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Understanding and treating the wide range of neurological disorders — from brain tumors and stroke to traumatic brain or spinal injury or epilepsy — requires a dedicated team of extraordinary clinical specialists with access to the most advanced neurosurgical technology.
The Neuroscience Institute at Maine Medical Center has both. In fact, its experts developed a model of care for acute stroke intervention that’s become the industry standard. Using advanced CT Perfusion imaging, the treatment team can identify the patients who will benefit from life-saving thrombectomy to remove the clot causing the stroke.
“Our patients don’t need to travel outside the state to access a system of care that is as good as any program in the nation. We built the model here at MMC over the past 10 years, and are among just a handful of hospitals with the most advanced technology supporting it,” said neurosurgeon and Director of the Neuroscience Institute at Maine Medical Center, Robert Ecker, MD.
“In stroke, every millisecond matters as millions of neurons die every minute a brain vessel is blocked,” said Dr. Ecker. “We leverage the latest technologies and our care pathway to achieve the best possible outcomes for patients.”
In brain tumor surgery, MMC is one of the first hospitals in the country and the only one in Maine to use 5-ALA, a state-of-the-art, FDA-approved imaging agent that helps surgeons remove brain tumors. Patients drink the medicine 5-ALA, and surgeons can precisely locate brain tumor cells using a special fluorescent light, maximizing the safe removal of the tumor and improving patient survival and quality of life.
In addition to 5-ALA, MMC was an early adopter of indocyanine green (ICG) angiography, a state-of-the-art imaging technology that after an IV injection of ICG allows the surgeon to visualize that an aneurysm has been cured and the surrounding blood vessels are open, making the surgery safer. Surgeons at MMC now have a decade of experience with ICG.
Neurosurgeons at MMC are the first surgeons in Maine to use laser interstitial thermal therapy (LITT). LITT is a minimally invasive MRI-guided surgical technique that involves a tiny incision and small hole in the skull to treat tumors and epilepsy where previously only much larger craniotomies were needed.
This significant investment in the most advanced technology available, together with unparalleled expertise, reflects a system-wide commitment to provide world-class coordinated, tertiary care to our patients and communities.
In its commitment to enhance care for opioid-exposed newborns and their families, the MaineHealth Pediatric service line, in partnership with our local health systems, is evolving how substance-exposed newborns (SEN) are treated. In the past, the majority of SEN babies born at a community hospital were transferred to Maine Medical Center Neonatal Intensive Care Unit (NICU) for evaluation and care. The average length of stay for treatment was 13.1 days.
Eat, Sleep, Console
The "Eat, Sleep, Console" model is an innovative care pathway that aims to keep mothers and babies in their local community birthing hospital and nursery, with a transfer to MMC NICU only if the baby requires long-term pharmacological treatment. This care model has reduced average length of stay to just 6.9 days while enabling more families to remain together, close to home.
People living in rural areas of northern New England often have higher-than-average rates of cardiovascular disease. This high cardiovascular disease burden, coupled with challenges in access to care, often contributes to a shorter life expectancy for patients in rural areas compared with those in metropolitan areas. Dartmouth-Hitchcock Medical Center (DHMC) and Maine Medical Center were awarded a $3.9 million grant from the National Institutes of Health’s (NIH) National Heart, Lung, and Blood Institute to increase access to cardiac surgery clinical trials among rural populations.
The grant also provides funding to train the next generation of cardiovascular clinical researchers in late-stage translational research, through a Clinical and Implementation Research Skills Program (CIRSP). The CIRSP program will provide junior faculty and fellows from DHMC and MMC with comprehensive didactic training and mentored research, and will also provide funding for the education and training of national scholars drawn from populations traditionally underrepresented in clinical research.
“The CIRSP program will be a valuable resource for young surgeons from MMC and DHMC who wish to engage in clinical research,” said Doug Sawyer, MD, co-investigator on the grant and MMC’s Chief Academic Officer. “As doctors, we always want to move toward providing the most up-to-date treatments for our patients, and building our research capabilities is an important way to do that.”
The Innovation Cohort, supported by the MaineHealth Center for Performance Improvement and the Maine Technology Institute, launched in 2018 to empower trainees, clinicians and other care team members to develop novel solutions that can be scaled to address unmet clinical needs, improve patient care and reduce cost. The program combines the remarkable insights of MaineHealth employees with the talents of science and technology experts to transform “back of the envelope” drawings into products and services ready for clinical use.
To date, 12 provisional patents have been filed and several projects have advanced to partnership/startup stage, ranging from medical devices and IT applications to alternative care pathways for rural patients and new Mainers. Four projects are currently seeking external funding, and one is poised to incorporate as its own company in the second half of 2019. The Innovation Cohort welcomed its fourth cohort in fall 2019.
MaineHealth continues to leverage innovative technologies to expand access and increase care coordination. In 2019, MaineHealth provided 15,000 virtual visits to patients in nearly 20 specialties. Using video technology, families of children with serious gastrointestinal conditions can, for the first time, access vital nutrition services close to home and adults suffering from seizures can follow up with their neurologists without arranging for caregivers to drive them to Portland. MaineHealth continues to provide speech therapy to children at school, world-class stroke care directly to patients at their local hospitals, and home care services, all over video.
Project ECHO offers continuing professional education to providers via a case review model. MaineHealth ECHO currently covers 10 topics, including palliative care and breast cancer genetics, expanding the reach of our specialists by training local primary care physicians. The newest telehealth platform, eConsults, offers local providers the option to request consults from specialists anywhere in the system, keeping appropriate patients close to home and ensuring only medically necessary transfers.
“Patient safety is our number-one priority, so when the pharmacy recognized an increasing trend of nursing requests for albuterol inhalers, we wanted to learn the reason for the uptick and used OpEx to devise a solution,” said MMC Senior Director of Pharmacy Ricky Meinking, PharmD.
Upon reviewing the Pharmacy’s dispensing history, it became evident that some nursing requests for inhalers had already been completed and delivered, but were being reordered. The standard process was that nurses would order an inhaler, which the Pharmacy would label, dispense and deliver to the floor; but if the inhaler was not immediately found, a new inhaler would be reordered. A safe solution was needed to dispense an inhaler from the floors while ensuring each inhaler was labeled.
The Pharmacy and nursing teams worked together to develop a technology-driven solution using Pyxis ES, an integrated platform that enables nurses to dispense an inhaler and print a patient-specific label with all requirements in real-time on the floor; this provides more timely administration to the patient while ensuring all inhalers are labeled. This resulted in significantly reducing the number of duplicative orders and is saving thousands of dollars a month.
“This KPI was a big win from a safety and patient satisfaction perspective, and the icing on the cake was the significant financial savings due to this process improvement using the latest technology,” said Meinking.