KRH 2019 Neurology Overview

This past year has once again brought significant change to the Neuroscience & Spine Institute. Sweeping changes in our administration and governance structures have occurred in response to the OIG investigation into our hospital. Despite all these distractions, our mission to provide the best possible care to our patients with neurologic disease remains unchanged and our passion to deliver this care remains undaunted.

Access
Providing timely access to neurologic care for patients throughout northwest Montana has been an ongoing concern of the neurology department and continues to be a significant challenge. The number of neurologists actively practicing in Montana has continued to decline over the past several years and many of our larger communities are routinely left without hospital neurology coverage and outpatient wait times are often unacceptably long or at times simply unavailable. Our neurology group has likewise lost another neurologist in the past year which has further complicated our ability to provide timely access to neurologic care and increased our hospital on-call burden. Nonetheless, the core of our neurology group has remained intact and we have improved access to neurologic care in the past year. As our on-call exposure increases, we are often pressed to accommodate urgent outpatient consults against the backdrop of already busy clinic schedules. Whereas our providers once traveled to 10 outlying rural communities to provide neurology outreach clinics, we are now transitioning to telemedicine to provide services to smaller outlying communities more efficiently while maintaining provider presence for our home clinic and hospital here in Kalispell. We are actively recruiting a new adult neurology position; unfortunately, this has proven to be a difficult task as most competitive neurology recruits now seek positions which do not require being on-call and there are many such positions available throughout the country.

Cerebrovascular Disease
Our stroke service remains actively involved in delivering the best quality care for our patients with cerebrovascular disease. This year, Kalispell Regional Medical Center was awarded Primary Stroke Center certification through the Joint Commission after years of concerted effort by our neurology department. Our neurologists have continued to provide telestroke consultative services to rural hospital emergency rooms throughout Montana. We have continued to add sites this year and now provide acute telestroke consultative services to a total of 12 emergency departments throughout the state of Montana.

Neurophysiology
Our neurophysiology capability (EEG and EMG) has continued to grow over the past year. On the inpatient side, our advanced EEG system allows us to provide 24-hour continuous video EEG monitoring which has been invaluable in providing appropriate patient care. KRH continues to be a referral center for all of Montana for spell evaluation and management of complicated status epilepticus. Our advanced EEG system has improved the quality of our outpatient EEG services and will eventually allow us to interpret EEG studies from outlying communities remotely. Both EEG and EMG testing continue to provide important insight into the diagnosis and treatment of paroxysmal disorders and neuromuscular disease, respectively.

Education
The Department of Neurology continues to host fourth-year medical students from the University of Washington for their required month-long clerkships in neurology. Five students did their neurology clerkship with us this past year and we have committed to five additional students in 2020. The presence of our medical students has further invigorated our already strong commitment to education.

Collaboration
We look forward to continued collaboration with our talented colleagues within the Neuroscience & Spine Institute. Our patients continue to benefit greatly from this ongoing multi-disciplinary neuroscience collaboration. We remain inspired by our patients with neurologic disease and we aspire collectively to provide the best possible care for our patients with neurologic disease.

By Bret Lindsay, MD, neurologist at KRH's Neuroscience & Spine Institute