Gamma Knife

Gamma Knife | After months of discussion, planning and other heavy lifting – both literally and figuratively – the Rocky Mountain Gamma Knife Center opened its doors in the Anschutz Outpatient Pavilion on Monday, Jan. 9.

Those doors lead into a 4,700-square-foot addition built just for a center to house the 42,000-pound Leksell Gamma Knife Perfexion, which has spent the better part of a month in transit from its former St. Anthony Central Hospital home, and then in testing here at UCH. The Gamma Knife focuses cobalt-60 radioactive sources into 192 guided beams, which converge in precise patterns to destroy tumors and other malformations deep inside a patient’s brain noninvasively and with minimal collateral damage. Patients usually go home the same day.

The hospital celebrated the imminent opening of the center with an open house Jan. 4.  The moving-and-testing effort was challenging but relatively speedy compared to the months of work it took to bring the Gamma Knife Center into the UCH fold. That effort – involving dozens of people across UCH, the Gamma Knife Center itself, and community physicians who use the machine – has involved sorting out workflows, incorporating the Gamma Knife Center into the hospital’s Epic electronic medical record, and establishing the business arrangement between UCH and the Gamma Knife Center.

Rocky Mountain Gamma Knife Center, LLC, had been on the St. Anthony Central’s west Denver campus since 1993, where a succession of three Gamma Knives, operated by providers from across the Front Range, served a total of some 4,000 patients.

When St. Anthony moved to Lakewood last year, however, it decided not to bring the Gamma Knife along. A long period of negotiation between the Gamma Knife Center and UCH formally concluded Dec. 30 with UCH taking an equity stake in the center.

“With the hospital becoming an equity partner in this facility, we’re even more integrated into UCH,” said Kip Kochevar, the Gamma Knife Center’s business manager.

From the start, UCH was a front-runner to nab the Gamma Knife, Kochevar added.  “We had the opportunity to move to different hospitals, but when it came down to it, there wasn’t much of a choice to be made,” he said.

After months of preparations – and the construction of the AOP addition – the Gamma Knife moved across town during a snowstorm on Dec. 3. Installation at UCH, done by a team from Gamma Knife manufacturer Elekta AB of Sweden, started on Dec. 10 and finished on Dec. 16. Testing and calibration followed, and the knife itself is now ready to go.

The bulk of the work had less to do with hardware, though, than carving out a niche for the machine in the hospital’s complex operational machinery.

As Kochevar explained it, the Gamma Knife will be fully integrated into UCH’s outpatient processes. Patients will check into Day Surgery on the AOP’s second floor, where nurses will prepare patients for the procedure. Then patients will be transported down to the first-floor Gamma Knife Center, where a neurosurgeon will fit them with stereotactic head frames.

After a stop at UCH Radiology for scanning (usually magnetic resonance imaging, sometimes CT), patients will head back to the Gamma Knife Center, where a neurosurgeon, a radiation oncologist and a medical physicist will create a treatment plan and set the Perfexion’s treatment wheels in motion. Following the procedure, patients will recuperate in UCH’s outpatient surgery recovery area.

Laying out the details of these processes involved nine months of meetings with department heads and others at UCH, Kochevar said.

Integration into UCH also meant embracing Epic, the hospital’s electronic medical record (EMR). Some knew Epic already – the Gamma Knife Center’s co-medical directors, neurosurgeon Robert Breeze, MD, and radiation oncologist Brian Kavanagh, MD, are UCH physicians. But the Gamma Knife Center has been paper-based, and the six center employees – as well as many of the eight neurosurgeons and 10 radiation oncologists who use the Gamma Knife – had to get to know the Epic EMR.

It was a challenge for the hospital’s Epic team, too, says Jennifer Eldridge, RN, the UCH Epic systems analyst who led the effort to integrate the Gamma Knife Center with the EMR. She and colleagues had less than six weeks to translate the many Gamma Knife Center-UCH interactions into the new UCH system. The experience of having already done Epic go-lives – including the September inpatient “big bang” – was indispensable, Eldridge said.

“If we had started with this, we probably wouldn’t have been able to put it together and have it work,” she said.

The effort involved health information management, billing, orders, and perioperative services as well as the training of surgeons, nurses and business managers, Eldridge added. The goal from the beginning, she said, was to have Gamma Knife operate as if it were a part of UCH, “and not just on the sidelines and not really integrated with anything.”

In a conference room whose artwork still leaned against the walls, Kochevar summed it all up.
“We’ve very excited to be here at this hospital,” he said. “This is where everything’s happening in this town.”