Software-Assisted Spine Registered Nurse Care Coordination and Patient Triage-One Organization's Approach
West Virginia University Spine Center, West Virginia University Hospitals, Morgantown, WV, USA. Journal of Neuroscience Nursing
(Impact Factor: 0.82).
09/2009; 41(4):217-24. DOI: 10.1097/JNN.0b013e3181aaaaf5
Back disorders encompass a spectrum of conditions, from those of acute onset and short duration to lifelong disorders. The use of a traditional spine center model of patient flow, in which the patient is scheduled the first available appointment without an initial assessment of spine-related symptoms at West Virginia University Spine Center, Morgantown, West Virginia, resulted in frustration and delays for the spine patient and referring physician dissatisfaction. Today, the use of a software-assisted spine patient triage and registered nurse care coordinator patient navigation system in this multidiscipline, multimodality comprehensive spine program provides quick and efficient patient triage to the appropriate level of spine care (surgeon vs. nonsurgeon). The model consists of five major steps, which are explored in this article: medical history intake; films or studies retrieval; rapid review of the patient's medical condition and diagnostics by a spine specialist preappointment and subsequent triage to the appropriate level of spine care; registered nurse care coordinator patient education and guided navigation through the patient's preferred treatment plan; and last, diagnostic study, pain injection, and provider scheduling. Patient satisfaction scores, referring physician satisfaction scores, and resultant impact on referral volumes, ancillary utilization, workload productivity, and surgical yield demonstrate that this new approach to patient triage has made significant improvements in efficiency, productivity, and service.
Available from: Louise Wiles
- "General practitioners and orthopaedic surgeons are the most prevalent physician professions in the included studies. Of the studies that measured physician satisfaction (Pinnington et al., 2004; Rymaszewski et al., 2005; Oldmeadow et al., 2007; Blackburn et al., 2009; Crossley et al., 2009; Bath and Janzen, 2012) (n = 6), all but one report high satisfaction among either General Practitioners (GPs) or surgeons. For example, Blackburn et al. (2009) report that a majority of GPs were more satisfied with the physiotherapy-led clinic than with general orthopaedic clinic and 94% supported continuation of the clinic (Blackburn et al., 2009). "
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ABSTRACT: Background and purpose:
The aim of this study is to provide a systematic overview of the past decade of literature on processes of triage for patients with spinal pain, outcomes measured and markers of effectiveness.
A systematic search of the literature with narrative synthesis of findings was conducted. Studies in English language of any design concerning spinal triage programmes for adults with acute or chronic spinal complaints were considered for inclusion. Electronic database searches were conducted in OVID, Medline, Embase, CINAHL, Health Source Nursing, Scopus and Web of Science. Additional references were sourced through pearling reference lists, and expert input. Findings were synthesized descriptively.
Of 216 potentially relevant records, 21 papers (20 studies) were included. There was little commonality in triage activities/programmes and outcomes, although physiotherapists were common members of triage programmes. Positive outcomes were reported most commonly for wait times, with several studies also reporting high levels of patient and physician satisfaction. Outcomes such as surgical conversion rates and selection accuracy were less clear.
Spinal triage programmes have the potential to improve efficiency of care for outpatients with spinal complaints. The evidence gaps in health outcomes, service models and cost effectiveness should be addressed by more robust prospective research designs. Copyright © 2015 John Wiley & Sons, Ltd.
Available from: Elizabeth Oddone Paolucci
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ABSTRACT: The Spine Severity Score (SSS) is a 15-point scoring system devised for the purpose of triaging elective surgical spine referrals. From the referral letter and the accompanying radiology report, a total score is calculated based on clinical, pathological, and radiological criteria; a maximum score of 5 can be obtained within each category. A higher total score represents a referral that should be seen more urgently.
To report interrater and intrarater reliability for the SSS and compare the scoring system against the traditional system for triage, that is, the surgeon's clinical experience.
A prospective cross-comparison design was used to evaluate the reliability and convergent validity of the SSS using spine case referrals.
Four spine surgeons (experts) and three administrative assistants (nonexperts) at the University of Calgary scored 25 referrals. A second iteration of scoring was performed with a minimum time interval elapsed of 6 weeks. Raters were instructed to choose the most concerning (the one with the highest associated score) descriptor in each category that was thought relevant to the individual referral. No further instructions were given on how to interpret the referral letter or the radiology report. The surgeons also scored the referrals using their own preexisting four-point scoring systems. The results were analyzed with independent and dependent t tests, Pearson product moment correlation coefficient, and generalizability and decision analysis.
An independent-measures t test (p>.05) revealed no statistical differences between experts and nonexperts (ie, interrater reliability) for both Iterations 1 and 2 on total scores of the SSS and a moderately strong relationship between their ratings across iterations (r=0.79, p<.001). Similarly, a paired-samples t test (p>.05) indicated a nonsignificant mean difference between Total SSS ratings at Time 1 and Time 2 (ie, intrarater reliability) and a high degree of agreement (r=0.96, p<.001) between the two iterations. These results were confirmed with correlational analyses. Pearson product moment correlation coefficients between the gold standard and the mean score were calculated from expert ratings on Total SSS at Time 1 (r=0.71, p<.001) and at Time 2 (r=0.69, p<.001).
The SSS is a reliable scoring system for triage of elective spine referrals, even among nonexperts. We have been able to demonstrate strong interrater and intrarater reliability for the SSS and moderately strong correlation with the traditional triage system.
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ABSTRACT: As health care delivery becomes increasingly focused on patient-centered models, interventions such as patient navigation that have the potential to improve care coordination garner interest from health care managers and clinicians. The ability to understand how and to what extent patient navigation is successful in addressing coordination issues, however, is hampered by multiple definitions, vague boundaries, and different contextual implementations of patient navigation. Using a systematic review strategy and classification method, we review both the conceptual and empirical literature regarding navigation in multiple clinical contexts. We then describe and conceptualize variation in how patient navigation has been defined, implemented, and theorized to affect outcomes. This review suggests that patient navigation varies along multiple dimensions and that the variation is related to differing resources, constraints, and goals. We propose a conceptual model to frame further research and suggest that research in this area must carefully account for this variation in order to accurately assess the benefits of patient navigation and provide actionable knowledge for managers.
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