Standardizing care pathways for spinal implants

Team medicine — cooperation across sites and specialties — has long been a hallmark of patient care at Mayo Clinic. Now, Mayo neurosurgeons and orthopedic surgeons are taking that collaboration in a new direction, by developing standardized care pathways for spinal implants across all Mayo sites.

"When we started this effort, there was wide variation in the implants used across the Mayo enterprise," says William E. Krauss, M.D., a neurosurgeon at Mayo Clinic in Rochester, Minn. "Now just about every implant we use in lumbar and cervical spine procedures is one that everybody has agreed on."

This standardization of medical supplies is an outcome of Mayo's ongoing efforts to ensure the best quality care for patients at all sites. "The goal is to examine preoperative and postoperative care for patients with spinal disorders and to determine a best-practices model on which all sites cooperate," says Barry D. Birch, M.D., a neurosurgeon at Mayo Clinic in Phoenix, Ariz.

Forging supply chain agreement

Spinal implants — the plates, rods and screws that are surgically placed to help obtain spinal fusion — are essential components of treatment for spinal instability. The most recent round of spinal-implant procurement began with discussions among neurosurgeons and orthopedic surgeons at all three Mayo sites — as well as in the Mayo Clinic Health System, which provides care in communities in the Midwest — about which implants should be used for various procedures. After numerous meetings within sites, teleconferences among sites and discussions with Mayo's procurement executives, agreement was reached. As a result, Mayo is now able to source nearly all of its spinal implants from three medical-supply companies.

"A single company may not have all the instrumentation we need for all parts of the spine. With three companies we cover almost all our bases," says Mark A. Pichelmann, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Fla. "For very special needs we also have the capability to bring in a fourth or fifth vendor. It's not at all constricting in terms of how we practice medicine."

Indeed, the surgeons quickly realized a side benefit: Standardized instrumentation means fewer surgical-equipment trays. "We save a lot of shelf space in the operating room, and our staff become very proficient in the use of the two or three systems we have in place," Dr. Pichelmann says.

Standardizing the supply chain also offers potential cost savings. In an era of rising costs and increasingly complex health care, Mayo understands the need to reduce the cost of care. Standardization whenever possible is one way of reducing costs without compromising patient care. "When all Mayo sites cooperate, the practice is both cost-effective and beneficial in terms of improved patient outcomes," Dr. Birch says.

For Mayo physicians, this type of collaboration is an extension of their usual teamwork. "We work together on a clinical basis, discussing cases and sharing patients," Dr. Krauss says. "This is an opportunity for us to work together to standardize supplies."