Becker's Spine Review

9 SPINE SURGEONS How Penn Medicine's spine access center is streamlining patient referrals through its EMR system By Alan Condon I n 2018, with increasing and burdensome workloads for referring and primary care providers, the neuroscience service line at Penn Medicine sought a more unified ap- proach to treating patients with spine needs. Four different departments involved in spine — orthopedic surgery and neurosurgery, physical medicine and rehabilitation, and an- esthesia management — all had different pro- cesses to manage patients referred for spine care, which contributed to the workload of referring and primary care physicians. Addi- tionally, patients seeking spine care within the four departments were treated in siloes. Discussions with primary care providers re- vealed the barriers preventing streamlined patient navigation: six consult orders in the Epic EMR system pointed to various de- partments for spine care, but few were being reviewed. Referring providers were oen un- sure whether to send patients to a surgical or nonsurgical spine provider and patients were bouncing between the four spine depart- ments with little continuity of care. us, a pilot initiative was established at Phil- adelphia-based Penn Medicine, which creat- ed one consolidated Epic consult order for spine care and directed all internally referred patients through a single channel — the new- ly created spine access center. "A lot of patients want to be seen by a spine specialist but aren't really interested in sur- gery," said William Welch, MD, chairman of the department of neurosurgery and medical director of the spine center at Pennsylvania Hospital in Philadelphia. "e spine access center is able to screen the patient appropri- ately, utilizing clinical triage protocols estab- lished by the providers, to get the patient sent to the next available physician quickly." "So, when patients call, they're screened by a Penn Medicine nurse and her team and di- rected to the most appropriate physician and location, based on their diagnosis," Dr. Welch added. "is triage process gets nonsurgical patients to the appropriate provider, and as a result helps the surgical practices to be able to see more surgically appropriate patients." Now, primary care providers refer patients for spine care by placing one Epic order, which is managed by the spine access center. e team reviews the information and connects with the patient within 48 hours to schedule with the appropriate spine provider across all four spine departments, which encompasses more than 50 providers and 16 locations. In establishing this new process, there were concerns that needed to be mitigated amongst internal spine providers, particular- ly around referral patterns. If a provider re- fers their patient to a specific spine surgeon, they automatically are sent to that physician, eliminating referral concerns of some sur- geons at Penn Medicine. However, if there is no designation and the spine access center determines surgery is re- quired, the patient is scheduled with the first available surgeon — giving the patient choice of location based on his or her geographic preference — creating incentive for physi- cians to open their schedules. "Each quarter, the nurse manager publishes to the entire group the number of patient consults, the number of patients that went to nonoperative care such as rehab or anesthe- sia, and the number of patients that went to the surgical side," said Sean Grady, MD, chair of the department of neurosurgery and med- ical director of the neuroscience service line at Penn Medicine. "Everybody sees where ev- ery patient is going." "When everything's transparent, everyone can see that they are getting a fair shake," Dr. Grady said. "Our referring physicians are in- credibly happy and believe this is the best ini- tiative that they've seen in the health system. Our patients are happy as well. We're able to quickly get them scheduled for top-notch, in- tegrated care. It's been wildly successful." e program has been in place for more than 18 months, receiving more than 13,000 spine consult orders and scheduling over 12,000 spine appointments. Due to its success, Penn Medicine — which features a collaboration of employed and private practice physicians — has officially adopted the spine access center as a permanent offering across the four spine departments. n $816K+ awarded to North Carolina patient left with permanent spinal cord damage after surgery By Alan Condon A 67-year-old man was awarded $816,988 after a 2014 spine surgery at Ashe County Memorial Hospital in Jefferson, N.C., left him with perma- nent damage to his spnal cord. The man alleged he experienced a serious complication — spinal epidural he- matoma — after he was left untreated for days after surgery. After several alleged efforts to reach the spine surgeon's office and about a seven-hour stay in the hospital's ER, the man was transferred to Watauga Med- ical Center in Boone, N.C., for treatment. The man alleged the delay in diagnosis led to compression on his spinal cord, which became permanently damaged and left him unable to work. The jury awarded the man $416,988 in economic damages and an additional $400,000 in non-economic damages — the largest money damages jury ver- dict in Ashe County, according to the Clerk of Court's office. n

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