Spine & Neck Service Line Requires Planned Growth

Joe Cantlupe, for HealthLeaders Media , November 15, 2010
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"There is an important distinction between providing exclusively conservative or holistic treatment as opposed to providing comprehensive treatment that incorporates a conservative approach with surgical options," Newton says.

The interwoven relationship between the Chicago Back Institute and the Swedish Covenant Hospital is one of the major elements making the program work. Referring patients for physical therapy and pain management services, as well as utilizing radiology testing to help with diagnosis and planning "is one factor that is anticipated to lead to business growth," Newton says.

"Many back pain patients do eventually require surgery, and our leading neurological surgeons and minimally invasive technology are available for when that happens," he says. "This is a truly comprehensive program that provides all the treatments a patient may need along their continuum of care?an approach we are not aware of elsewhere in the Chicago region."

Newton is concerned about the increase of unnecessary procedures for back care. He notes a report that shows that costlier, more complex spinal fusion surgeries are on the rise, and they are often unnecessary.
Offering the comprehensive approach "throughout a highly navigated continuum of care" makes sense for the patients because of their various needs, and also "makes sense as a business approach because patients will be utilizing Swedish Covenant Hospital services throughout their treatment," says Newton.
The hospital conducted a "thorough business and market analysis" that identified a market need for creation of the Chicago Back Institute. "These analyses confirmed an increasing demand for spine and back care in the community and surrounding regions, which will continue to increase as baby boomers age," he says.

Success Key No. 4: Nurse navigators

To increase communication and improve patient outcomes, Sanford USD Medical Center in Sioux Falls, SD, a 504-staffed-bed tertiary care hospital, has developed a nurse case manager program within the spine center staff. The nurse manager, known as a "navigator," guides a patient through a prescribed treatment plan, providing education and support through the process and saving money by clearing time for physicians, who can do other tasks.

 "With our nurse navigator program, we evaluate the needs of the patient and coordinate with the patients. That's a very important piece of what we do in designing a prime spine program," says Kevin Lampe, Sanford Heath vice president for the national orthopedic practice. "The nurse navigates the patient through our system as quickly and as easily as possible and works through the decision-making pieces" to find the right level of care.

"The nurse navigator would produce benefits to the practice through patient education or 'health coaching' that would otherwise take physicians' time during appointments," says Thomas M. Boetel, DO, a physiatrist at Sanford. "Patients are encouraged to ask their doctor about anything regarding their care, but the relationship built with patients by nurse navigators enhances their confidence and comfort with patient experience."

"The more complex healthcare becomes, it seems natural that health systems will seek work flow and processes that enhance the patient experience," says Boetel. "Nurse navigators are one of the critical elements we use to do that here.

"Often, patients have longstanding histories and they may have been seen by different providers," Boetel says. "The nurse navigator gathers the information from the patient to find out what kind of treatment they've had in the past. The idea is not to waste the patient's time or the physician's time. Nurse navigators serve as a health coach for the patient. We want to see patients through a course of conservative care."

Under the nurse navigator program, one of the goals is to ensure that the patient knows the diagnosis, treatment options, and potential outcomes.  Boetel says patients benefit by receiving the most appropriate care based on individual needs and conditions. Different specialists discuss complex cases. "Often with back pain, people don't know where to go. Do they go to the primary care physician? Do they see a chiropractor, or orthopedic surgeon? We are gatekeepers for spine care and are focusing on finding appropriate treatment."

Boetel says the hospital is continuing to explore further innovations in its spine program because of the need, and potential for cost reductions.

Because weight issues are often involved in back pain, Boetel says the hospital is working with its wellness program and may coordinate future efforts in pain and back care. "We are looking for solutions for continuum of care; we're working on departments getting together," he says.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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