GPS-guided, Minimally Invasive Treatment for Brain Tumors

GPS-guided, Minimally Invasive Treatment for Brain Tumors

GPS-guided, Minimally Invasive Treatment for Brain Tumors
A new technology at Jewish Hospital, part of KentuckyOne Health, can help patients with epilepsy and brain tumors previously considered inoperable.

The NeuroBlate System is a new technology that treats tumors and epilepsy using a laser guided by magnetic resonance imaging (MRI). The laser applies heat directly to diseased tissue in the brain until the damaged area dies. Depending on the size of the tumor, removal can take as little as two minutes.

When using NeuroBlate to treat patients, surgeons make a small opening in the skull. The tiny incision means NeuroBlate patients have less pain, discomfort and scarring, as well as a faster recovery following the procedure, compared to patients who have open procedures.

“NeuroBlate is a minimal access procedure — it’s done through a hole the size of a pencil eraser, and we only need to make one incision the width of a pinkie,” said Brian J. Williams, MD, neurosurgeon and director of the Brain Tumor Program in the University of Louisville Department of Neurosurgery. Dr. Williams uses the NeuroBlate system on brain tumors. “The procedure is done using a GPS-guiding system that allows us to be ultra-precise. We watch the brain in real time to monitor the procedure.”

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A Broader Scope

NeuroBlate procedureNeuroBlate allows physicians to treat areas of the brain that are difficult to reach and is often used on patients who have recurring brain tumors. NeuroBlate may also be appropriate for patients with epilepsy who have tried two or more medications and still have uncontrolled symptoms.

“There are a lot of patients having seizures who don’t realize something can be done,” said Joseph S. Neimat, MD, neurosurgeon and chair of the Department of Neurosurgery at the University of Louisville. “If you’ve had seizures twice a week for 20 years, that’s a tough way to live. It’s difficult to hold down a job or drive. With NeuroBlate, we help patients get their lives back.”

NeuroBlate is part of the neurosurgical hybrid operating room at Jewish Hospital, which was funded by the Jewish Hospital & St. Mary’s Foundation.

This article originally appeared in the Winter 2017 edition of One Health magazine. For the latest news on KentuckyOne Health, visit our News Center and read more about robotic laser therapy for brain tumors.

Say Goodbye to Blood Thinners

Goodbye to Blood Thinners

Say goodbye to blood thinners

A small umbrella shaped device is revolutionizing stroke prevention therapy for patients with atrial fibrillation.

The WATCHMAN™ device is now available at Jewish Hospital, part of KentuckyOne Health, which may eliminate long-term use of blood thinners for some patients with nonvalvular atrial fibrillation (AFib).

“This is a therapy revolution for stroke prevention in these patients,” said Rakesh Gopinathannair, MD, MA, FHRS, director of cardiac electrophysiology at the University of Louisville School of Medicine and Jewish Hospital. “If you have been told you need to take blood thinners for the rest of your life because you have AFib and you have concerns about doing so, this is a great alternative.”

How It Works

Shaped like a small umbrella, the WATCHMAN implant (pictured below) is designed to catch blood clots that patients with AFib may develop. A highly trained cardiac electrophysiologist or interventional cardiologist inserts the implant, which is roughly the size of a quarter, using a minimally invasive procedure. The physician places a large IV into the femoral vein in the groin and threads the WATCHMAN device through a catheter until it reaches the upper left chamber of the heart.

Once in place, the device is well-positioned to catch clots that may form in the left atrial appendage, thus preventing these clots from breaking loose and traveling to the brain or lungs and causing a stroke.

The procedure to place the WATCHMAN is performed under general anesthesia, and typically takes between one and two hours. Patients typically stay in the hospital for just one day and then return home.

Easing Off Medication

Following the procedure, doctors will prescribe six weeks of a blood thinner, but that is only temporary.

“Usually within four-and-a-half months, the patient can be off all blood thinners — possibly for the rest of his or her life,” Dr. Gopinathannair said. “If you are seeking an alternative to blood-thinning medications, talk with your health care provider about this option.”

If you have AFib and are on blood thinners, you might be a candidate for WATCHMAN. To reach the Jewish Hospital WATCHMAN Team, call 844.206.3936.

“The WATCHMAN™ will be a game changer in how we prevent strokes in patients with nonvalvular AFib. Jewish Hospital offers patients in the region a great opportunity to try this option, and we have a great team in place with all of the expertise necessary to get this done.”

Rakesh Gopinathannair, MD, MA, FHRS

This article originally appeared in the Fall 2016 edition of One Health Magazine. For the latest news on KentuckyOne Health, visit our News Center and read more about the WATCHMAN procedure.

A Quicker, Better ER

Emergency Care

A Quicker Better ER

Providing better care when you need it most

The emergency room (ER) can be an extremely busy place. The Centers for Disease Control and Prevention found that there are 136.3 million emergency department visits each year in the United States, with the south having one of the highest population-based visit rates. With such high volume, patients can easily feel lost or forgotten in the crowd.

“At the end of the day, all patients really care about is getting quality care within a reasonable time frame,” said Michael Waterman, division director, performance excellence at KentuckyOne Health. “While we were having some successes, we knew we could improve and that our patients deserved better.”

A look at the ER data from all KentuckyOne Health facilities revealed opportunities to improve care and enhance the patient experience. One of the most telling numbers came from the “left without being seen” (LWBS) rates – a number that represents patients who leave the ER before getting help due to long waits.

“The worst kind of care is no care at all,” Waterman said. “Our LWBS rates showed that people from our communities were coming in and leaving before we could get to them. That wasn’t acceptable, and we knew there had to be a better way.”

Reducing Wait Times

In  February 2016, the first KentuckyOne Health facility, Sts. Mary & Elizabeth Hospital, began its ER redesign with $9 million from the Jewish Hospital and St. Mary’s Foundation. The process started by bringing in consultants who had worked with more than 200 ERs across North America.

“We saw where there were certain holes in our processes that provided us with opportunities for improvement,” Waterman said. “We just needed a tried-and-true template to get us moving in the right direction.”

After seeing improved outcomes within the Sts. Mary & Elizabeth Hospital ER, the decision was made in March to begin redesigning the ER in each KentuckyOne Health facility. Every ER went through a four-day process to initiate the transformation.

Day 1: Analysis

The hospital supplied a multidisciplinary team to analyze the current state of their ER. They reviewed what was done well, what could be improved upon and future goals.

Then, the department went through a “lean” process, where the team examined their current procedures and pointed out any step that didn’t add any value or contribute to meeting patients’ needs.

“When we sent the teams to review their own processes, it quickly became apparent that many of the steps, such as asking people for their information multiple times, were adding no value,” Waterman said. “By cutting this waste, we could drastically reduce the time necessary to see patients, treat them and send them on their way.”

Day 2: Redesign

The redesign process was modeled after the Sts. Mary & Elizabeth Hospital ER. However, each site modified the original plan to make it better match their setup. These modifications came from feedback from every member of the department. At Jewish Hospital and Sts. Mary & Elizabeth Hospital, Jewish Hospital and Sts. Mary’s Foundation provided funding for expansions and remodeling.

“All team members were involved with tweaking the processes to match their site,” said Jennifer Nolan, president, Sts. Mary & Elizabeth Hospital and Our Lady of Peace. “this wasn’t something that was being done to them by some outside force. It was an opportunity to control their own future as a department.”

Days 3 & 4: Testing

Once the redesigned process was created, the hospital teams tested it. Modifications were made as needed and then the entire process was tested again.

“A great part of this process is we collected data in real time,” Nolan said. “So we could immediately see if our goals were being met and then make process changes, if necessary.”

In the Future

The results of this four-day process across the entire system have been promising.

“Based on some preliminary data, we can see patients’ experiences are improving,” Waterman said. “Regarding LWBS, we have seen a range of results with reduction from 15 to 63 percents. The time from when a patient arrives to seeing a provider [physician or nurse practitioner] has decreased 38 percent on average across all our locations. The length of stay is also down by an average of 17 percents, and in some locations, it’s been reduced more than 30 percent.”

Regardless of how things are going, the ER teams meet every day to discuss the previous day’s performance and ideas of how to continuously improve.

“The future only looks brighter for our ERs,” Waterman said. “We allowed those in the department to make the process their own and put structures in place to provide them help and suggestions when they need it.”

This article originally appeared in the Fall 2016 edition of One Health Magazine. For the latest news on KentuckyOne Health, visit our News Center and read more about our 30-minute ER pledge.


Advanced Imaging Enters the OR

Neurology imaging

Saint Joseph Hospital, part of KentuckyOne Health, is the 10th facility in the United States to utilize computed tomography (CT) technology during cranial and spinal procedures.

For some time, the neurology team at KentuckyOne Health has had its eyes on one of the most sophisticated tools available to surgeons today — the Airo Mobile Intraoperative CT®. Now, Saint Joseph Hospital is utilizing the next-generation technology.

“It has been a two-year process to get all of the pieces in place,” said Christopher Robb, director of surgical services with Saint Joseph Hospital. “It has been well worth the time. This is a tool that enhances the quality of surgical care and the experience of our patients.”


How It Works

The digital CT scanner works in tandem with Saint Joseph Hospital’s guided imagery system to scan the human body in real time and communicate images to surgeons as they work.

“Traditionally, surgeons base their work on diagnostic images that were gathered a week or two before the actual operation,” Robb said. “With the Airo, they can gain a better understanding of the area where they are working while they are operating.”

As a result of the improved views, surgeons are able to perform surgeries with more efficiency and spot-on accuracy, making smaller incisions that may heal more quickly. Patients may also experience decreased risk of infections.

“We are extremely satisfied with the results we have seen by utilizing the Airo at Saint Joseph Hospital,” Robb said. “We look forward to bringing this technology to more KentuckyOne Health facilities in the future.”