NIGUARDA GENERAL HOSPITAL AND COMPREHENSIVE CENTERS

International Info Point international@ospedaleniguarda.it phone: +39 02 6444.7220 www.ospedaleniguarda.it/eng www.ospedaleniguarda.it/fr www.ospedaleniguarda.it/ru www.ospedaleniguarda.it/chi 2 4 6 10 12 16 18 20 22 24 26 MILANO HEALTH CAPITAL ABOUT US HIGHLIGHTS CLINICAL AREAS GOVERNANCE AND PERFORMANCE NIGUARDA S DATA NEW NIGUARDA: A MODEL OF CARE A MODERN HOSPITAL: TECHNOLOGY AND SERVICES ROOMS AND FACILITIES RESEARCH INTERNATIONAL TEACHING HOSPITAL INTERNATIONAL RELATIONSHIPS

MILANO HEALTH CAPITAL The Italian National Health System is one of the best in the world. Given the data, it s the second best overall globally for quality, accessibility and cost-effectiveness 1, and ranked third most efficient globally 2. The secular vocation of Milan reception of the disease makes it an ideal place of care, across the border. The integration of innovation, research and clinical and leading position established internationally make it a world-class health center. In this system, Milan has a prominent role, and can be considered the italian capital of health, with an exceptional concentration of large and small institutions anchored in a glorious past that has its roots in the Renaissance. The historic supremacy in Europe of Milan hospital care model has remained intact over the centuries due to its ability to conjugate health needs and innovation. Thanks to a careful and strategic partnership among public and private operators and health players and Institutions, today Milan is a health center in the world which includes excellence throughout the health sector: structures leaders in technological equipment and integration between research and care, specialized institutes, university hospitals, a chemical and pharmaceutical industry that makes Milan and Lombardy the most important biotech cluster in Italy and important research centers. 1 World Health Report, 2000 2 Bloomberg, 2014 data provided by the World Bank, International Monetary Fund and World Health Organization 1 2

Highlights ABOUT US Niguarda is a general hospital and offers all clinical and surgical specialties for adults and children, but its core identity that brings it to the highest levels of excellence is the ability to integrate care competences and technology, from diagnosis to rehabilitation. A LEADING ITALIAN GENERAL HOSPITAL As a General Hospital, Niguarda hosts all the disciplines for adult and children. All medical disciplines and technologies, from diagnosis to rehabilitation, are integrated on serving the best care even in situations of emergency or high complexity. Physicians, scientists, and nurse staff are trained to work together Situated in the North of Italy, in the heart of Europe, Lombardy represents a bridge to the Mediterranean. With its surface area of about 24.000 square km and almost 10 million inhabitants, it can be compared to a nation. The Lombard territory, symbol of modernity and development, present a great number of natural, artistic and cultural beauties. The health system in Lombardy protects the health of patients with a mixed system, based on synergies between the public and private sectors, focused on quality and efficiency, in order to increase the accessibility of its strong network of hospitals, clinics and pharmacies. Niguarda is located in the north of Milan, the main city, but it s a point of reference for all Lombardy and Italy too. 3 4

CLINICAL AREAS NIGUARDA ALSO HOSTS: Burned Care Unit Tissue Bank Anti-Poisoning Center Stroke Unit Rare Disease Center Mobile Unit for maxi emergency ONCOLOGIC SURGERY AREA DIAGNOSTIC AREA The diagnostic clinical activity is over the highest standard and in a continuous development in the treatment of all tumours. The patient can rely on a multidisciplinary team with the guarantee of a certain diagnosis, surgical operations high technologically supported and personalized chemiotherapy targeted on individual molecular basis. The goal for the oncologic patients is to improve the survival rate and the quality of life supported by innovative technologies (mininvasive approach, magnetic resonance guided focused ultrasound surgery, robotic surgery). The hospital is equipped with laboratories that guarantee a wide range of diagnostic-therapeutic services, as an effective support to the clinical activity. The laboratories, national centres for the diagnosis and treatment of specific pathologies, are developed by highly specialized and authomatic technologies. TRANSPLANT AREA Niguarda is the only centre in Lombardy that has performed transplants of every organ (heart, lung, pancreas, kidney, liver, cornea), and tissues and cells transplants. In the hospital there is a Skin Bank, a laboratory specialized in engineered skin and cartilage for reconstructive operations, able to sustain the internal need and to supply other national and international structures. Also the robotic surgery is applied to the transplantation area with considerable advantages to the donor. 5 6 CARDIOTHORACIC & VASCULAR AREA Built on the heritage of one of the first Cardiothoracic surgery centers this area provides all medical interventional and surgical options for patients with any kind of disease at any age (e.g. from newborn and pediatric cardiac surgery, including pediatric transplantation, to transcatheter aortic valve implants). Multidisciplinary team case discussion, highly specialized cardiac and anaesthesiology intensive care staff, intermediate facilities, active outpatient and telecardiology services, provide the full spectrum of care in both the emergency and long-term care settings. Niguarda is national referral Center for heart transplantation and assist device for advanced heart failure, complex arrhythmias, acute and chronic coronary artery disease.

NEUROSCIENCE AREA The aim of thi area is to coordinate specialist competence and the most up-to-date technologies to guarantee a diagnostic and therapeutic excellence path for therapy of nervous system pathologies. The strengths are the treatment of the medullar lesions, the surgery of pharmacoresistant epilepsy and of Parkinson s disease, the use of gamma-knife for tumor pathologies, the presence of the stroke unit for emergency treatment. GENERAL SURGERY AREA Thanks to its high professionals and technological competences, the hospital is a national and international reference point for the general surgery, treated with a minimal invasive approach and with the robotic surgery. The goal is to develop the excellence in the surgical activity both in emergency and in elective areas, through a multiprofessional cooperation, integrted application of the most advanced technologies and the operators training. EMERGENCY-URGENCY AREA Niguarda is able to host patients from the whole metropolitan area of Milan, in very severe conditions, thanks also to the helicopter service. Its emergency- urgency dedicated services, including: Coronary Unit and ICU, Stroke Unit, Trauma Team, Centre of Poison Control, Emergency Medicine and Surgery and Burn Unit. Moreover the hospital has a national role for the maxi-emergencies in case of natural disaster and nuclear catastrophe. SPECIALIST MEDICINE AREA Niguarda offers the widest set of high complexity services of general and specialist medicine. The hospital is the headquarter for many Regional and National reference Centres in allergology, diabetes, nutritional, endocrinology, rheumatology, infectious diseases, pneumology, as well as in pre and post transplantation treatments for heart, lung, liver, kidney-pancreas and pancreatic islet. It has an important role for diagnosis and treatment for more than 120 rare pathologies too. It hosts one of the main psychiatric department of the town. MOTHER AND CHILD AREA The mother and the child are protagonists of a health project that goes beyond the prevention, the treatment and the rehabilitation, that places them at the centre of the research and care activity, from the conception to the adul age. In fact, the service for the family includes a full phases assistance, from the wish of the procreation to the delivery. The child treatment is assured for every type of pathology, even the rare, through personalized technologies and routes in the respect of the religious, social and cultural diffrences. ADVANCED TECHNOLOGIES Advanced MRI, PET, interventional radiology, linear accelerators, robotic surgery, hybrid OR, gamma knife, focused ultrasound: the constant updating of the technological park is driven by the development of professional skills of high profile. Diagnostic tests are shared in real time in safe and responsible way through our ICT system. 7 8

GOVERNACE AND PERFORMANCE Clinical activity data 2014 We want to create places for the promotion of the culture of life and health where doctors are motivated to improve themselves. Every day at Niguarda we are committed to meet the health needs of our people. As providers of the Regional Health care services, our clinical activity and research must comply with quality standards according to the government criteria, which calls for the provision of appropriate health care without waste, within the economic and financial rules which guarantee the best use of public fund. Economic and financial performance prediction budget 2014 The hospital is also strongly oriented to the development of new organizational and administrative procedures aimed to improve the quality of its services in terms of efficiency and effectiveness according to the national guidelines planned by the Social Health Care Plan of the Lombardy Region. 9 10

NIGUARDA S DATA 1.213 BEDS 4116 TOTAL EMPLOYEES 1.138 ORDINARY 75 DAY HOSPITAL & DAY SURGERY 712 MEDICAL OFFICERS 30 BABY CRIBS 20 NEONATAL PATHOLOGY BABY CRIBS 8 INTENSIVE CARE BABY CRIBS 39 CLINICAL UNIT DIRECTORS 42 OPERATING ROOMS 1967 NURSING STAFF 340 AMBULATORY ROOMS SETT. 2015 11 12

New Niguarda A MODEL OF CARE Modern medicine requires a new model of hospital organization designed around the patient The New Niguarda project, started in 2007 and completed by 2014, is based on a health organization specialized for the intensity of care and on the optimization of the efficiency putting the patient at the center of the healthcare service organization. The new hospital has been planned on three blocks: > The Emergency-Urgency (DEA block) > The South Block for high intensity of care patients (surgery, onco-hemathology, cardiology and transplantation) COMPREHENSIVE CENTERS New Niguarda has changed the organization developing multidisciplinary team focus on 4 core business: CANCER CENTER DE GASPERIS CARDIO CENTER TRANSPLANT CENTER TRAUMA CENTER > The North Block for medium intensity of care patients and medical services. The hospital structure is designed according to the patient s need. The process of care is completely realized within one single unit, in order to avoid moving the patient. 13 14

TECHNOLOGY AND SERVICES The integration between diagnosis and treatment in 25 the different specialties is at the base of rational clinical, an appropriate use of the resources and a better efficiency of the intervention, even with high complexity situations or emergencies. Imaging advanced technologies RMN, PET, interventional radiology, linear accelerators, robotic surgery, gamma knife, focalized ultrasound: the constant update of the technological park is driven by a development of high profile professional competences. Diagnostic tests are shared in real time in liability and safety through our ICT system. The integration between diagnosis and treatment in 25 the different specialties is at the base of rational clinical, an appropriate use of the resources and a better efficiency of the intervention, even with high complexity situations or emergencies. DA VINCI SURGICAL SYSTEM With the da Vinci Surgical System, surgeons operate through just a few small incisions. The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, it enables your surgeon to operate with enhanced vision, precision, dexterity and control. We use da Vinci in urolgy, cancer and general surgey treatments. The robotic surgery is also applied to the transplantation area. HYBRID OR A hybrid OR is huge room, with radiological equipments, permits to carry out both the traditional and the radiological guided operational activity. The hybrid OR allows interventions invasivelyreduced for the valves surgery, the by-pass, the installation of aortic endoprothesis and the hybrid installation of devices for the cardiac resynchronization. It is the integrated room, it means that the machines are linked together and consent the use of videoconference technologies, intervention fied records in hd with the possibility for the operators to utilize wide screens and touch screen use. In the angiography hybrid OR are performable simultaneous operations of different specialists: cardiosurgeon and vascular surgeon, hemodynamist, electrophysiologist, radiologist, torax surgery specialist and interventional radiologist. GAMMA KNIFE SURGERY Gamma Knife surgery sometimes referred to as stereotactic radiosurgery (SRS), is a non-invasive method for treating brain disorders. It is the delivery of a single, high dose of irradiation to a small and critically located intra-cranial volume through the intact skull. It is preferred for its extreme accuracy, efficiency and outstanding therapeutic response. System benefits include faster set-up and treatment delivery to one or more tumors in a single session. Perfexion allows treatment of a wider range of targets faster and more efficiently than ever before. 15 16

ROOMS AND FACILITIES Niguarda has custom-made furnishings with a design concept that reaches beyond the basic requirements of quality, duration and ergonomics. The hospital is equipped with more than 40 front offices for booking and check in: the modern centralized system for managing the customers flow, drives the patient from the access to the hospital and it conducts him, through the front office activities, to the call in the outpatient where the doctor is waiting. Throughout the integration of digital signage systems, algorithms and complex technologies it is possible to design and customize systems of information facilities and welcome and booking processes managing both with the National Health System and in private area. PATIENTS HAVE ACCESS TO: 17 single-double beds rooms with private bathroom foreign patients office free service of language assistance vegetarian menu on demand relatives: hotels at special price children s or over 65 relatives can stay all the day long with the patient coffee shops, self-service restaurants cash point shopping centers internal paying parking 18

RESEARCH In recent years a positive trend in clinical trial has been observed, in neuroscience, diabetology, pain therapy, gene therapy, cardiovascular diseases, haematology, oncology, resulting in an improved scientific impact factor. defining Niguarda as one of the best possible clinical sites for translational research. It offers concrete opportunities to pharma and biotech company. Niguarda is at the forefront of research for trials testing new therapies supported by international cooperation activities. Niguarda is a public hospital dedicated to care; clinical research and knowledgesharing are fully integrated in the hospital strategy. The presence of professional skills, technological competences, certified laboratories and high complexity patient cohorts make Niguarda a unique and interesting partner for future cooperation. It offers concrete opportunities to Pharma and Biotech Companies that are looking for a reliable and expert clinical/ scientific partner. The attitude to a real multidisciplinary approach offered to researcher makes Niguarda as a unique one stop shop for research and development. The main strength point is the high volume of diagnostic/ therapeutic activities that allows an optimal integration between research and patient care, 19 20

INTERNATIONAL TEACHING HOSPITAL Affiliated to: Università degli Studi Statale -Milan Università Bicocca- Milan High professional competences, high tech and teaching accreditation, make Niguarda Hospital a centre of attraction for professional figures which want to bring themselves up to date on new technologies, diagnostic and therapeutic procedures to gain an excellent operative methodology and new skills. International training activity is based on different standards: TWINNING among international hospitals scheduled by international cooperation programs TRAINING STAGES included in international institutions agreements. AORTIC PROSTHESES IMPLANTATION Niguarda is an European training school adopting the advanced system of the hybrid room that performs delicate surgeries in an accurate and minimally invasive way. ADVANCED INTERNATIONAL MINI-INVASIVE SURGERY AIMS Academy (the first multidisciplinary structure in Italy dedicated to research and training in minimally invasive advanced surgery, third pole of an European network with Strasbourg and Guildford. The program includes demonstrations of laparoscopic surgery, theory sessions and practice sessions made of simulations in the wet lab. ECOCARDIOGRAFY CENTER Niguarda and its ecocardiografy center is accredited by European Association of Cardiovascular Imaging. An Ecolab is fully equipped for training. NIGUARDA FACULTY OF NURSING Niguarda is a University Teaching Center for Nursing ( Università degli Studi Milan). 21 22

INTERNATIONAL RELATIONSHIPS To the aim to abet exchanges of professional experiences among Hospitals, tailored meetings can be arranged to visit Niguarda and get in touch with the Board, the doctors and the service Providers. Niguarda usually receives: Hospital Board Delegations Medical and Nurse staff Authorities and Ministerial Delegations COMPANIES Niguarda is connected in a network of international collaboration toward to provide the best medical practices to patients coming from all over the world. Niguarda has partnerships and agreements with Helthcare Consultancy companies, Health Management companies, Travel&Health Companies, Health Insurance companies, for: consultations taking care patients with private treatment CONSULATES AND EMBASSIES During Expo due to its international skills and its relevant role in Lombardy Niguarda has been selected among the public Hospitals to provide healthcare services to people coming from other countries and, in particular, the Hospital has been designated as reference for the treatment of the eminent people. The aptitude and competence to understand the needs of people coming from all over the world allows the Hospital to manage also the healthcare requirements of international patients, travelling or living in this area. Tailored health service can be arranged for compatriots living in Italy compatriots coming from foreign countries HEALTH COOPERATION Every year Niguarda hosts patients from other nations affected by pathologies that are incurable in their own countries. Niguarda also plays an active role in international cases of health emergencies. 23 24

HOSPITAL BETWEEN HISTORY AND ART Niguarda is a relevant structure even from the architectural and artistic point of view. The hospital hosts a series of permanent works of art and itinerant exibitions, aware of the social and therapeutic role of the art. OSPEDALENIGUARDA.IT/ ARTGALLERY NIGUARDA IS ITSELF A MASTER- PIECE OF ARCHITECTURE Niguarda is protected by the ministry of fine arts and it has been always sensitive to the beauty and to the artistic culture. In 1940 it has been defined as the city of art by the historian Costantini, it expresses a strong connection with the city of Milan and its history by its monumental and rationalist structure. Up to its entrance moving through the paths and in the indoor sections, it is possible to admire works of art made by great artists as Arturo Martini, Francesco Messina, Franco Lombardi, Mario Sironi and Aldo Carpi. MODERN ART Niguarda hosts MAPP museum (Museo d Arte Paolo Pini) and artworkshops in the area of mental disorders treatment. Over time it has formed a collection of internationally and wellknown artists, including Enrico Baj, Emilio Tadini, Gunter Brus, Martin Disler. With new ideas and projects MAPP participates in international fairs of modern art and organizes and supports various initiatives. Niguarda also hosts extemporary exhibitions and installations of contemporary artists and promotes cultural events. 25 26

STAY CONNECTED Follow the video interviews of our doctors OspedaleNiguardaTV Stay updated with our Tweet @ospniguarda Discover hospital s activities and all the useful info www.ospedaleniguarda.it/eng

Niguarda Hospital Piazza Ospedale Maggiore, 3 20162 Milano, Italy phone:+39 02 6444.1 www.ospedaleniguarda.it International Info Point international@ospedaleniguarda.it phone: +39 02 6444.7220 www.ospedaleniguarda.it/eng www.ospedaleniguarda.it/fr www.ospedaleniguarda.it/ru www.ospedaleniguarda.it/chi