Hospital neuroscience services treat a broad range of conditions, from headache disorders to stroke to Alzheimer's. Some hospitals and health systems are developing neuroscience centers to better coordinate these services and boost quality of care. The Cushing Neuroscience Institute, part of the North Shore-Long Island Jewish Health System in Manhasset, N.Y., was established in 2006 and offers numerous programs for different neuroscience-related disorders. Raj K. Narayan, MD, chair of the department of neurosurgery at North Shore University Hospital and Long Island Jewish Medical Center and director of CNI, shares nine steps to help hospitals and health systems build a successful neuroscience center.
1. Define "neuroscience center." Dr. Narayan says the term "neuroscience center" is used so often that it has started to lose its meaning. While a hospital with a large team of multidisciplinary physicians may designate its program as a neuroscience center, a hospital with a department of only one or two neurologists may also call its program a neuroscience center. "First of all, the definition of a neuroscience center needs to be clearly understood by everybody who is trying to create one," he says. "For it to be a true neuroscience center, it has to be a combination of multiple disciplines."
2. Choose one director. While a successful neuroscience center relies on a cooperative, multidisciplinary team, there needs to be one leader to provide direction. Dr. Narayan says the specialty of the director is less important than his or her leadership qualities, such as communication and organization.
3. Gather a multidisciplinary team. A neuroscience center should include neurology; neurosurgery; neuroradiology; neuropathology; otolaryngology; physical medicine; and rehabilitation, according to Dr. Narayan. Forming a team of experts from different specialties helps physicians coordinate care and treat the whole patient.
4. Include subspecialists. Within the various disciplines there should be representatives of subspecialties, such as neurooncology, cerebrovascular care and pediatric neurology. "To really provide state-of-the-art care, you need to have people who have special interests and experience in some of those areas," Dr. Narayan says. For example, neuroscience centers should also have a neuro-intensive care unit because the physicians and staff are trained to treat specific neurological conditions. "The quality of care provided to patients in a specialized neuro ICU is superior to that which can generally be achieved in a general ICU," Dr. Narayan says.
5. Encourage collaboration among team members. The neuroscience team should meet regularly to discuss cases from different perspectives to reach fully informed decisions. "There has to be a strong degree of collaboration between those disciplines so a patient can get the best opinions regardless of which door they enter through," Dr. Narayan says.
6. Establish a morbidity and mortality program. An M&M program, in which physicians discuss each death and complication that occurred at the center, provides quality control. Dr. Narayan recommends hosting a monthly M&M meeting where the center's team can evaluate the cause of death — whether it was due to the disease itself or an error, such as performing an inappropriate procedure. These discussions hold everyone accountable for the center's outcomes and present an opportunity to learn from any mistakes. "We have to have a sense of assurance that we could not have done things better," Dr. Narayan says. "If we could have done things better, we need to learn from those experiences."
7. Measure outcomes. Quantifying outcomes at a neuroscience is a difficult but necessary task, as it provides a method for tracking improvement over time. To be meaningful, outcomes data need to be separated by the type of condition, the diagnosis under that condition and patients' demographics. For example, Dr. Narayan says outcomes for a patient who has a grade five — the highest risk level — subarachnoid hemorrhage, should be separated from outcomes for a patient with a grade zero subarachnoid hemorrhage, which has the lowest risk of death. "Outcomes have to be divided and subdivided into what the patient looked like when [he or she] came in," he says. "When you mix all of those in one pool and come up with a lumped outcome, it may not mean that much."
8. Evaluate new therapies. In addition to treating patients, a hospital neuroscience center should evaluate new therapies for their potential clinical and financial impact. Dr. Narayan suggests the center create a committee to assess new medications and devices by comparing them with existing products. "There's a lot of technology and a lot of medications that are constantly coming down the pike, and there's a great deal of pressure to use the latest device or the latest medication, even if that medicine has not been shown to be superior to what is already available. And they're usually several times as expensive," he says.
9. Conduct research. A true neuroscience center needs to be adding to the body of knowledge in the field. "One has to invest in research in order to stay at the cutting edge," Dr. Narayan says. "It adds to the excitement and helps attract the best and the brightest people to the center."
Learn more about the Cushing Neuroscience Institute.
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1. Define "neuroscience center." Dr. Narayan says the term "neuroscience center" is used so often that it has started to lose its meaning. While a hospital with a large team of multidisciplinary physicians may designate its program as a neuroscience center, a hospital with a department of only one or two neurologists may also call its program a neuroscience center. "First of all, the definition of a neuroscience center needs to be clearly understood by everybody who is trying to create one," he says. "For it to be a true neuroscience center, it has to be a combination of multiple disciplines."
2. Choose one director. While a successful neuroscience center relies on a cooperative, multidisciplinary team, there needs to be one leader to provide direction. Dr. Narayan says the specialty of the director is less important than his or her leadership qualities, such as communication and organization.
3. Gather a multidisciplinary team. A neuroscience center should include neurology; neurosurgery; neuroradiology; neuropathology; otolaryngology; physical medicine; and rehabilitation, according to Dr. Narayan. Forming a team of experts from different specialties helps physicians coordinate care and treat the whole patient.
4. Include subspecialists. Within the various disciplines there should be representatives of subspecialties, such as neurooncology, cerebrovascular care and pediatric neurology. "To really provide state-of-the-art care, you need to have people who have special interests and experience in some of those areas," Dr. Narayan says. For example, neuroscience centers should also have a neuro-intensive care unit because the physicians and staff are trained to treat specific neurological conditions. "The quality of care provided to patients in a specialized neuro ICU is superior to that which can generally be achieved in a general ICU," Dr. Narayan says.
5. Encourage collaboration among team members. The neuroscience team should meet regularly to discuss cases from different perspectives to reach fully informed decisions. "There has to be a strong degree of collaboration between those disciplines so a patient can get the best opinions regardless of which door they enter through," Dr. Narayan says.
6. Establish a morbidity and mortality program. An M&M program, in which physicians discuss each death and complication that occurred at the center, provides quality control. Dr. Narayan recommends hosting a monthly M&M meeting where the center's team can evaluate the cause of death — whether it was due to the disease itself or an error, such as performing an inappropriate procedure. These discussions hold everyone accountable for the center's outcomes and present an opportunity to learn from any mistakes. "We have to have a sense of assurance that we could not have done things better," Dr. Narayan says. "If we could have done things better, we need to learn from those experiences."
7. Measure outcomes. Quantifying outcomes at a neuroscience is a difficult but necessary task, as it provides a method for tracking improvement over time. To be meaningful, outcomes data need to be separated by the type of condition, the diagnosis under that condition and patients' demographics. For example, Dr. Narayan says outcomes for a patient who has a grade five — the highest risk level — subarachnoid hemorrhage, should be separated from outcomes for a patient with a grade zero subarachnoid hemorrhage, which has the lowest risk of death. "Outcomes have to be divided and subdivided into what the patient looked like when [he or she] came in," he says. "When you mix all of those in one pool and come up with a lumped outcome, it may not mean that much."
8. Evaluate new therapies. In addition to treating patients, a hospital neuroscience center should evaluate new therapies for their potential clinical and financial impact. Dr. Narayan suggests the center create a committee to assess new medications and devices by comparing them with existing products. "There's a lot of technology and a lot of medications that are constantly coming down the pike, and there's a great deal of pressure to use the latest device or the latest medication, even if that medicine has not been shown to be superior to what is already available. And they're usually several times as expensive," he says.
9. Conduct research. A true neuroscience center needs to be adding to the body of knowledge in the field. "One has to invest in research in order to stay at the cutting edge," Dr. Narayan says. "It adds to the excitement and helps attract the best and the brightest people to the center."
Learn more about the Cushing Neuroscience Institute.
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