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Spine collaborative develops new surgery protocols to better prepare patients for spine surgeries The Michigan Spine Surgery Improvement Collaborative, or MSSIC, a collaboration of 29 hospitals, two surgery centers and associated orthopedic surgeons and neurosurgeons, was in the spotlight recently. Members of the collaborative were interviewed by the ERAS® USA Spine organization about the progress MSSIC sites have made toward the development and implementation of ERAS, or enhanced recovery after surgery, across the state of Michigan. In 2019, MSSIC introduced ERAS for spine surgery protocols and began to lay the groundwork for future surgical performance measures. These protocols promote an evidence-based approach to better prepare patients for surgery, which is ultimately designed to facilitate an early recovery for patients undergoing major surgery. In a Spotlights feature by the ERAS® USA Spine organization, MSSIC Co-Director Victor W Chang, M.D., and Senior MSSIC QI Lead Kari Jarabek, R.N., answered questions about how MSSIC and the incorporation of these protocols began, as well as their experiences and challenges. Getting started MSSIC built an ERAS toolkit on its website — mssic.org — that includes resource documents, patient education tools, publications, example protocols and risk assessment tools. It also partnered with the American College of Surgeons to educate and provide templates for MSSIC sites to use so that they could take them to their multidisciplinary team meetings. In addition, MSSIC developed a video for sites to incorporate into their pre-surgical patient education. The video is intended to engage patients on how they can play an active role in their recovery. ERAS initiatives are linked through MSSIC to Blue Cross Blue Shield of Michigan’s pay- for-performance program, which provides a financial reward for the effort and supports the platform MSSIC uses to support its sites. A phased approach In Phase 1, sites that had been enrolled for two or more years had to demonstrate multidisciplinary team engagement toward the development of ERAS. Then each site documented its entire ERAS protocol, describing in detail, each Phase 1 ERAS element and the standardized process for implementing them. During Phase 2, MSSIC is tracking compliance with implementation so that processes can be evaluated and adjusted, if needed. It’s also prescribing an enhancement of risk assessment and optimization. MSSIC is requiring the sites have at least the following risk assessments with optimization in place:
Early results With Phase 2 recently started, the results are limited. However, the rate of ambulation within eight hours of surgery has improved 152% as compared to the baseline. In the last two years, nearly 11,000 patients have been ambulated at MSSIC sites within eight hours of surgery who previously would not have been. That impacted the urinary retention rate, dropping it from about 9.5% to under 3%. Given the spine surgery volume across all sites in MSSIC and the dollar figure of urinary retention per event costing around $9,000, it’s estimated that this intervention has resulted in considerable savings since 2017. More about MSSIC MSSIC brings orthopedic surgeons and neurosurgeons together to study ways to improve spine surgery outcomes in Michigan. Participants aim to improve the quality of care of spine surgery, reduce surgical complications, improve patient functional outcomes, reduce costs and episodes of care, and reduce the need for repeat surgeries. The MSSIC Coordinating Center is housed at Henry Ford Health. For more information on MSSIC, including provider resources, toolkits and fact sheets, go to mssic.org. Support for the MSSIC CQI is provided by Blue Cross Blue Shield of Michigan and Blue Care Network as part of its Value Partnerships program. To learn more about Value Partnerships, visit valuepartnerships.com. |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |