NewYork-Presbyterian hosted the 1st Annual Safety in Spine Surgery Summit on Friday, Feb. 19 bringing together physicians, clinicians and spine care stakeholders from around the world to discuss the biggest issues in adult and pediatric spine surgery outcomes.
"We in healthcare are in a journey to optimize the quality of the product we offer and although spine surgery can be very safely performed with very good benefit to patients, we all know there are risks," says Michael Vitale, MD, MPH, the Summit's chairman. He is also the chief of the pediatric spine and scoliosis service at NewYork-Presbyterian /Morgan Stanley Children's Hospital at Columbia University Medical Center.
Over the past few years, there has been increased emphasis on adopting a formal approach to minimizing patient safety risks and developing better outcomes for patients. But the outcomes are only partially related to the technical aspect of surgery; many of the complications can be reduced through preoperative planning, education and communication to optimize the patient before surgery.
"The healthcare system we practice in can be a challenge and we can use formal tools and quality science to optimize the environment in healthcare and make errors even more rare," says Dr. Vitale. "The biggest changes have come from looking at the episode of care rather than the surgical treatment. That means developing formal ways to assess risk before surgery and using a multidisciplinary team to ensure indications are appropriate and we are choosing the best treatment possible for any given patient."
At the moment, patients with similar indications will likely receive different treatment recommendations based on their surgeons' assessment, but in the future data will help optimize each diagnosis so patients truly receive the best value. The tools clinicians can use to decrease variability include:
• Quality science
• Algorithms
• Check lists
• Clinical care guidelines
Collecting and understanding key quality data will take the field a long way toward achieving this goal. High quality, actionable data exists but surgeons don't always have access to that data, or the datasets are difficult to interpret.
"There are a lot of examples where the data exists to export without any carrot or stick to improve care for everyone involved, not just the high performers," says Dr. Vitale. "Just showing the data on blood loss during scoliosis surgery to a group of surgeons results in less blood loss over time. It's the Hawthorne Effect, when people know others are watching they improve, and we use it well in spine surgery."
Dedicated care teams will also lead to better outcomes. Many spine surgeons performing complex cases work with nurses and surgical teams who aren't familiar with the complex spine and may not have the necessary experience to deliver reproducible outcomes for each patient.
"The surgeons are doing complex cases without nurses, anesthesiologists and assistants with personal familiarity, experience and commitment to that process," says Dr. Vitale. "I think there is a real opportunity to develop teams that have a dramatic impact on improving the quality of spine surgery."
Once the teams are established, truly integrated care takes the culture a step further to promote constant communication and empower different team members to affect change.
"Multidisciplinary teams are really powerful, but you need to develop the right culture and that's hard to do if you don't have familiarity, trust and a common goal," says Dr. Vitale. "That's why centers which have appropriate volume are a real advantage with hospitals and are able to dedicate focused teams in spine."
The true collaboration then expands beyond the clinical care team to include hospital executives and administrators, implant companies and payers as well as patients and other stakeholders in public health. When negative complications occur for one spine surgeon, it affects the reputation of all spine surgeons.
"If you look at the airplane industry, an Airbus crashing in Europe or Asia generally means Boeing stock will decline as well because they share the same space and are equally susceptible to the negative perception of safety in air travel," says Dr. Vitale. "We are all in the same boat aligned around the imperative to make care better. It's why you see meetings like the Spine Safety Summit generate so much enthusiasm among not only surgeons, but also administrators, hospitals and industry."
The future in healthcare ultimately centers on value with the proven numerator being quality, safety and patient experience and the denominator being cost, according to a presentation for BCBS's CMO. Providers can either take away from the numerator or denominator, and in many instances there isn't room to decrease the cost.
"Unless we are really able to improve quality, safety and patient experience, there will be money taken out of the system," says Dr. Vitale. "And that's not just the physician salaries, but also the ability of patients to have access to needed care."