Spine Team Focuses on Improving Value of Care

January 18, 2019

The NHRMC Clinical Excellence (CE) Program is working to improve the value of care delivery, reduce unwarranted care variation and produce highly reliable evidence based outcomes. The program’s efforts can enhance and accelerate the work of clinical and operational teams. Numerous CE initiatives are underway in several clinical areas, including spinal fusions. 

The Spine Fusion service line has demonstrated an impressive ability to implement change for care improvement in the two years since orthopedic spine surgeons and neurosurgeons aligned to participate in Spine HQEP (Hospital Quality and Efficiency Program).  Aligning with their efforts, the Spine Fusion Clinical Excellence Team, led by Brandon Hill, RN, Dr. Todd Rose, and Dr. Adam Brown, was organized to address opportunities for improvement. This team used in-depth data analytics, process engineering, and rapid cycle Lean PDSA (Plan, Do, Study, Act) methodology.

Where evidence and best practices exist, care teams should implement standardized pathways to deliver high value, waste free and coordinated care. The Spine Fusion CE Team has worked to improve the value of care for our patients by implementing changes such as:


  • Combining and optimizing order sets to drive evidence-based care and avoid unwarranted clinical variation.
  • Eliminating IV Tylenol use in Spinal Fusion cases.  Evidence shows that Tylenol given by mouth has equal efficacy to intravenously administered Tylenol.  Additionally, Tylenol given by mouth results in significant lower cost to patients. 
  • Optimizing the process for ordering back braces. Back braces ordered during inpatient admission led to delays in patient care. The redesigned ordering process provides less wait time for braces, results in decreased lengths of stay, and reduces cost of care delivery.
  • Establishing an extended recovery plan for patients who are appropriate for same-day discharge thereby reducing the overall length of stay.


This Lean effort has identified key takeaways that will support future improvement efforts:


  • Frontline team member engagement is essential in identifying areas for improvement, as some opportunities are not always easily identified from just the data alone.
  • Keep the core team small to allow for effective and efficient action, but bring in additional subject matter experts when appropriate.
  • Some variation is warranted when it is specific to a patient’s individual healthcare needs.
  • There is enormous value in discussions among providers to develop consensus about clinical practice.


The Spine Fusion CE Team is comprised of the following core members:

Brandon Hill (spine service line)

Dr. Todd Rose (neurosurgeon)

Dr. Adam Brown (neurosurgeon)

Dr. Jean Nelson (anesthesiologist)

Dr. Alex Thomas (neurosurgeon)

Kim Duggan (RN Navigator)

Bruce Kavanaugh (supply chain)

Laurie Lustiber (rehabilitation therapy)

Marianne Billeter (pharmacy)

Danelle McNeal (pharmacy)

Jeff Probst (neurosurgery PA)

Amber Woodard (IS Applications)

Abby Roetger (CE Department)

Sandy Mitchell (CE Department)


Categories: Strategic Plan

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