University of Colorado Southern Region Neuroscience and Spine News HEADlines NEWS FROM THE NEUROSCIENCE AND SPINE SERVICE LINE Spring 2022
Neurology
Inpatient Neurology Recruitment
• MD Brianna Poynor – Offer accepted – start date end of August
• MD Kelly Money – Offer made, verbally accepted
• APP interviews ongoing to fill one vacant slot
Outpatient Neurology Recruitment
• MD Michele Gatheridge – Contract signed, start date 4/24
• MD Diane Hesselbrock – Contract signed, start date 6/5
Service Line Updates
• Changing Thrombolytics: Effective Dec 5th tenecteplace has replaced alteplase for acute ischemic strokes. Alteplase will remain on formulary for wake-up strokes only.
• In-House Neurology: Effective Sept 1, 2022 Neurology began providing in-house coverage 24/7 at Memorial Central
• Dedicated MSTU Rig: Funds have been raised and a dedicated MSTU rig is currently being manufactured for Southern Colorado with an anticipated completion date of late fall.
• Post TNKase Transfers: EMS has created a guideline to allow ALS crews to transport post TNKase patients to higher level of care facility – Critical care transport for post thrombolytic reason only is no longer required.
Neurology Volume Southern Region FY 21 FY 22 Total Admitted Stroke Volume 858 982 Total Alteplase Volume 110 116 Total Stroke Alert Volume 1077 1199
Neurosurgery
Neurosurgey Recruitment
• Dr. Andrew Youkilis – Preparing the Offer
• Dr. Rahul Singh – Contract Signed: Start Date 6/5
Expanded Locums Team
• Dr. Manish Singh
• Dr. Albert Wong
Service Line Updates
• Spine Vendor Consolidation: Vendor consolidation efforts to potentially yield $1 million in annualized savings. Big 3 model (NuVasive, InnoVasis, Depuy)
• Operating Room Optimization: New O-arms at MHC and MHN, preference card standardization, new spine drills, new bone drills and streamlined neuro sets
• Increased Neurosurgery Footprint at MHN: MHN Neurosurgery OR Block time weekly for elective spine patients as well as a Neurosurgery Clinic presence in the Orthospine Clinic at the North Medical Office Building
• Dedicated Ortho/Neuro Pod at MHN: Spine coordinator worked with inpatient team to establish a dedicated pod for postop inpatient spine patients. Focusing on nursing education for this specific patient population
• OR’s 9 and 10 at MHN: Fully operational new OR rooms at MHN. Spine located in rooms 8 and 10.
Neurology Volume Southern Region FY 21 FY 22 Total Admitted Stroke Volume 858 982 Total Alteplase Volume 110 116 Total Stroke Alert Volume 1077 1199 Neurosurgical Volume Southern Region FY 21 FY 22 FY23 TD Cranial Volume 340 349 334 Spine Volume 388 426 415 Total Neurosurgical Volume 728 775 749
Neuroendovascular
Neuroendovascular Surgeons
• Currently fully staffed – no open MD or APP reqs
Expanded Locums Team
• Dr. Richard Dalyai
• Dr. Thomas (Adam) Oliver
Service Line Updates
• Neuro Procedural Team: Beginning phases of building dedicated neuro procedural team, recruiting techs with neuro experience to be part of team.
• Closure Devices: Staff education and re-engagement with Vascade rep for deployment of post procedural closure devices.
• Sedation Narrator: Cath lab management team is currently working with EPIC to build a sedation narrator to improve compliance with medication administration during procedural charting
• Post Procedural Care: Significant efforts to improve documentation, improving cath lab pulse and groin assessments to 100% as well as helping create an assessment frequency document of post-procedural disposition.
• CVSS Education: Created neuro education for CVSS to begin recovering post procedural diagnostic angiograms
Neurology Volume Southern Region Total Admitted Stroke Volume Total Alteplase Volume Total Stroke Alert Volume Stroke Procedural Volume Southern Region FY 21 FY 22 Thrombectomy 50 56 Embolization 33 74 Surgical Clippings 5 1
Neurodiagnostics
EEG Technician Recruitment
• Bethany Ristoff – Started Early March – Currently in training
EEG Growth
• Intranerve: In-house EEG reads were moved from Locums to a third party. This group is responsible for all inpatient reads. Cost savings of 40% per year.
• EEG Fleet Increase: Additional EEG Machine arrived at MHC early February, increasing fleet to (7) total machines. Capital funds will be released to purchase 3 rd EEG machine for MHN late spring.
• Tech Coverage: Consistent increase in EEG volume allowed for expansion to 7 day a week in-house EEG model. No change to on-call tech available for evening/night.
• Pursuing ABRET EEG Lab Accreditation: A successful accreditation means the EEG Laboratory has met strict standards and is to be recognized as a place where patients and physicians can have confidence they are receiving quality diagnostics.
• Additional EEG Slots: Due to increasing demand additional slots added to outpatient scheduling for ambulatory and continuous EEGs
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NeuroCritical Care
Service Line Updates
• NeuroCritical Care Huddle: Neurocritical care huddle began early February. Huddle team includes Neurology, Neurosurgery, Neurocritical Care, and Pulmonary in the ICU with the goal of determining plan of care for the day and improve communication amongst the teams.
• Neuro Critical Care Council: Quarterly meeting with Pulmonary, Trauma, Neurology, Neurosurgery, Neurocritical Care and Nursing Leadership to optimize Neurocritical care. Council will review clinical practice guidelines, develop new processes, review education plans, etc. First meeting held end of March with primary discussion around implementing a dedicated Neuro ICU.
• Nursing Education: Pandemic staffing crisis led to a large majority or new grads in NTICU. Currently fully staffed but working with new RN educator to restart RN lecture series, update existing materials and references, and improve cadence of initial education/competencies and re-education.
• Neuroscience DRG Template Mortality Build: Currently mortality scores do not accurately reflect care provided. Working on template/dot phrases to accurately capture severity of comorbidities/conditions on arrival to accurately reflect O/E
Spine Program
Spine Market Share
• Pre-Op Education Booklet Completed: Pre-op educational booklet is now in the Neurosurgery and Orthospine Clinics. Booklet is provided to all elective surgical patients
• Pre-Op Educational Videos: Funding approved and in the planning states of creating pre op educational videos to be provided to our elective spine population
• MHN post-Op Walker Obtainment: Pilot program at MHN to address gap of patients newly identified in need of FWW post-op who did not have to buy one after discharge or wait for insurance to ship. Now 100% of pts have walker at home by day of discharge. Clinic identifying and providing local resource sheet and prescription.
• Regional Post-Op Mobility: Post- Op Spine pts mobilized an average of 6 hours earlier with 51% being mobilized within 4 hrs. of arrival to inpt floor.
• Pursuit of Joint Commission Disease Specific Spine Accreditation: Dedication Spine coordinator, Implementation of post surgical mobility goals, Pre-operative walker obtainment initiative, Quality Review Process – plan to apply end of current fiscal year
2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 0 10 20 30 40 50
Spine Market Share
Surgical Spine Volume FY 21 FY 22 FY23 TD Memorial Hospital North 628 513 477 Memorial Hospital Central 385 414 363 Overall Combined Volume 1,013 927 840