Streamlining Delivery of Surgical Spine Care
May 25, 2021
University Hospitals Spine Institute creates evidence-based care pathways, center of excellence to improve patient experience
Innovations in Neurology & Neurosurgery | Summer 2021
Surgery is usually a last resort for people suffering from spine conditions, so it can be disheartening when patients begin their treatment in a surgeon’s office.
“When I joined UH, surgeons were the first point of access for any type of spine issue,” recalls Gabriel Smith, MD, a neurosurgeon at University Hospitals Neurological Institute since 2018 and co-director of the University Hospitals Spine Institute and Assistant Professor of Neurosurgery, Case Western Reserve University School of Medicine. “It would leave patients frustrated because we’d say, ‘Good news, you don't need surgery, but you should go see this other physician or try these other alternatives to surgery.’”
Reengineering a multidisciplinary approach to spine care is one of the ways University Hospitals has worked to streamline care for patients over the last several years. Since 2018, the health system has launched the integrated UH Spine Institute, as well as created comprehensive spine centers such as University Hospitals St. John Medical Center, in Westlake, Ohio.
UH St. John is now in its second year serving as a spine center of excellence for Northeast Ohio’s West Side region. It has become a teaching site for the neurosurgical residency program and is an integral part of the complex spine fellowship offered for advanced training. UH St. John Medical Center serves residents of western Cuyahoga and eastern Lorain counties. The center is the anchor location for the complex spine surgery, housing the latest equipment for neuronavigation, imaging and multidisciplinary care.
These developments have laid a strong foundation for surgical spine care at UH, while improving access to high-quality care for patients with all types of spine conditions — including the most common ones.
Connecting the Dots
UH St. John’s designation as a spine center of excellence was part of a systemwide effort at UH to transition its surgical services to comprehensive centers for patient care. The health system’s West Side patients now have one place to access expertise, resources and advanced technologies for complex spine care, as well as non-surgical spine care closer to home.
An important step in building the spine center of excellence was beginning to standardize care for surgical spine patients by creating simpler “care pathways” to subspeciality care.
“Before, it was very confusing for patients,” explains Nicholas Bambakidis, MD, director and vice president of UH Neurological Institute, and Professor of Neurological Surgery at the School of Medicine. “They would end up in a surgeon's office with no scans and they needed an MRI, or they’d end up in a pain management office and they clearly needed surgery.”
Since the formation of UH Spine Institute, Dr. Smith has partnered with UH orthopedic spine surgeon Zachary Gordon, MD, to develop these evidence-based care pathways for surgical spine care, focusing on patients with neck and back pain.
“Conservative care is the gold standard of care for anyone who has a spine problem,” Dr. Smith says. “So our emphasis over the last two years has been to identify gaps in direct access to physical therapy and other conventional treatment.”
The care pathways act as a roadmap to the patient’s journey from initial diagnosis through post-surgical care. For someone reporting back pain, for example, UH now has a medical spine referral with a diagnosis code opening a medical spine visit with an intake provider specializing in non-operative care. The care path continues with medical therapies and other treatments, ranging from physical therapy to weight loss programs, smoking cessation, counseling and pain management from providers who work directly with UH surgical practices.
Providers can also begin the process of investigating the patient’s condition with advanced imaging before recommending a surgical visit. If the patient fails conservative care, they’ll meet with a spine surgeon, who can then determine if surgery is needed.
“Spine care used to be a silo of care that was being delivered throughout the hospital system at different locations,” Dr. Smith says. “Now every single aspect of the patient’s care is evidence-based and designed to lower clinical variability and improve their experience with our hospital system.”
One of the hallmarks of the UH Spine Institute is finding ways to improve the quality of care delivered for patients, Dr. Smith says. Streamlining delivery of surgical spine care is one approach. Another is recruiting top spine surgeons like Dustin Donnelly, MD — who trained in spine surgery at some of the nation’s leading medical programs. The Ohio native is joining the UH Spine Institute in August 2021 after completing a complex spine fellowship at Duke University School of Medicine and completing neurosurgical training at Brigham and Women's Hospital in Boston.
“At St. John, we now have three fellowship-trained surgeons, so we’re very excited about the opportunities to drive quality as well as value,” Dr. Smith says.
Surgeons at UH St. John are now performing more complex revision and scoliosis surgeries than ever before, using the latest technologies and minimally invasive techniques. Because these advanced surgical technologies are resource-intensive and require specialized training, it makes sense to house them at centers of excellence, so that patients can access that world-class care in a community setting, Dr. Bambakidis explains.
“With advanced imaging and 3D navigation, we can perform more complex cases in a shorter time period with less blood loss and smaller incisions,” he says. “Our patients can get home, back to work and back to their recreational activities even sooner.”
St. John is among a small number of sites to pilot a new, precision virtual reality technology from Surgical Theater Inc. to improve patient satisfaction in spine surgery. The platform reconstructs the patient’s CT scan as a 3D model, so that they can view a real-time simulation of their upcoming surgery through a virtual headpiece.
“A difficult part of spine surgery is managing patient expectations, and our goals is to really improve that arm of our surgical experience,” Dr. Smith says. “With Surgical Theater, we can walk patients through their surgeries before they undergo them to improve comprehension of what they’ll have done, answer questions and help them understand the goals for surgery.”
These investments to improve quality and value for patients have also contributed to tremendous growth for the UH Spine Institute, Dr. Smith says. “Our medical spine services have grown by almost a 150% and our surgical volume has grown as well — even though our surgeons are seeing fewer patients in the office.”
Patients are also reporting a better experience, even when they do end up in a surgeon’s office.
“Patient satisfaction is improving because our patients have already begun their plan when they see a surgeon,” he says. “They understand the purpose of spine surgery — and that surgery is a discussion worth having.”