VAMC

INTRODUCTION

The Minneapolis Veterans Affairs Medical Center is an affiliated teaching hospital that serves as the tertiary referral center and main office for the VA Midwest Healthcare Network (VISN 23). As such, it provides services to veterans from Iowa, Minnesota, Nebraska, North Dakota, South Dakota, portions of northern Kansas, Missouri, Western Illinois, Wisconsin, and eastern Wyoming. This facility is designed to integrate patient care, education and research in order to provide state-of-the-art medical care. It has 230 acute care diagnostic and treatment beds, as well as a 104-bed extended care unit.

HISTORY

In 1925, construction of a 554-bed hospital at the Fort Snelling Military Reservation began. There were seven buildings built in a horseshoe arrangement. The new hospital, considered the finest in the Veterans Bureau system, began receiving patients in March 1927. After World War II, a 200-bed Annex was added and was used primarily for the treatment of neurological and psychiatric patients. It also became one of the first in the VA system to be affiliated with a medical school, the University of Minnesota Medical School. In 1950, construction began on a 472-bed addition. Patients from the annex were moved to the new facilities in 1956, which had grown into a 1,014-bed capacity. In 1974, the administration decided to build a new facility. This facility was completed in 1987 and is the present modern, state-of-the-art, Minneapolis VA Medical Center.

The actual establishment of the neurology service is not well documented. However, there are first hand experiences reported by senior neurologists that provide evidence for the existence of a full clinical and teaching neuropsychiatry unit since the 1950’s. The service was described as a beehive of academic activity with 2 wards of 30 beds each. There was a chronic ward where some patients stayed for years. Resident trainees and year 3 and 4 medical students have always been part of the team. Weekly staff inpatient rounds three times a week was complemented by weekly brain cutting, EEG, and neuroradiology sessions. Grand rounds happened on a regular basis.

MISSION

The neurology service has the mission to facilitate the implementation and integration of the specialty product service line’s and the medical center’s mission to care for the network veterans by providing timely, effective care in the field of neurology in both the acute and outpatient settings. This will be done in an evidence-based, patient-centered care. It is expected that values of trust, respect, excellence, commitment, compassion, empowerment, continuous improvement, and collaboration will be reflected while serving the veterans.

CLINICAL PROGRAM

The neurology service has four full-time and four part-time neurologists. These neurologists have specialized training in clinical neurophysiology, epilepsy, movement disorders, and neuromuscular disorders and are involved in research in each of their subspecialties. The staff also includes an advanced practice registered nurse.

There are three inpatient beds located on ward 3F dedicated to the neurology service. Admissions beyond three go to beds that are shared with the medicine service. There is a dedicated video EEG monitoring bed located in the specialized diagnostic and treatment unit.

In the outpatient setting, several clinics are established. This includes epilepsy, general neurology, headache and chronic pain, movement disorders, multiple sclerosis, and neuromuscular disease. There are also eight resident continuity clinics that are closely supervised by the neurology staff.

The clinical neurophysiology laboratory operates state-of-the-art EMG and EEG equipment. There is also equipment for autonomic testing.

EDUCATIONAL PROGRAM

Every month, a senior and a junior neurology resident from the university rotates through the department. One or two psychiatry interns from the university program spend their required two months of neurology rotations throughout the year. In addition, three to four medical students spend their required four-week rotation, with their time divided between the inpatient/consult service, clinic and clinical neurophysiology laboratory. Clinical case conferences are held every second and fourth Wednesdays of the month. A biweekly professor’s rounds where interesting cases are discussed in depth add a unique experience for every trainee’s tour of duty. Each of the clinical neurophysiology fellows from the university program spends four months at the VA learning both peripheral and central neurophysiology with subspecialty clinics in the areas of neuromuscular disease and epilepsy.

STATISTICS FOR CALENDAR YEAR 2004

• Inpatient admissions: 155 with average length of stay of 1.9 days

• Inpatient consultations: 610

• The top five diagnoses in the inpatient setting are stroke/TIA, alteration in awareness, epilepsy/loss of consciousness, vertigo and abnormal gait.

• Outpatient visits: 4,122

• The top five diagnoses in the outpatient clinics are Parkinson’s Disease, epilepsy, multiple sclerosis, peripheral neuropathy and chronic pain.

• EEG: 490

• Long term video EEG monitoring: 19

• EMG: 569