The following are excerpts from an article that will be appearing in Proliance Outlook Magazine (April 2013):
The surgical treatment of the human spine can be challenging in diagnosis, surgical decision-making, and technical execution. While there is general agreement among spine surgeons on appropriate care pathways, there is substantial variation in the rates of surgery, delivery of care, cost of care, and outcomes. Surgeons often struggle with meeting the best practices involved in caring for this population because they have limited data for tracking of performance or pathways to improve care delivery.
To meet this challenge, Spine SCOAP was created through the effort of a dedicated group of Washington State spine surgeons under the leadership of Dr. Neal Shonnard from Rainier Orthopedic Institute. Modeled upon the structure and principles of general SCOAP surgical surveillance, Spine SCOAP captures information on various cervical and lumbar spine procedure types and includes data about patient demographics and history, risk factors, comorbidities, operative care, perioperative interventions and post-operative events at 30 days, and then at six month intervals for up to five years after the intervention. Spine SCOAP is collecting data for spine surgeries at 18 hospitals across Washington state. Over 4000 cases from 2011 to the present are now in the database.
Concurrently, healthcare stakeholders (Labor and Industry, employers, payers, regulators, advocacy groups) are interested and motivated to achieve the same goal (proof of benefit to patients, improving safety and quality of care) but for different, often competing, reasons. All stakeholders see Spine SCOAP as an objective, real world representation of truth that is impartial and not easily influenced by any stakeholder. Stakeholders are coming together through the CERTAIN Spine Care Forum to share perspectives and work to commonly own issues facing those who treat, receive, and pay for treatment of spine issues. The CERTAIN Spine Care Forum is a venue where all stakeholders can share data about “what works” and “what does not work”, in spine care. Clinicians participate in frequent peer-led educational and interventional activities aimed at creating behavior change around metrics, sharing best practices, and improving outcomes. Through quarterly meetings with stakeholders, providing information back on the correlation between quality metrics and outcomes in their patients, and embracing interventions aimed at improving outcomes,
One of the first quality improvement initiatives to come out of the data is the issue of smoking and spine fusion surgery. Numerous studies of spine fusion have shown that smokers have much higher rates of non-union. Failure rates of up to 40% have been reported and many surgeons are now refusing to operate on smokers with some even testing for nicotine prior to surgery. With that in mind, Spine SCOAP compared the rate of fusions among current smokers across the collaborative and found that there is great variation among hospitals, ranging from 14% to 40% performing fusions on smokers. Given the potential for poor outcomes, higher infection rates, and greater incidence of wound complications, Spine SCOAP is sharing that data with hospitals and surgeons.
Traditional quality metrics around surgery have started once the patient reaches the hospital. But what can be done to improve outcomes for our patients before they reach the hospital? SCOAP hospitals participating in CERTAIN are now shining a spotlight on the pre-surgical setting. In that spotlight is the Strong for Surgery campaign -- an initiative aimed at identifying and improving evidence-based practices to help patients have better outcomes. The Strong for Surgery initiative offers an additional way to translate the importance of smoking cessation into successful spine fusion. This public health campaign offers pre-surgical checklists to ensure that all patients are screened for smoking and directed to appropriate cessation resources. Use of a checklist ensures consistency in delivering best practices, helps communication between team members, and serves as an opportunity to educate patients about methods to improve their health prior to the surgical intervention. Thus the best care is delivered to each and every one of our patients, all of the time. In addition to smoking cessation, Strong for Surgery offers three other checklists targeting the risk factors of nutrition, medication use, and glycemic control.
“Strong for Surgery takes the idea of checklists and moves them where decisions are being made before the patient gets to the hospital,” said Tom Varghese, MD, Medical Director of Strong for Surgery. “Putting the checklist in every doctor’s office across the state takes the focus of surgical safety beyond the operating room. Surgical preparedness now becomes part of the basic conversation about planning for surgery and the patient shares in that process. It empowers patients.”