Carondelet Becomes Global Model for Neurological Care

By Christy Krueger –

Not long ago, Southern Arizona residents who suffered a significant stroke or brain or spinal cord injury often faced the added stress of having to be transferred out of town for care.

Today, Carondelet Neurological Institute at St. Joseph’s Hospital provides 24/7 access to specialists, cutting-edge technology and support for patients and families that goes beyond just meeting their medical needs.

Carondelet Neurological Institute on Tucson’s eastside opened its doors in 2008 on the top two floors of St. Joseph’s new medical pavilion. A significant part of the Institute’s success is credited to Medical Director Dr. Eric Sipos, a Johns Hopkins-trained neurosurgeon, and Chairman Dr. Robert Goldfarb, whose career in Southern Arizona spans more than 40 years in neurosurgery.

Together, with Carondelet Health Network leaders and their partners at Western Neurosurgery, they developed the concept that led to the creation of a premier neurological facility.

Prior to the opening of CNI, neurological patients were often sent out of town for emergency care, said Goldfarb, because local hospitals didn’t always have a neurosurgeon on call or there were a lack of ICU beds.

Today, CNI is rated among the best in the nation in caring for strokes and designated as a Center of Excellence by NeuStrategy, providing specialized care for neuromuscular disorders, brain and spine tumors, epilepsy, Alzheimer’s and the surgical treatment of Parkinson’s disease, according to the Institute.

Goldfarb and Sipos approached several area hospitals with the idea of developing a center dedicated to neurological care. Carondelet recognized the need. “They said give us your vision,” Goldfarb recalled. “We crafted our vision about what it would look like, with the latest in technology in ORs and throughout the Institute. Carondelet said, if your group steps up, it would happen.”

Both sides stepped up, with Carondelet Foundation securing donations and the doctors working with architects on innovative plans offering effective uses of the latest technologies.

Fundraising started about the time the administrators, architects and physicians were putting the finishing touches on their concept, and after everyone agreed that St. Joseph’s was the right location, according to Richard Imwalle, CEO of Carondelet Foundation. “The Foundation Board made a commitment to assist Carondelet Health Network to collect funds.”

Donations, he reported, came from a variety of sources, including individuals, foundations and corporations – most being secured by members of the Foundation Board. Carondelet receives no local or state government funds, so philanthropy is important, Goldfarb said.

Jim Click, in particular, was dedicated to helping make CNI a reality. “Jim came forward to do a couple things,” said Imwalle. “Number one, he told the story about the place. He assisted in fundraising, and he and Vicki provided generous personal support.”

Imwalle said additional needs at CNI come about periodically, such as new equipment, and the foundation continues to accept charitable gifts from the community.

On the medical side, Dr. Sipos was instrumental in the design of the facility, helping to make it the one-of-a-kind neurological care center it has become.

“When hospitals are built, generally administrators and architects design them. This was built with physician input,” Sipos said.

“We participated in weekly meetings with IT, nurses and architects during the design,” Sipos said. “This is what can happen when the ideas of a surgeon are considered.”

The physician-planned details of this collaboration can be found throughout CNI, starting in the patient rooms and neurological critical-care unit – Tucson’s first. Beds are not pushed up against the walls restricting doctor access to the patient’s head. Instead, they are located in the center of the room, allowing immediate access from all sides.

Patient beds sit between columns with built-in data connections that integrate the room’s life-support systems as well as instantly delivering vital information to the patient’s doctor anywhere, anytime. Sipos carries an iPad with him so he has constant contact to patients’ latest diagnostic information – no matter where he is.

Recently obtained, thanks in part to a local donation, is a mobile CT scanner – the only one south of Phoenix – that can be rolled into patients’ rooms. “Instead of going to radiology for a brain scan, we can deliver the CT scanner to critical patients in their rooms,’’ Sipos said. “Patients don’t have to be moved – it’s safer for them.”

Andy Cosentino, Carondelet Health Network’s VP of service lines planning and development, said that is just one example of innovative design.

“In anticipation of this kind of technology, our architects and doctors had the foresight to design the rooms to fit a CT scanner through the doors,” Cosentino said.

Other innovations can be found in operating rooms and in the tumor center. The neurological surgical suite was the first one of its kind in North America. Two adjacent ORs share a CT scanner that moves between the rooms on rails and slides over the patient on the operating table.

This CT scanner saves doctors from having to move the patient to another room for a post-surgical scan, which is generally done to check the accuracy of a procedure. At CNI, the scan is completed in the OR and any necessary surgical adjustments can be made while the patient is still on the table.

“It has virtually eliminated re-operative rates,” Cosentino said.

Ceiling-mounted cameras and precision surgical navigation software in the suite allow for smaller incisions and a higher degree of accuracy, providing sub-millimeter precision, according to Sipos.

The setup of the surgical suite was so innovative that medical teams from around the world have traveled to Tucson to get a look at the technology, including neurosurgeons from Johns Hopkins in Baltimore, Md.

“I helped Johns Hopkins design theirs and address concerns they had,” Sipos said of his alma mater. “It was nice to be able to collaborate.”

Patients with head and spine tumors who face radiation therapy also receive cutting-edge treatment at CNI. Stereotactic radiosurgery is performed in the Institute’s SRS suite with such precise focus on the tumor that even at high doses the healthy tissue surrounding the tumor is spared. This treatment can be done on an outpatient basis with few, if any, side effects.

The SRS suite was built inside a concrete bunker with a lead door and is computer-driven. The table on which the patient is placed can rotate for the most precise angle of radiation delivery, explained Dr. David Frye, a radiation oncologist at the Institute.

“The theme of what we saw today is leveraging technology in a less destructive way,” added Sipos. “You can have back surgery and go home the same day or have a tumor treated in 45 minutes.”

Being cared for at CNI is not only about having the latest technology available to Southern Arizona residents, Sipos said. He believes it is also about relationships between the care teams and their patients.

“Doctors and patients don’t always have the bond they should. Patients want to know their doctors are capable but also that they have a heart and they care,” he said while hugging a patient. “When I see patients, it’s also about smiles and laughter.”

CNI offers a unique patient experience, different than what’s found in most medical settings. “Patients tell their friends this is unlike any hospital they’ve been in before,” Goldfarb said.