Shooting Victim Gabby Giffords Shares Insights on Aphasia, Gun Safety

as a key aspect of public engagement and developing the AAN’s Brain Health Initiative, with Dr. Rost being instrumental in planning the Brain Health Summit and promoting it to key neurologists, educators, and thought leaders in and outside our profession. Designed as a call to action to raise awareness and improve understanding of brain diseases and the importance of maintaining a healthy brain, the summit is intended to set the stage to enable the public to become better educated in brain health during every stage of life. Despite a growing number of local, national, and global brain health initiatives created to promote disease prevention and advance research, no singular medical or allied profession has ever been able to curate whole brain health. I believe that neurology, bolstered by the vast experience of the AAN in public education, is the ideal profession to lead this effort. Toward that end, the US House of Representatives granted our request to designate September 15 as National Brain Health Day. A highlight of the event was the surprise appearance of New Mexico Sen. Ben Ray Luján, a recent stroke survivor, who shared his experience with attendees and expressed his ongoing commitment to brain health. He is already a leader on the ENACT Act (S. 1548), a bill to increase the participation of underrepresented populations in research and clinical trials for Alzheimer's disease and related dementias, and the Neuroscience Center of Excellence Act (S. 3427), which would establish a Neuroscience Center of Excellence at the Food and Drug Administration. Just hours before the September 15 Brain Health Summit convened, the Neurology journal published a special editorial I had asked Dr. Rost, and Mr. Evans to write with me. It goes into greater detail about the need and purpose of the Brain Health Initiative and the goals of this initial meeting, which brought together 90 of the brightest minds in American neurology. As I finish composing this column the day after, I am still energized by the enthusiasm our colleagues brought to this event and the torrent of creative ideas they shared. I wish to thank the National Institute on Aging, Healthy Brain Global Initiative, Center for BrainHealth, American Heart Association, the Health Metrics and Evaluation, Feil Family Brain and Mind Research, and AARP, among others who were represented at the summit and shared their work in brain health. I’d also like to recognize other international neurology associations, such as the European Academy of Neurology and the World Federation of Neurology, on their brain health efforts and look forward to future collaboration with all of them. I’d like to believe that Drs. Marston and Munsat and their colleagues would be proud to learn how far their vision to reach the public has come. The bold steps we take now with this new initiative will have a tremendous impact on the brain health of America for decades to come. 

Orly Avitzur, MD, MBA, FAAN President, AAN oavitzur@aan.com @OrlyA on Twitter

PRACTICE

Shooting Victim Gabby Giffords Shares Insights on Aphasia, Gun Safety

In the latest issue of Brain & Life®, former US Representative Gabby Giffords talks about her experience with aphasia and her advocacy work, which includes gun safety and speaking up for others with aphasia. The feature includes a sidebar on understanding aphasia, including the importance of speech therapy and recent research on the use of brain stimulation to treat the disorder. With the Senate passing a bill to make daylight saving time permanent, sleep experts caution against it, noting several health risks. Brain & Life looks at the evidence and offers advice on how to protect sleep in any situation. Seeking a second opinion makes good sense but how do patients resolve conflicting perspectives? This article provides various examples (a general neurologist’s diagnosis differs from a specialist’s; one doctor recommends surgery, another says it isn’t necessary, etc.) and provides tips for making informed decisions. Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free. If you would like to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen@WasteFreeMail.com. All members have online access to the magazine articles and additional Daylight Saving Time Sleep Experts Explain How Changing the Clocks Affects Health OCTOBER/NOVEMBER 2022 BRAINANDLIFE.ORG resources at BrainandLife.org and are encouraged to share the website with their patients. Second Thoughts When to Seek Another Medical Opinion AAN members, patients, and caregivers also can listen to the new Brain & Life podcast, an entertaining Aphasia doesn’t change who you are, even if it’s harder to communicate.” —ACTIVIST GABBY GIFFORDS weekly podcast featuring neurology experts, celebrity advocates, and people whose lives are affected by brain conditions. Follow and subscribe wherever you get your podcasts. Learn more at BrainandLife.org/podcast. 

Put Compensation and Productivity Data to Work for You—Soon!

If you completed the 2021 Neurology Compensation and Productivity Survey, your free access to the dashboard is available only until December 31, 2022. With more than 4,000 AAN participants in the latest survey, this is the largest and most robust source of neurology data anywhere. Use the dashboard that has been created for you to filter the data by subspecialty, practice setting, region, and more. Visit AAN.com/Benchmark today to start changing your practice for the better. The Academy again thanks all members who participated in the 2021 survey and looks forward to your continued contributions to the new survey coming in 2023. 

Patients of Axon Registry Participants Eligible for Data-driven Clinical Trials

The AAN’s strategic data and technology partner for the Axon Registry®, Verana Health, is focused on elevating data quality and the value practices derive from their registry participation. A new participant benefit supported by Verana Health is data-driven trial opportunities, which may help you refer patients with limited treatment options to innovative studies. One open study is for patients with frontotemporal dementia (FTD), a rare neurodegenerative disease but the most common form of dementia for people under 60. It can change a person’s behavior and personality and limit their verbal and physical abilities. It also can be challenging to diagnose, and current treatment options are limited. Verana Health is supporting a Phase III Study sponsored by Alector Therapeutics by using de-identified Axon Registry data to find and alert neurology practices with patients who may qualify for study participation. Patients who are referred for this trial and meet key criteria may be offered no-cost genetic testing and counseling services. Learn more at info.veranahealth.com/ aan-trials. 

Neurology: Clinical Practice Serves up Latest Brain Research

Research published in the new Neurology® Clinical Practice spans a range of neurologic topics, including “A Review of Practices Around Determination of Death by Neurologic Criteria by an Organ Procurement Organization in the WAMI Region,” by Abhijit Vijay Lele, MD, MBBS, MS, FNCS, et al.; “Discordance Between Perceptions and Experience of Lumbar Puncture: A Prospective Study,” by Adrienne Boire, MD, PhD, et al.; “Objective Neurophysiological Markers of Cognition After Pediatric Brain Injury,” by Sudhin A. Shah, PhD, et al.; “Creating a Patient-based Diagnostic Checklist for Functional Tics During the COVID-19 Pandemic,” by Steven Patrick Trau, MD, et al.; and “Clinicopathologic Correlations of Jaw Tremor in a Longitudinal Aging Study,” by Sana Aslam, DO, et al. Published continuously online and in print six times a year, Neurology: Clinical Practice is free to AAN members via the website (and available in print for US members only) who have a current subscription to Neurology® . Visit Neurology.org/cp for more information. 

Volume 12, Number 5, October 2022 Neurology.org/CP

A peer-reviewed clinical neurology journal for the practicing neurologist

RESEARCH

Objective Neurophysiological Markers of Cognition Aft er Pediatric Brain Injury

COMMENTARY

Coordination of Care Among Physical Th erapists and Neurologists in Huntington Disease

RESEARCH

A Standardized Approach to Treatment Over Objection in Patients Lacking Decision-Making Capacity Secondary to Neurologic Disease CLINICAL/SCIENTIFIC NOTE Reversible Cerebral Vasoconstriction Syndrome in a Previously Healthy Child: A Case Report

22 Tips Your Colleagues Use in Their Efficient Practices continued from cover

EHR Efficiency

Electronic health record (EHR) software tools can be an easy way to increase efficiency. These tools can simplify documentation, maximize billing, and improve communication with your patients. Consider adjusting the outline of user notes or note templates to reflect the 2021 outpatient E/M guidelines. Learn more at AAN.com/EM. Use any onboarding or development time with clinicians to equip them with EHR tools for easier, faster, and better documentation. Leverage the EHR’s custom dictionary or autocorrect function using unique codes or acronyms that automatically spell out the whole word. This gives the user the speed for which the acronym was developed yet spells out the word to avoid confusion by the reader (e.g., sz = seizure, emu = epilepsy monitoring unit). Ensure all forms and questionnaires are electronically available through the patient portal for efficient integration and utilization in patient charts.

Technology Efficiency

There are many technology tools that can increase efficiency. Using technology can make tasks easier, improve accuracy, and streamline business processes. Consider incorporating and becoming proficient in using speech recognition software in your documentation workflow. A secure text messaging system to communicate with patients (e.g., sending appointment reminders) can help reduce staff time needed to make patient phone calls. Send patient questionnaires via a portal or other secure third-party web application to patients, and caregivers when appropriate, in advance of the appointment to capture reported outcome measures. Use telehealth software that integrates into the EHR system to streamline the patient touchpoints such as check-in. Consider having support staff send telehealth appointment links in advance to confirm connectivity. Develop a backup plan for synchronous audio/visual connectivity challenges, e.g., confirming the best way to connect with the patient via audio only. Connect the entire care team via telehealth to enhance the patient experience, e.g., connecting with the ICU pharmacist when doing medicine reconciliation, or including the patient’s rehab nurse when seeing a patient at a rehab facility.

Staffing Efficiency

Optimizing staffing and their workflows is one of the best ways to improve clinician efficiency. It can ensure clinicians are practicing to the top of their license and increase access by enabling the clinician to spend more time with patients. Invest in training support staff to ensure accurate work. Use team-based huddles to plan for the upcoming day and week. Consider having the medical assistant bring the after-visit summary and patient instructions into the exam room to review with the patient prior to checking out. This allows the clinician to move to the next room more quickly while still allowing the patient to ask final questions with a member of the team. Have your rooming staff prepare patients by asking them for any specific questions in advance of the physician’s arrival into the room. Consider increasing medical assistants’ mobility by assigning them a laptop each day. Using a secure messaging system to allow for real-time updates and communication with support staff (e.g., if an exam is taking longer than expected so staff can communicate with patients) can increase efficiency and patient experience by having a coordinated team.

Workflow Efficiency

Building in workflow efficiencies can reduce burden across the organization, improve the health of the business, and establish best practices to deliver exceptional patient care. Create a separate “short notice” cancellation list that indicates when patients can be available to fill an opening on short notice, either by coming in person or connecting via telehealth. This can reduce staff moving through a long cancellation list to fill an unexpected opening, such as a no-show. Create a list at the start of each day that shows scheduled patients’ balances to make it easier for administrative staff to collect the outstanding balances during check-in. Consider offering incentives for collecting a certain percentage of the balances. As much as possible, set up all exam rooms the same way so restocking is easy, and everyone knows where everything is kept. This will minimize “looking around” for supplies, forms, equipment, etc. Minimize phone calls by scheduling outpatient follow-up appointments prior to discharge from the hospital. Ask all patients at check-in if they need refills or forms completed and establish a workflow to communicate and complete these tasks with the team. Be sure the patient has enough refills to get them to the next visit to reduce patient phone calls and refill requests. Consider a nurse triage call system to differentiate emergent, urgent, and routine requests with common language. 