For Penn Neurology, Pavilion Poised to Streamline Patient Care and Accelerate Research

Penn Medicine's state-of-the-art Pavilion is changing the way medicine is practiced, particularly in the neurological field. Opened in late October 2021, the facility's patient-centered layout and new technology has already ushered in a paradigm shift for the Neurology Department.

Kathryn A. Davis, MD, MTR, describes the Pavilion's Epilepsy Monitoring Unit (EMU) as a "lightning shift forward" for patients and neurologists alike.

"We would not have been able to achieve this same momentum for many years — if ever — in the old space, without access to the types of resources we have now," says Dr. Davis, Medical Director of the EMU and Epilepsy Surgical Program. "At the same time, it also enables us to provide a higher level of care to our patients."

Penn Neurology in the Pavilion — A Space for Innovation

Throughout the department, but especially within the EMU, the Pavilion has physically married the research and patient care arms to an extent they never were before. Dr. Davis and her colleagues are taking advantage of that arrangement with a new tool called a "Blackrock," purchased in November through a grant from the NIH S10 Instrumentation Program. A data acquisition and processing system, Blackrock collects high-bandwidth multi-scale neurophysiologic information to understand functional networks in the human brain.

"Our main purpose is to improve our ability to pinpoint where seizures are coming from in patients' brains," Dr. Davis says of the system. "But many other investigators will be using this valuable data to study brain function, including memory, olfaction, vision, and motor function."

To aid in this effort, she and her team will also be using a new research-dedicated MRI scanner for a functional type of imaging called arterial spin labeling an innovation co-invented by John Detre, MD, Director of Penn Medicine's Brain Science Center.

"It's widely used in stroke, but not in epilepsy," Dr. Davis says. "It allows you to measure blood flow to different areas of the brain with the understanding that blood flow will increase in areas with higher metabolic demand."

At the Pavilion, A Space for All Penn Neurology Services

At the Pavilion, for the first time, all Penn Neurology services – the ICU, stepdown unit, and neurocritical care – are together on one floor. Previously, they were in separate buildings.

"We've always been collaborative by nature, but we had physical barriers that prevented us from collaborating in the way we wanted to clinically," says Joshua Levine, MD, Chief of the Division of Neurocritical Care. "Now those barriers have largely been removed."

Dr. Levine describes the installation of the new MRI scanner next to the ICU as a significant advance both in patient care and, potentially, researchers' understanding of coma. "MRI imaging of the brain is one of the most powerful tools we have," he says. "But it was hard to transport a very sick patient across the hospital to an MRI where there is no one around who can deal with a clinical emergency. Now we can use it to understand not only our individual patients, but also how coma from these diseases works in general."

Monisha Kumar, MD, Director of the Neurology ICU has also seen the advantages the Pavilion has to offer. "Because we're all co-localized, we can actually transition care wherever the patient is, as opposed to having to wait for the patient to physically move," she says.

That process has already begun with the stroke team. Dr. Kumar expects it to be adopted by other types of providers, too. Also in the name of streamlining patient care, the step-down unit — the intermediate level of care between the ICU and the general medical-surgical wards — has grown from 12 beds to 24.

"What that allows us to do is bypass the ICU altogether for a certain subset of our population," Dr. Kumar says.

For example, patients treated for "routine" brain tumors could potentially go straight to the new step-down unit. The care they would receive is the same, Dr. Kumar says, the process is just shorter.

Finally - A Penn Pavilion Space for the Mind

The Pavilion's technology also empowers Drs. Kumar and Levine with an unprecedented level of situational awareness. "This place is wired to do things we could have only imagined," says Dr. Levine. "From any place in the hospital or my home on my iPhone, iPad, or PC, I can see any patient's hospital monitor and know when there's an alarm."

He shares that this data is being stored so that in the future, it can be analyzed using artificial intelligence. "Ultimately, we want to be able to predict a deterioration in a patient's state and bring resources to the bedside before they get worse."

But one of the most impactful features of the building for Dr. Levine is the view itself.

"Being able to look out and see the entire city, has really driven home the importance of our mission," he says. "We're serving the people who live in every section of this city and beyond. That's a pretty profound realization."