Saint Thomas Hospital's Unity System: What a Fully-Integrated Neurosurgical Center Looks Like

On April 11, Saint Thomas Hospital in Nashville, Tenn., opened the first fully-integrated neurosurgical center of its kind in the United States. The center, called Unity System, combines communication, teamwork and technology to treat brain tumors and other neurological disorders. Steven Abram, MD, and Paul Rosenblatt, MD, co-medical directors of Saint Thomas Hospital's Brain and Spine Tumor Center, explain what a fully-integrated neurosurgical center looks like and why it's important for patient care.

Saint Thomas Hospital opens a new neurosurgical center.Communicating in real time creates real value

Real-time communication that connects multidisciplinary specialists is one aspect of a fully-integrated neurosurgery center. Unity System's physician team meets weekly as a tumor board to discuss cases preoperatively, a practice that occurs at many neurosurgery centers. Unlike most centers, however, the physician team is able to stay connected from beginning to end on each case and make treatment decisions as a group more easily due to integrative technology in the operating room. The OR's video and audio capabilities allow the neurosurgeons to consult with other members of the team who are not in the OR in real time.  

This communication, combined with the OR's intraoperative MRI, allows Dr. Abram, a neurosurgeon, to communicate with the pathologist, determine if the entire tumor was removed and make treatment decisions without leaving the room or closing up the patient. In fact, Dr. Abram says the center's intraoperative treatment plan has changed approximately 50 percent of the time based on data from the intraoperative MRI. Being able to access data and consult with other specialists quickly helps avoid delays in care and improves efficiency because the surgeon does not need to leave the OR or reopen the patient if the tumor was not completely eradicated.

"The real distinction [between other centers and ours] isn't just the technology — the fact that we have the intraoperative MRI, the fact that we have the latest technologies for stereotactic radiosurgery — the difference and the power is how we're communicating and the platforms we use to communicate," Dr. Abram says.

Working together as a team

Another component of fully-integrated care is teamwork — not just being part of a team in name, but actually working together collaboratively and honestly. "What's unique [about Unity System] is how [the physicians] work together in an unbiased way to determine the best combination of treatment," says Stefan Vilsmeier, founder and CEO of Brainlab, the company that provided much of the center's technology. Getting many physicians from different backgrounds and perspectives to truly function as a team can be challenging; it requires everyone to buy in to the philosophy that collaboration can enhance patient care. The extent of cooperation in a team also depends on the team members. "It takes a special chemistry between people to realize we're not competing with each other; we're serving one patient," says Dr. Rosenblatt, a radiation oncologist.

Embracing the role of technology

Adopting technology that benefits both the patient clinically and the physicians and staff operationally is also part of a fully-integrated center. The hybrid neurosurgical OR, intraoperative MRI, radiosurgery equipment and other technology all help to optimize care delivery. "The commitment to leveraging software technology to make the best decisions for patients is what sets this program apart," Mr. Vilsmeier says. "Typically many hospitals have a tumor board, a discussion forum to have a consensus on how patients are treated. But typically they don't have the technology infrastructure to facilitate that." The technology thus enhances the center's ability to provide coordinated care efficiently.

"You have to have the right team of physicians as well as be willing to work with developers of new technology so that you are advancing the ability to perform safer and more effective therapies," Dr. Rosenblatt says. "The administration has to be willing to invest in the technology. And it's a large investment and ongoing, because the technology keeps changing."

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