Structuring a Spine Program

Joe Cantlupe, for HealthLeaders Media , August 15, 2011
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After evaluations are completed, a spinal team can determine the appropriate course of treatment, whether surgical or not, says Laurel Valentino, RN, CNRN, director of Methodist's neurosciences program. The process has led to greater efficiencies and patient approval. Since the program has been in effect less than a year, data is still being compiled, she says.

It was important to develop Priority Consult because although surgical procedures are sometimes necessary, more than 80% of spine patients are treated without surgical intervention, says Elian Shepherd, MD, the spine care center medical director.

Under the hospital's program, physicians evaluate patients in preappointment screenings that enable staff to make evaluations even before an initial appointment. That occurs after a patient or referring physician calls the spine program's central line for consultation or referral. At that point, an intake specialist captures the medical history.

"The idea is to get the patient to the right service as soon as possible," says Valentino. "It takes a team approach to get patients in to see the physicians in a timely manner and also support them. We try to get the appropriate tests done before the patient sees the doctor so that they can develop a plan of care, with their needs. Also, patients can call directly if they do not have a physician.

"We think this is the wave of the future," Valentino adds. "We have a kind of virtual center, and with a nurse navigator we get prior information about the patient that helps the doctors screen them. If it is the highest priority, a patient gets to see a surgeon right away; if there are onset symptoms, like they cannot walk or have numbness, they go to the emergency department. If there is a disc issue or some type of herniation, they can be screened and within three to five days to see a surgeon. If there is no pathology," she adds, "a physical medicine doctor is seen, and then we get patients on physical therapy and we can build upon that."

The Methodist patient care team includes a physical therapist, an occupational therapist, an orthopedic surgeon as needed, and a care manager, such as a nurse specializing in neurology, to coordinate the patient care. The physician assigned to the case is regularly updated from the care coordinator, a nurse who offers education service and assists with pain management, therapy, or treatment, says Valentino.

"We don't do tests to do tests; the idea is to be more economical. There will be definitely more patients because of the aging population," Valentino says. "There are more issues with stress on the back, but it's not only age. Someone may just twist the wrong way, and even younger people have that happen.

"You are bringing a full service to the patient, not just doing the back surgery and sending them out," Valentino says. "We are doing medical management and making sure the patient gets the right diagnostic tests and physical therapy through the multidisciplinary approach." With greater efficiencies, Valentino says the hospital can handle greater volume. "This is from a holistic standpoint, and as part of those changes, you bring in more patients, and it is good for the ROI."

Success Key No. 2: Osteoporosis specialty


The Methodist Hospital has a spine specialty program, but hospital leadership decided the hospital needed to specialize further with development of a program for osteoporosis care.

The hospital has begun widespread screenings on bone density for patients on an outpatient basis to determine if there are any problem areas and alert them to possible treatment. It has designated practitioners and nursing staff to work specifically on osteoporosis, a disease that is increasing, especially among women. Osteoporosis—which leads to the weakening and breaking of bones in the spine, hips, or wrists—can be brought on by minor accidents.

"As physicians we are not paying serious attention to the problem," says Shepherd, referring to osteoporosis. "The only time we take care of it is when there is a fracture, and at that point we may be very well beyond the point of an osteoporosis condition."

Because of what Shepherd and other Methodist Hospital officials have described as undertreatment of osteoporosis, the hospital officials have placed key importance on bone scan studies as part of overall care. If a problem exists, they refer the patient to the spine center for osteoporosis treatment. Such actions can help the patient properly combat osteoporosis conditions, Shepherd says.

Another important aspect of care is to form continuing relationships between the hospital and the primary care physicians regarding osteoporosis and improved treatment regimens, Shepherd says. "We have a nurse dedicated for follow-up care," Shepherd says. "We see patients who are admitted for other conditions, but with a bone evaluation, we make them aware of the problem. We are definitely seeing more of these osteoporosis cases than in the past as a result of degenerative changes affecting the spine. People come into the hospital stooped or standing with a stoop, having lower-back issues." Kristy Darnell, MSN, APN, FNP, an advanced nurse practitioner and care coordinator for the hospital, says Methodist officials are working to educate female patients about the necessity for prompt treatment of the condition, especially at a younger age. "We are getting them screened and making sure they are receiving early treatment," Darnell says.

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