Archive February 2014 XV, No. 2

How We're Pushing the Outpatient Spine Envelope

Six ways you can innovate to perform bigger cases with better outcomes.

Robert Bray

Robert Bray


new devices and hardware AT THE FOREFRONT The DISC Sports & Spine Center holds surgeon and technology panel meetings to discuss new devices and hardware as they arrive on the scene.

After 7,000 orthopedic, spine and pain cases in 7 years, we've never had an MRSA infection, blood clot, pulmonary embolism or hospital transfer for a surgical complication. And we're not doing your run-of-the-mill outpatient spine procedures. Rather, we're handling abdominal-approach lumbar fusions, extreme lateral interbody fusions, pedicle screws, intradural tumors and more. And you can, too, if the proper attention is paid.

Make no mistake, though: It's been a progression over many years to develop a practice that focuses on higher-acuity cases in an outpatient setting. We've deliberately set out to lead the way by doing bigger and bigger cases with increasingly safe outcomes. With that in mind, here's an inside look at how one of the nation's busiest dedicated spine centers is pushing the outpatient envelope.

1 Surgeon selection
Good surgeon selection means the following to me: They're well-trained, they truly understand the goals of minimally invasive surgery, they're abreast of new technology and they're driven to meet the highest standards in all surgical protocols. These surgeons will seek out patients who will benefit most from less-traumatic procedures — from having less hardware implanted and fewer levels of the spine operated on. The result will be surgeons who don't resist change and who do the best by their patients. Our surgeons track what they're doing and follow up with analysis. For example, one of our surgeons has begun doing lateral spine cases through the abdomen, and has published the first 70 cases. He's putting in less hardware, doing less invasive surgery and reaping good patient outcomes.

2 Nurse selection and training
In addition to caregivers, we want our nurses to be teachers, students and motivators. Like our surgeons, we expect them to come with a philosophy of holistic care. Our patients aren't handed off from one person to the next (more on that later); instead, our nurses provide personal attention from admission to recovery, including patient education and encouragement. They have to interface with pain management and understand the clinical post-op progress desired for each procedure.

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