An Eye to the Future at Mischer Neuroscience Institute
A model for best practices in clinical care, the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center actively supports the next generation of physicians through teaching and learning. Through a robust research program, physician investigators at the Institute discover new treatments and move advances in neuroscience quickly to the bedside.
“Our goal at Mischer Neuroscience Institute is to instill a culture of accountability and adaptability in a time of unprecedented change in health care,” says Dong Kim, M.D., director of the Institute and professor and chair of the Vivian L. Smith Department of Neurosurgery at UTHealth. “Performance improvement tools and strategies keep progressing, which allows us to sharpen our focus on collaboration and results.”
Strategies used at the Texas Medical Center are also in place at all Mischer Neuroscience Associates (MNA) practices located across the Greater Houston area. “As healthcare reform moves the focus of medicine toward keeping patients healthy, MNA’s quality and accountability effort has expanded,” says Rahil Tai, manager of clinical quality review for the Memorial Hermann Health System.
“By proactively looking at our own data and continuously improving our practice, we remain among the top performing hospitals.”
Moving Quality Initiatives to the Community
MNA practices now hold regular Morbidity and Mortality (M&M) Conferences in which all neurosurgery operative cases with complications, excessive length of stay or unexpected outcomes are reviewed – just one example of how the Institute has moved quality initiatives used in academic medical centers to the community. “M&M Conferences allow physicians to sit down as partners and have cases presented to them,” Tai says. “If an outcome was unexpected, they look at it analytically and discuss what could have been done differently, which allows us to identify small problems before they become larger, and implement practices to prevent future occurrences.”
The result has been positive. “We’re doing great,” Tai says. “Every year we have fewer complications. If there’s a variance in practice or a complication we can identify it. It’s a collegial peer-review process. The objective is not punitive but educational, so that physicians in MNA practices can learn from these cases.”
Teaching the Next Generation
Mischer Neuroscience Institute’s relentless focus on quality is transferred to the next generation through education. Through its affiliation with the Vivian L. Smith Department of Neurosurgery and the department of Neurology at UTHealth, the Institute offers both neurosurgery and neurology residencies and fellowships.
“We are fortunate to have outstanding teachers and mentors, cutting-edge research and a large, diverse patient population in Houston, which gives our residents and fellows exposure to an exceptionally broad range of cases,” says Arthur L. Day, M.D., director of clinical education in neurosurgery at the Institute and professor and vice chair of neurosurgery at UTHealth. “Multiple neuroscience subspecialties are well represented in our educational programs and supported by the latest technology.”
Fellowships offered include cerebrovascular/skull base, neurocritical care, neuroendovascular surgery, stroke and stroke interventional track, multiple sclerosis, movement disorders, neuro-oncology, neuromuscular diseases and epilepsy. The Institute is currently training 16 neurosurgery residents and one fellow through a program started in 2008; in the department of Neurology there are 28 neurology residents and 13 fellows. “We’ve developed a system to help residents clearly understand the responsibilities they’ll have after they complete their programs,” Dr. Day says. “They include the basics of quality patient care from the physician standpoint – promptness, doing dictations on time and including the correct information, checking up on patients within a few hours after surgery, and strategies to keep infection rates low.”
Senior residents present quality projects at the end of their seventh year of training. “They spend their last year polishing up the areas they need to refine and some may even start a fellowship while still in residency,” he says. “They develop projects in areas where they see opportunities for improvement, implement them and present their results and conclusions.”
A New Focus on Discovery
With high quality scores, the citywide infrastructure of MNA, and residencies and fellowships in place, Dr. Dong Kim has turned more of his focus to the discovery of new knowledge that will change the face of patient care. Clinical research is critical to optimizing care and providing patients with state-of-the-art options. Under Dr. Kim’s leadership, physicians affiliated with the Mischer Neuroscience Institute are bridging research and clinical practice. Patients are evaluated and those who meet qualifying criteria are invited to participate in innovative research studies.
Among those under way are the HOPES trial (Hypothermia for Patients Requiring Evacuation of Subdural Hematoma), a randomized, prospective trial studying the effect of very early cooling in patients undergoing evacuation of acute subdural hematomas, and the National Center for Testing Treatments in Chronic Spinal Cord Injury and Traumatic Brain Injury (NCTT), which is unique in its focus on research to improve the lives of people who have passed the acute phase of spinal cord injury and are living with the injury as a lifelong condition.
Through the NCTT and The Will Erwin Headache Research Center, leadership at the Mischer Neuroscience Institute has committed to investment in discovery in two areas that affect Americans profoundly. Recruiting physicians who will spend 75 percent of their time focused on research is a new direction for the Institute.
“Our culture encourages asking questions,” Dr. Dong Kim says. “In our search for answers we create new research infrastructures that provide substantial data on long-term outcomes. We tie that data to the decisions we make about future research. In this way we continue down the path to revolutionize neuroscience.”