Inpatient Care: Growth of the Clinical Enterprise
The growth in operative volume in our Department has necessitated the dedication of new resources to our mission for patient care. In addition, the recruitment of new faculty has brought new skills and techniques into the operating room that require expanded surgical facilities and equipment. Over the past five years, our Department has grown to incorporate the latest surgical instruments, including new surgical microscopes, intra-operative angiography, completely new intra-operative neurophysiology equipment for deep brain electrode recording and placement, expanded frameless navigation capabilities, the newest radiosurgical treatment modalities, and with the recruitment of an endovascular neurosurgeon, the creation of two new angiography suites. As the primary provider of spinal neurosurgical care in Rochester, we continue to update the implants and techniques available, including minimally invasive technology.
As patient care demands have increased, we have also dedicated new inpatient units for the care of neurosurgical patients. The main neurosurgical ward has been renovated, a new Trauma-ICU has been opened that allows for the care of multi-system trauma including brain and spinal injury.
Outpatient Experience: the "Art" of Patient Care
The Department opened a new outpatient clinic at 2180 S. Clinton Ave. All NS faculty (except for Dr. Wensel) see patients for their practices & the Resident Clinic is also held every 2nd and 4th Friday of the month.
All residents, PGY-1 through PGY-7 participate at this primary outpatient site, located at 2180 South Clinton Avenue in Rochester. 2180 South Clinton Ave is 11,000 sq. ft. including a 5,300 ft pain treatment center with 5 exam rooms, and fluoroscopic treatment room and recovery rooms. The patient evaluation space includes 14 exams rooms, 3 dedicated physician rooms for dictation and consultation, with 10 workstations, and a common waiting room. Full-time secretarial staff responsible for scheduling, outpatient testing, surgical scheduling and follow-up visits staff the clinic for residents and attendings. Most recently, we have added a physical therapy at this clinic location.
A secondary outpatient site is in Drs. Wensel's and Silberstein's offices at the Rochester General Hospital Professional Office Building. The offices are approximately 2,700 sq ft with 4 exams rooms and 2 consult rooms.plus support space. Full-time secretarial staff are responsible for scheduling, outpatient testing, surgical scheduling and follow-up visits for the RGH attendings.
The Resident Clinic has evolved over the past five years into a highly-structured experience offering the residents and patients a strong sense of identification and “ownership”. Beginning with the PGY-1 year (three month neurosurgery rotation), the resident is brought into the clinic setting ready to acquire and amplify his/her history taking and physical examination skills. As new patients arrive in the clinic, a junior resident first sees the patient, takes a careful history and does a full neurological exam, initially either with a senior resident or the supervising attending neurosurgeon (usually the Program Director). The findings are then discussed in detail with the attending neurosurgeon; imaging studies are viewed, and a differential diagnosis is formulated. If further studies are determined to be necessary, they can then be recommended. When a treatment plan is determined, the resident and the attending return to the room to complete the visit..
If the patient is deemed to need surgical intervention, the chief resident is introduced to the patient and he/she becomes acquainted with the patient. In scheduling the patient for surgery to be admitted on the service of the supervising neurosurgeon, every effort is made to pair the chief resident with the junior who initially saw the patient. If surgery is not recommended, then the resident has the opportunity to formulate a plan for further management of the patient’s problem becoming familiar with a variety of modalities.
As patients return to clinic for follow up, the resident who initially saw the patient is prioritized to see that patient again, particularly in the post-op situation. Since Resident Clinic occurs on the Friday at 10:00a directly following academic conference, most residents are available. Resident presence in the OR on Friday afternoon is kept to an absolute minimum. The outpatient clinical is constructed to promote a strong sense of individual commitment and ownership, mimicking the doctor-patient relationship that the resident will encounter in the practice of clinical neurosurgery. There are multiple opportunities for residents to work with faculty in their own specialty clinics to further round out the experience of the residents at all levels.