A Unique Approach to Spine Care
Friday, April 15, 2011
Through the development of the PinnacleHealth Spine Institute, patients throughout Central Pennsylvania have access to comprehensive, quality spine care.
Photo: The PinnacleHealth Spine Institute is truly comprehensive, utilizing a host of nonsurgical therapies, including physical therapy through two of less than 30 Certified McKenzie Clinics in the U.S. Photo © Stephen Moyer
PinnacleHealth — a hospital and health care system located in Harrisburg, PA — developed the PinnacleHealth Spine Institute by bringing together all of the resources necessary to deliver efficient, expedient spine care. Through a multidisciplinary team approach, a streamlined referral process and the employment of nurse navigators to help patients find their way through the care process, patients benefit from an integrated approach for the treatment of their spine conditions.
“PinnacleHealth has pulled together a variety of providers, including spine surgeons, physiatrists and pain management physicians, and put them all under the umbrella of the PinnacleHealth Spine Institute to help provide collaborative patient care,” says William Beutler, M.D., Medical Director of the PinnacleHealth Spine Institute. “From conservative modalities, such as pain management and physical therapy, to surgery and rehabilitation after surgical care, we offer the full complement of spine services.”
Expedient Care
The PinnacleHealth Spine Institute’s Intake Center allows patients to benefit from timely care after referral. Instead of waiting several weeks for an initial appointment and consultation, physicians view patients’ information within 72 hours of referral and make a treatment recommendation or order more diagnostic tests. A full range of imaging modalities for the spine are available at a variety of locations through PinnacleHealth Imaging services, including MRI, bone scan, CT scan, X-ray imaging and myelograms. Based on the physician’s review, patients who need acute, surgical care can benefit from expedited consultation rather than waiting for the next available appointment. If a patient’s needs are not urgent and it’s in the patient’s best interest to try conservative therapies before proceeding with surgery, physicians can make that decision at the time of review and begin pain management or physical therapy before the patient comes in for a surgical consultation. This offers the patient referrals to physiatrists or pain management specialists and a trial of nonsurgical treatments so patients can begin receiving services rather than waiting until after their initial appointments with a surgeon.
“Typically, when people have pain in their lower back, neck or anywhere in their spine, they will call a physician’s office and then have to wait several weeks before receiving a treatment recommendation,” says Dr. Beutler. “Through the Intake Center, patients complete a detailed questionnaire that takes 20-30 minutes and reviews history, as well as symptoms the patient is experiencing. All of the patient’s clinical information is stored in a computer database for review by a surgeon, which occurs within 72 hours of receiving the patient’s information. This allows treatment recommendations to be made and appointments to be accommodated as soon as possible.”
After a treatment recommendation has been made, a nurse navigator reaches out to the patient to discuss the treatment recommendations and the next steps that will need to be taken. The patient’s nurse navigator also communicates information back to the patient’s referring physician, keeping them updated on the treatment plan, upcoming appointment times and ongoing progress. If patients need surgery or if they need to see a pain management physician for an epidural steroid injection, for example, a nurse navigator stays in contact with the patient to coordinate all appointments, surgeries and any follow-up services that may be necessary.
State-of-the-Art Spine Care
Through the PinnacleHealth Spine Institute, patients have access to physiatrists, orthopedic spine surgeons, neurosurgeons and pain management physicians. Specially trained nurses, physical therapists and occupational therapists round out the dedicated, comprehensive spine care team. Treatment modalities range from conservative therapies — including therapy, medication and injections — to a full spectrum of surgical procedures used to address a wide range of spinal disorders. More than 1,600 surgeries are performed each year by the PinnacleHealth Spine Institute’s team of neurosurgeons and orthopedic spine surgeons. Regular spine case conferences are also held to discuss specific cases and provide a forum for physicians to collaborate on patient selection, surgical approaches and treatment options. These spine case conferences help enhance and support residency education, as well.
“In terms of surgical options, there are numerous procedures we offer to patients for degenerative conditions occurring in the cervical, thoracic and lumbar spine,” says Michael Fernandez, M.D., Assistant Medical Director of the PinnacleHealth Spine Institute. “Depending on surgical candidacy and each patient’s individual diagnosis, kyphoplasty or microsurgical procedures may be recommended.”
Keeping up to date on the latest techniques, the PinnacleHealth Spine Institute also offers cervical artificial disc replacement.
“The PinnacleHealth Spine Institute is an integrated, multidisciplinary approach that provides a seamless point of referral to facilitate each patient’s spine care needs. Referrals are accommodated in a timely manner, and physicians provide a comprehensive review of information so that patients and their physicians can rest assured that the most thorough evaluations will be performed. Without going to many different places, patients receive a full complement of spine care.” — Michael Fernandez, M.D., Assistant Medical Director of the PinnacleHealth Spine Institute
While the majority of patients are able to find relief from conservative therapies, patients proceeding with surgical intervention benefit from several unique program features, including preop spine education classes, customized rehabilitation and private patient rooms during their hospital stays. Prior to surgery, patients participate in a preoperative course that outlines what to expect before and after surgery. This class is conducted by nurse care coordinators and physical and occupational therapists who provide patients with the opportunity to ask any questions, which helps ease any anxiety that may be experienced in the days leading up to their procedure. Patients also receive a detailed guidebook that outlines the surgical procedure and what will be involved in preoperative and postoperative care that patients can review at their leisure.
Surgery takes place at either PinnacleHealth’s Harrisburg or Community Campus. At both locations, patients are admitted to an Inpatient Spine Unit after surgery that includes private patient rooms and nursing care provided by nurses who are specially trained in caring for patients with conditions of the spine. The nurse care coordinators work with the patient and their caregiver “coach” during their hospitalization to ensure the patient is progressing toward expected outcomes and preparing the patient for discharge. Physical therapists and occupational therapists use evidence-based protocols developed specifically for each procedure to help patients regain optimal functioning after surgical interventions.
Nurse care coordinators continue to follow patients after discharge to address follow-up questions or concerns, monitor progress and ensure the staff is continuing to meet all of the patient’s health care needs.
Ensuring Quality
To help ensure that the care provided meets patients’ expectations and exceeds national standards, protocols are in place to measure quality outcomes and patient satisfaction. At the end of their stays, patients are able to answer questionnaires about their experience, which give staff a firm feel of where they stand in regard to patient satisfaction. Patient functional outcomes are analyzed using the Oswestry Disability Index and Neck Disabilities Index, and quality outcomes in areas such as infection rates, complications, 30-day readmission rates, mortality, discharge disposition, length of stay and reoperation rates are evaluated, as well. A dedicated committee made up of spine surgeons then meets to examine data and develop action plans to address quality concerns, if needed.
To learn more about the PinnacleHealth Spine Institute or to refer your patient, call 1-877-499-SPINE.
PinnacleHealth Spine Institute
Photos © Stephen Moyer
MD News April/May 2011, Central Pennsylvania