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A New Model for Endovascular Services

With the Tower, Rush became one of the first major academic medical centers in the United States to build a perioperative and interventional platform: adjacent floors that bring perioperative and interventional services together in the same location.

This consolidation, Rush leaders hoped, would promote clinical collaboration, improve outcomes and enhance the patient experience. But because the platform was a new concept, not even the physicians who would operate within it could predict its level of success.

A year later, the platform is fulfilling its promise. Endovascular specialists at Rush say it has created a new model for endovascular services by catalyzing an unprecedented level of collaboration between interventional cardiologists, electrophysiologists, interventional radiologists, neuroradiologists, neurointerventionalists and vascular surgeons.

Collaborative Care

"The interventional platform makes sense because there is a bond between these services," says neuroendovascular surgeon Demetrius Lopes, MD. "We're all trained to think the same way and to use our tools in the same fashion for fixing vascular problems, just in different parts of the body. Now, instead of being spread out across the Medical Center, we're neighbors."

The close proximity of these specialists — and their technology — enables them to work together in ways that were not possible before, says interventional cardiologist Jeffrey Snell, MD. "We can plan in advance to do a case together or, because we're all working in the same area, to bring in another specialist to help as the need arises during a procedure."

For example, when a patient had a stroke two days before he was scheduled for a heart procedure, Lopes was brought in to remove the clot. But there was a complication: The patient had a balloon pump in his aorta, so Lopes could not use the conventional entry point in the groin to treat the stroke.

"The path was blocked. We had to instead go in through the radial artery in his arm, a procedure commonly done by cardiologists but rarely in neurointervention," Lopes says. "I was able to quickly ask a cardiologist which catheters he uses for this approach, and then I was able to get the catheters right away. Having rapid access to both the expertise and the tools enabled me to remove the clot and prevent significant damage."

Meeting of the Minds

Another exciting development facilitated by the interventional platform: the monthly global endovascular conference, at which the specialists take turns presenting their most compelling or complex endovascular cases.

"It's a forum for sharing ideas, techniques and technology on a regular basis," says Lopes, who co-chairs the conference with Snell. "We all have our own ways of treating problems, and hearing how other specialties approach those problems — such as which types of catheters and stents they use, or how they administer medications — can be really useful."

The hope is that by learning from each other's differences, endovascular specialists at Rush will be able to continually raise the bar for patient care.

"Sharing knowledge and technology is one way to get everyone on the same page," Snell says. "We've also launched a number of quality improvement projects that will enable us to develop best practices and apply them consistently across the platform. If we can determine the most effective strategies for things like management of vascular access sites and radiation safety, we have the potential to dramatically improve outcomes."

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