For the past 60 years, the University of North Carolina Health Care's Department of Neurosurgery has been providing neurological, brain and spine procedures and treatments, innovative research and continual resident training. However, a department with that much scope and size did not develop overnight.
Matthew Ewend, MD, chairman and professor of UNC Health Care's Department of Neurosurgery, and Jim Murphy, associate chair for administration in the Department of Neurosurgery, will be the first to say maintaining a high-quality neurosurgery department within a hospital or health system requires a lot of diligence, patience and collaboration. For hospitals looking to enhance their neurosurgery departments, they might look to these seven suggestions.
1. Collaborate with neurology. UNC Health Care's neurology and neurosurgery departments recently partnered to create a 16-bed "neuroscience" intensive care unit, an increase from the previous eight-bed unit. This collaboration led to the hiring and integration of neurointensivists, nurse practitioners and other staff — and eventually to a better flow for patients. "Given our open access policy, neurosurgery can accept for neurology and vice versa," Mr. Murphy says. "The two departments have worked extremely well together and are accepting appropriate patients."
Dr. Ewend says it made sense for neurology and neurosurgery to partner not only because of their overlapping medical specialty but also because it allowed the entire neuroscience department to progress on its clinical and financial goals. "It has been wildly successfully," he says. "Quality has grown quite high, acuity of patients has gone up and it has been very successful from a physician and financial standpoint."
2. Have dedicated neurointensivists. Dr. Ewend is quick to point out that the neurointensivists are a key cog to the success of the neuro ICU and the department as a whole. They are trained in neurology, neurosurgery and spinal cord care, and having those types of specialized physician staff members gives the department more comfort to take on sicker patients, conduct more complex surgeries and increase volume overall. "We can now take the sickest folks, and it's comforting to know the intensivist team will be there the whole time," Dr. Ewend says.
3. Find out true volume from transfer center data. When Dr. Ewend and the neurosurgery staff looked at transfer center data to see how many patients were transferred or turned away before expanding, they were shocked. He says they were turning away hundreds of neurology requests per year because they didn't have the capacity — which consequently was hurting patients and revenue.
That is one of the major factors why the ICU went from eight to 16 beds. Now, with 16 beds, the unit has a higher volume, does not turn any cases away is bringing in more revenue. In fact, the department came in under budget last year, all by finding an unmet need in the transfer center data, Dr. Ewend says.
4. Reward the nursing staff and other team members. After expanding the department and the ICU, the neurosurgeons and staff consequently had a larger caseload. Mr. Murphy says it makes a huge difference to have dedicated nurses and physician extenders to work in conjunction with the neurosurgeons and residents, and they should be rewarded justly. "The nursing staff was instrumental," Mr. Murphy says. "They were pulling extra shifts and were willing to be flexible." He adds they offered overtime to the nurses, which actually helped the bottom line because they did not have to pay full-time equivalent salary or benefits of new nurses.
Overall, the department added three neurointensivists and eight nurse practitioners. Dr. Ewend says their presence was felt by more than just the physicians — patients also noticed the increase in help, which raised patient satisfaction. "They have a lot more contact with patients in this setting," Dr. Ewend says. "Now patients see a much bigger presence instead of their only point of contact being the attending surgeon, so there's much more interaction, and issues get picked up quicker."
5. Establish a shared vision between the hospital and physicians. Mr. Murphy and Dr. Ewend suggest that hospital neurosurgery department physicians and hospital executives have a regular assessment of shared goals, feasible projections and honest cost expectations. Establishing this type of teamwork will help the neurosurgery department reach its business and financial goals, and more importantly, Mr. Murphy says a comprehensive evaluation will ultimately be in the best interest of the neurosurgery patients.
6. Integrate medical leadership. When UNC Health Care's Department of Neurosurgery opened its new Spine Center — a two-story, freestanding spine and imaging hub — it made to sure to get buy-in from all the different medical specialties — surgical and non-surgical. For example, faculty members from neurosurgery, orthopedics, physical medicine and rehabilitation, anesthesia, pain and physical therapy were consulted to make sure the collective spine center had cohesive medical leadership running the show.
7. Push for gender equality. A national goal was set to have women comprise 20 percent of neurosurgery residency programs by 2020. By 2010, women already constituted 50 percent of UNC Health Care's neurosurgery residency, making UNC Health Care one of the first neurosurgery programs in the country to reach gender equality.
Neurosurgery is traditionally a male-dominated field, and Dr. Ewend says for healthcare to be completely representative, hospitals should actively push to reach gender equity within their neurosurgery departments.
Matthew Ewend, MD, chairman and professor of UNC Health Care's Department of Neurosurgery, and Jim Murphy, associate chair for administration in the Department of Neurosurgery, will be the first to say maintaining a high-quality neurosurgery department within a hospital or health system requires a lot of diligence, patience and collaboration. For hospitals looking to enhance their neurosurgery departments, they might look to these seven suggestions.
1. Collaborate with neurology. UNC Health Care's neurology and neurosurgery departments recently partnered to create a 16-bed "neuroscience" intensive care unit, an increase from the previous eight-bed unit. This collaboration led to the hiring and integration of neurointensivists, nurse practitioners and other staff — and eventually to a better flow for patients. "Given our open access policy, neurosurgery can accept for neurology and vice versa," Mr. Murphy says. "The two departments have worked extremely well together and are accepting appropriate patients."
Dr. Ewend says it made sense for neurology and neurosurgery to partner not only because of their overlapping medical specialty but also because it allowed the entire neuroscience department to progress on its clinical and financial goals. "It has been wildly successfully," he says. "Quality has grown quite high, acuity of patients has gone up and it has been very successful from a physician and financial standpoint."
2. Have dedicated neurointensivists. Dr. Ewend is quick to point out that the neurointensivists are a key cog to the success of the neuro ICU and the department as a whole. They are trained in neurology, neurosurgery and spinal cord care, and having those types of specialized physician staff members gives the department more comfort to take on sicker patients, conduct more complex surgeries and increase volume overall. "We can now take the sickest folks, and it's comforting to know the intensivist team will be there the whole time," Dr. Ewend says.
3. Find out true volume from transfer center data. When Dr. Ewend and the neurosurgery staff looked at transfer center data to see how many patients were transferred or turned away before expanding, they were shocked. He says they were turning away hundreds of neurology requests per year because they didn't have the capacity — which consequently was hurting patients and revenue.
That is one of the major factors why the ICU went from eight to 16 beds. Now, with 16 beds, the unit has a higher volume, does not turn any cases away is bringing in more revenue. In fact, the department came in under budget last year, all by finding an unmet need in the transfer center data, Dr. Ewend says.
4. Reward the nursing staff and other team members. After expanding the department and the ICU, the neurosurgeons and staff consequently had a larger caseload. Mr. Murphy says it makes a huge difference to have dedicated nurses and physician extenders to work in conjunction with the neurosurgeons and residents, and they should be rewarded justly. "The nursing staff was instrumental," Mr. Murphy says. "They were pulling extra shifts and were willing to be flexible." He adds they offered overtime to the nurses, which actually helped the bottom line because they did not have to pay full-time equivalent salary or benefits of new nurses.
Overall, the department added three neurointensivists and eight nurse practitioners. Dr. Ewend says their presence was felt by more than just the physicians — patients also noticed the increase in help, which raised patient satisfaction. "They have a lot more contact with patients in this setting," Dr. Ewend says. "Now patients see a much bigger presence instead of their only point of contact being the attending surgeon, so there's much more interaction, and issues get picked up quicker."
5. Establish a shared vision between the hospital and physicians. Mr. Murphy and Dr. Ewend suggest that hospital neurosurgery department physicians and hospital executives have a regular assessment of shared goals, feasible projections and honest cost expectations. Establishing this type of teamwork will help the neurosurgery department reach its business and financial goals, and more importantly, Mr. Murphy says a comprehensive evaluation will ultimately be in the best interest of the neurosurgery patients.
6. Integrate medical leadership. When UNC Health Care's Department of Neurosurgery opened its new Spine Center — a two-story, freestanding spine and imaging hub — it made to sure to get buy-in from all the different medical specialties — surgical and non-surgical. For example, faculty members from neurosurgery, orthopedics, physical medicine and rehabilitation, anesthesia, pain and physical therapy were consulted to make sure the collective spine center had cohesive medical leadership running the show.
7. Push for gender equality. A national goal was set to have women comprise 20 percent of neurosurgery residency programs by 2020. By 2010, women already constituted 50 percent of UNC Health Care's neurosurgery residency, making UNC Health Care one of the first neurosurgery programs in the country to reach gender equality.
Neurosurgery is traditionally a male-dominated field, and Dr. Ewend says for healthcare to be completely representative, hospitals should actively push to reach gender equity within their neurosurgery departments.
More Articles on Neurosurgery:
101 Hospitals With Great Spine and Neurosurgery Programs
Michigan's Sheridan Community Hospital Highlights New Neurosurgery Program
Neurosurgery Residents Say New Rules on Work Hours Hinder Training