3 Best Practices for Technologies and Facilities at Hospital-Based Spine ProgramsWritten by Lindsey Dunn | November 11, 2009
Chicago-based NeuStrategy and San Diego-based SpineMark recently completed a nationwide survey of hospital-based spine programs to determine best practices of leading spine programs.
The Spine COE® (Center of Excellence) Survey evaluated the infrastructure of four critical components — programs, staff, facility/technology and business — of 99 spine care programs across 35 U.S. states and three international locations. The survey segments participating hospitals into two categories: emerging versus comprehensive programs, with comprehensive programs leading the way in spine care.
The results of the survey shed light on some of the best practices being employed at leading spine programs across the country. Marcy Rogers, president and CEO of SpineMark, a spine center development firm, shares the following three best practices for technologies and facilities at spine programs as indicated by the survey.
1. Offer cutting-edge technologies. One of the largest differences between emerging and leading spine programs is the type of technology available for treatment of patients. Comprehensive programs offer diverse technologies, including cutting-edge imaging equipment and various technologies for minimally-invasive procedures, and adopt new technologies more quickly than emerging programs. For example, comprehensive programs are at least twice as likely to have an intraoperative MRI, a 3.0 Tesla MRI and intraoperative CT scanning, according to the survey. Intraoperative imaging using these technologies helps ensure proper placement of instrumentation and minimizes nerve damage, says Ms. Rogers.
"Only a small number of facilities have an intraoperative MRI or CT. These are a huge ticket item for facilities and in some cases may require remodeling of on OR to fit the equipment," says Ms. Rogers. Programs that want intraoperative imaging but cannot afford such expensive and large technology may want to consider investing in 3-D software that reconstructs images of patients' anatomy during surgery, she says.
Emerging programs, on the other hand, may rely on a 64-slice CT scan and an intraoperative C-arm for imaging during procedures.
Leading spine programs also offer patients access to the most cutting-edge treatments for spine conditions, including technologies and materials that support minimally-invasive treatments, says Ms. Rogers.
2. Develop a strategic plan to govern continual investment in technology. Decisions regarding which technology to invest in depend on the comprehensiveness and goals of each spine program. Programs with enough patients to support large investments in technology and more complex cases are more likely to benefit from intraoperative imaging and monitoring than programs that treat a smaller number of patients, says Ms. Rogers. A smaller program may forgo an intraoperative MRI or CT and instead consider the purchase of 3-D software or use an OR that provides quick access to MRIs.
After a hospital has determined its goals for the spine program, leaders should work closely with spine surgeons to develop a strategic plan that will oversee new technology purchases to support new techniques.
"A facility needs to have a continued partnership with its physicians. Leaders should be asking physicians about their plans for learning new procedures and should think about how to budget to bring in any new technologies to support those procedures," says Ms. Rogers. "Collaboration becomes very critical. Bringing in a new technology requires planning, budgeting and careful consideration. You need to make sure the staff is educated about how to use it, that payors will reimburse it and that it will be attractive to patients."
3. Create a dedicated spine unit for inpatient and outpatient spine services. Finally, leading programs are more likely to have dedicated spaces within the hospital for spine services. For example, 97 percent of comprehensive programs feature dedicated spine ORs, while only 59 percent of emerging programs have dedicated OR space, according to the survey. Additionally, 80 percent of comprehensive programs have dedicated spine unit beds, while only 48 percent of emerging programs have dedicated beds.
"Anytime you're in an environment dedicated to one specialty, there are efficiencies and improved outcomes that come with a group that is specially trained for the specialty and doing it everyday," says Ms. Rogers. "Dedicated units can have nurses trained specifically for spine in the OR as well as specially trained and dedicated staff who really understand the needs of spine patients."
Whether or not a program warrants a dedicated spine unit depends on the program's volume and current facility. "A dedicated unit elevates a spine program and can attract patients," says Ms. Rogers. "While we wouldn't suggest a remodel just to do this, if a hospital is remodeling anyway, we recommend building a dedicated unit with rooms that keep in mind the limited mobility of spine patients and allows additional space for the equipment that is needed to care for spine patients."
Leading spine programs with dedicated units are also more likely to offer ancillary and complementary medicine services within the spine unit. For example, some of the largest spine programs include a dedicated radiology suite and physical therapy areas on the spine floor specifically for spine patients. Some spine programs also offer complementary medicine to spine patients through services such as aquatic therapy, massage therapy, acupuncture and chiropractic services.
Learn more about the Spine COE® Survey.
Read four best practices for hospital spine center programming unveiled by the Spine COE® Survey.
Read four best practices for hospital spine center staffing unveiled by the Spine COE® Survey.
Note: "COE" is a registered trademark of NeuStrategy, Inc.
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