, M.D.§ Chakrapani Ranganathan, M.D.£ Ayman Rayes, M.D.£ Andrea M. Rossi, D.O.¥£ Howard S. Rossman, D.O.¥ Vijay Samuel, M.D.¥ Steven H. Schecter, M.D.¥ Manaf Seidarabi, M.D.§ Alka Y. Shah, M.D.¥ Vaqar K. Siddiqui, M.D.§ Mark B. Silverman, D.O.¥ Bruce M. Silverman, D.O.¥ Lalitha Sivaswamy, M.D.¥ Susan L. Smietana, D.O.¥ Elizabeth C. Smith, M.D.¥ Alexander R. Spitzer, M.D.¥ Alex M. Steinbock, D.O.¥ Yi Chul Sul, M.D.§ Danette C. Taylor, D.O.¥ Gary L. Trock, M.D.¥£ Richard M. Trosch, M.D.¥ Narayan P. Verma, M.D.¥ James Matthew Voci, M.D.§ Nader S. Warra, D.O.¥ Danny F. Watson, M.D.¥ Esther L. Young, D.O.¥£ Nadia F. Zaki, M.D.£
Chris D. Kazmierczak, M.D.¥ Anant Krishnan, M.D.¥ Samir E. Noujaim, M.D.¥ Sneha R. Patel, M.D.¥ Richard Silbergleit, M.D.¥ Kurt E. Tech, M.D.¥ Ay-Ming Wang, M.D.¥ Jeffrey M. Wilseck, D.O.¥ § - Grosse Pointe ¥ – Royal Oak £ - Troy ß – Gamma Knife only