Just about everybody has had the experience. Someone is sick. A doctor’s appointment is needed. The call is made, and the office representative delivers the bad news:
“We are scheduling people for three months from now.”
Which doesn’t help right now. Access to good medical care can be frustrating, even for those who have the best insurance plans. To Dr. Roy Proujansky and the rest of the administration of Nemours Children’s Health System, that is unacceptable. When a child needs to see a physician, he or she can’t wait weeks or months. It needs to happen now.
That’s why, no matter how much new equipment Nemours purchases, how many new specialists it adds to its impressive ranks and whatever new facilities it builds, service is always the most important thing.
“Part of our culture and mission is our service to patients and their families,” says Proujansky, chief executive for Nemours in the Delaware Valley since July 2013. “We are committed to decreasing wait time and increasing transparency so we can increase patient and family satisfaction.”
There is a lot happening at Nemours in terms of research and care. But unless those who need to benefit from that can have easy access, they don’t mean much. Proujansky reports that 80 percent of new patients can see a physician in three days or fewer, a statistic that has helped boost happiness—and overall health—greatly. Nemours is in the 90th percentile nationally for patient satisfaction.
“We are patient- and family-centric here,” Proujansky says.
Though Nemours started as an orthopedic institute, it has since become a full-service children’s hospital, so it is looking at all times for ways to enhance the care it provides. There has always been a strong link between orthopedics and neuroscience at Nemours, and part of that relationship has involved children with epilepsy. As the treatments have matured and improved, Proujansky and other administrators began to think about the possibility of expansion in that area.
“We started talking about an epilepsy surgery program to help children with the most difficult seizure problems,” Proujansky says. “We also wanted to look at behavioral problems and autism.”
That’s how Harry and Diane Chugani came to join the Nemours staff in the fall of 2015. The couple have done pioneering work in epilepsy research and treatment, and they have helped the hospital move into exciting new territory. Harry Chugani was last division chief of neurology at the Children’s Hospital of Michigan, where he established the nation’s first PET (positron emission tomography) center in a children’s hospital. Diane Chugani, a neuropharmacologist with an expertise in autism research, was last at Wayne State University. She will split her time between Nemours and the University of Delaware.
The couple’s use of PET and MRI technology allows Nemours to be more proactive in surgery on children with the most difficult epilepsy cases. It also enables Nemours to increase its research and treatment in the areas of autism and behavioral health. The presence of the Chuganis has helped lead to the establishment of a new PET/MRI Center and a radiopharmaceutical center that will allow for brain imaging that can aid in epilepsy surgeries.
“A PET scan can be used to study the metabolism in the brain, while the MRI gives you the anatomy,” Proujansky says. “When you combine the two pieces of equipment into one, you can do the two scans together and get overlapping images to find out where a functional problem exists in the brain.
“For epilepsy, the combination can be used to find the part of the brain where the resistant seizures are. The MRI gives the picture of the brain, and the PET locates where the abnormality is.”
The technique provides an unprecedented look at where the surgeon can go to remove and repair anything that is causing particularly damaging and heavily recurring seizures, Proujansky says. The combination of scans can also help locate areas of the brain where metabolic changes have caused autism.
Nemours is only the third freestanding hospital in the country to have dual PET/MRI capability. It is now working to bolster treatment options so it can eventually provide comprehensive care.
Nemours also hopes to expand its behavioral health offerings. As the community at large becomes more aware of the various challenges children face in that area, Nemours is committed to providing leadership in addressing many different conditions.
“We will be working with families to help their children with anxiety, depression, school testing issues, ADD and also more complicated issues,” Proujansky says. “We are looking to expand these services throughout the state.”
More than three years ago, Nemours began a strategic planning program aimed at meeting Delaware’s needs over the next five to 10 years. One result was the realization that Nemours needed to provide specialty care in lower Delaware.
“Many patients had to travel a lot, and some weren’t getting care,” Proujansky says. “Other children were seeing physicians who treated adults. Their parents had to drive them back and forth.”
Nemours settled in Milford, which Proujansky terms “a perfect destination.” The goal was to shorten the trip for care, so families downstate wouldn’t have to head north to Wilmington late in the day, fight traffic or return home at late hours that were inconvenient for children. Though Proujansky reports that the Milford facility operates at a financial loss, providing convenience for patients, he says, is worth the sacrifice.
Another way to move Nemours forward was to improve its ability to do research. Though the hospital had provided a facility that allowed physicians to conduct biomedical experiments, it wasn’t of a quality that allowed for consistent, groundbreaking work.
In January, the DuPont Co. announced a $200 million renovation of its century-old experimental station—one of the first industrial research laboratories in the world and a neighbor of the hospital—to allow for greater collaboration between the company and outside scientists such as Nemours researchers. The aim is to create an incubator that will lead to significant advancements in many disciplines, including medicine.
“It’s going to be a great space,” Proujansky says. “We want to be a catalyst to bring more research to Delaware. This has a chance to be a real research park.”
One exciting aspect of the expansion will be the opportunity to form partnerships with entities such as the University of Delaware, and with biomedical companies that may be attracted to do research under the DuPont umbrella. DuPont will create new space for scientists to work that will spawn innovation. Proujansky says the hope is that the experimental station will attract start-ups and establish the state as the place to be for scientists.
“We’re talking about future businesses within the state,” Proujansky says. “It will be an important part of what we do here.”
One of the good things about Delaware’s size is that Nemours can expand its services to all areas without taxing its resources. By opening a center in Milford, cutting down the amount of time new patients wait to be seen, and increasing treatment and research in areas that are emerging as key for the future, Nemours can continue its status as Delaware’s pediatric care leader. New facilities, technology, staff and partnerships with outside businesses can help that become a reality.
“We want to continue to grow, so that our service to patients and their families remains among the best in the country,” Proujansky says.
Not to mention the fastest.