Complex spine surgery requires an all-hands-on-deck approach, often with multiple experts in the operating room.
Seven spine surgeons discuss their communication strategies for these cases.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What strategies do you use to ensure consistent communication and alignment within a multidisciplinary care team for complex spinal cases?
Joel Beckett, MD. DISC Sports and Spine Center in Marina del Rey, Calif.: In comparison to academic and hospital employed positions, achieving consistent communication and alignment within a multidisciplinary care team for complex spinal cases requires an intentional, highly organized approach. Without the formalized structure of a teaching institution, private practice demands proactive effort to build and maintain the relationships and workflows necessary to achieve optimal patient outcomes.
First, I prioritize open communication channels. This involves creating dedicated pathways, such as secure messaging platforms, scheduled check-ins, or collaborative team meetings. While academic systems often have these workflows established, in independent practice, the onus often falls on the surgeon to establish and maintain protocols and ensure alignment among all providers.
Additionally, building trust within the care team is key. In independent practice, where you may work with different providers in various settings, fostering consistent relationships and mutual respect ensures that all team members stay on the same page. One must strive to create an environment where each provider feels valued and invested in the patient's care plan, facilitating smoother collaboration and more coordinated decision-making.
In summary, the surgeon must have a proactive approach to multidisciplinary coordination. This is particularly true in independent practice where communication pathways and clinical trust may not be as established as in hospital employed or academic positions.
Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): Schedule regular interdisciplinary meetings to discuss patient care plans, share updates, and address any challenges that may arise. This fosters open communication and ensures everyone is on the same page. Conduct interdisciplinary rounds where team members from different specialties come together to discuss individual cases. This encourages collaboration and allows for diverse perspectives in treatment planning.
Implement feedback mechanisms that enable team members to express concerns or suggestions for improvement. Creating a safe space for feedback promotes a culture of continuous improvement. Organize case conferences for complex cases that require in-depth discussion. These meetings can facilitate problem-solving and consensus-building among team members.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Keeping a team aligned and informed is critical to a smooth case flow. When we are looking down the barrel of a long case, I walk into the room and greet everyone and catch up. Then we go over the "order of business" and what steps will happen when. I've usually gone over the case in my brain a half dozen times by then and when I walk into the OR, it all crystallizes. As a team we also discuss possible forks in the road and talk about "if this, then that" scenarios. We make sure everyone in the room including the patient has their needs met.
If there is a position change, we talk about that as well. During the operation, I also give updates like: "OK, holes are drilled and we need to get the fluoro people in," just so we can help the "music" and the "dance" of the operation continue to flow. I also check in with different members of the team and verbally "round" with them, making sure anesthesia, neuro monitoring, the circulating nurse, and the other folks in the room involved and acknowledged really helps keep things running smoothly. Timely, but not incessant communication and updates are very necessary to success in a smooth surgery.
William Kemp, MD, VSI (Virginia Spine Institute) in Reston: At VSI, our weekly multidisciplinary teaching conference brings together our in-house specialists from neurosurgery, orthopedic spine surgery, physiatry, neurology, and physical therapy to collaborate on patient care. With all critical spine specialties under one roof, our team shares a commitment to open communication and collective decision-making. This approach ensures that complex cases are evaluated from multiple perspectives, leading to well-informed decisions and optimized patient outcomes.
Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): There are several areas in medicine where protocols + consistent meetings are incredibly crucial — coordinating multidisciplinary care teams for complex spine cases is absolutely one of them. I don't think there is a universal blueprint (given the "complexity" of the care for these patients), but I think that developing a consistent process for review with all stakeholders/disciplines present are key. And most importantly, a "buy-in" from each care team member from all disciplines, because in reality, the time spent in these multidisciplinary activities are generally not as "revenue-generating" as their specific standard clinical duties.
In our center:
We have a PA (physician associate) who leads the organization of our complex spine care and serves as the quarterback for each patient. This is incredibly important because they have the clinical background and the administrative skills to coordinate the providers and the patients. And from a cost/resource perspective, the value added is much greater than that of a surgeon/physician.
Monthly Multidisciplinary Meetings with all disciplines to discuss upcoming cases and review all aspects of care.
Monthly "Carpentry" Conference for pre-operative planning and post-operative critical evaluation.
Specific segments of M&M conferences focused on these patients and their complications.
Annual review of the multidisciplinary care to assess areas of success, areas that need improvement, assess staff involvement, and consideration of additional members & processes.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Complex spine cases require an integrated communication alignment strategy with a multidisciplinary care team in the preoperative, intraoperative, and postoperative settings. I think about strategies in each of these arenas as being important in their own right to ensuring the best outcomes for patients undergoing complex spine surgery.
In the preoperative setting, we employ a multidisciplinary conference that includes our surgeons, anesthesiologist, physician assistants, internal medicine physicians, physical therapist, occupational therapist, and others who were involved in the care of these patients. This multidisciplinary team opines upon the appropriateness and optimization of a given patient for undergoing complex spine surgery. This team also helps ensure that all testing has been completed in the right way.
In the intraoperative setting, we utilize regular hard stop timeout before and during surgery to ensure that the patient is stable to continue. We prepare two-stage surgeries whenever it is appropriate. We also planned staged surgery such that no patient undergoes more than 2 stages in any given day, particularly when 3 or more stages may be planned. Similarly, in the postoperative setting, we have an integrated team of intensivist, hospitalist, nursing staff, physical therapist, occupational therapist, and physician assistants dedicated to the care of these complex spine patients. Their familiarity with the needs of complex spine patients allow them to optimize their care for these patients.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Good team communication is a strategic imperative to fuel success in healthcare delivery. Effective communication can lead to enhanced specificity, heightened patient satisfaction, and significant cost efficiencies. On the other hand, poor communication can negatively impact your brand's reputation, employee engagement, and the bottom line.
Intramural discussions usually occur preoperatively as surgical planning and strategy takes place prior to scheduling. This process allows for direct requisition of surgical care and avoids delays within the insurance morass and potential confusion.
For all patients, but most particularly for the complicated and infirmed patient populace, mechanisms are in place for automatic consultation and oversight by ancillary and nursing services as adjuncts to assist patients with their post-operative management.