By Debra Anscombe Wood, RN
Back pain, one of the most common reasons people seek medical care, remains a frustrating and often difficult condition for patients and providers to treat and manage. But a team of three nurse navigators at Salem (Ore.) Spine Center streamlines patient access to the appropriate care provider.
I love knowing the process moves people through more quickly to where they need to be, instead of the traditional pattern of waiting weeks to get in with the surgeon only to find out you dont have all the diagnostics or dont need surgery, said Nancy Stuckart, RN, a nurse navigator at Salem Spine Center, a part of Salem Health. If they do need surgery, we make sure they have everything in place when they see the surgeon.
The nurse navigator program began about five years ago in response to patients waiting eight to 12 weeks to see a neurosurgeon. The physicians wanted to improve access and felt frustrated that 80% of the patients they saw needed referrals elsewhere, such as for interventional injections, to see a physiatrist or to receive other conservative treatment instead of spine surgery to treat their back pain.
Primary care physicians often dont know if the patient needs to go to a surgeon or not, and now they have a place to send them, said Stuckart,
Navigator know how
The navigators possess strong nursing and critical-thinking skills, something Jane Ray, RN, MSN, NE-BC, program manager for Salem Spine Center, considers essential in determining next steps or whether to send someone to the ED.
Patients were getting lost in the system; no one was monitoring them, said Ray. Since nurse navigators became part of the process, an intake specialist calls each patient referred by a primary care or other provider and completes an assessment to learn more about the patients symptoms. Questions include what makes the pain better and worse, where does it radiate, how it began, and what already has been tried?
The intake nurse also collects any diagnostic imaging and sends the information electronically to one of the neurosurgeons or physiatrists affiliated with the center. The physiatrist assess only cases associated with motor vehicle accident or work injuries and patients without an MRI while the neurosurgeons assess all other cases. The physicians look at the information and make recommendations as to whether patients need surgery or other care.
Nurse navigators educate each patient by telephone about the suggested action plan and coordinate any new imaging, interventional treatments or physical therapy the physicians order. The spine center keeps the referring physician informed as the patient progresses through the process. Since many patients are referred for other treatment, nearly all surgical candidates are seen within
[That nurse] was the best thing that happened to me; she took me by the hand and walked me through it, said patient Gary Griesen, 72, who is from Salem.
Nurse navigators triage about 280 patients each month. Software helps the nurses track diagnostics, patient status and outcomes, including pain, depression and functional indexes for two years. Hospital length of stay has decreased and surgical volume has increased. Inpatient hospital stays declined from 3.55 days in fiscal year 2012 to 2.8 days in fiscal year 2013. Surgical volume is 817 cases. Both metrics help keep the program financially viable for the hospital. We have seen the value of the nurse navigator, and its the wave of the future, Ray said.
Stuckart teaches the preoperative class, which patients and their family members find invaluable. Griesen said the class helped him prepare and understand what was going to happen during his right lumbar hemilaminectomy microdiscectomy. She rounds daily on post-operative patients as part of an interdisciplinary team, which assesses whether the patient is on the right clinical path and troubleshoots problems. Patients typically stay one to three days, depending on the procedure.
Its challenging but rewarding as well to know we are helping people get relief for something they may have suffered with for a very long time, said Stuckart.
Several nurses have shadowed the Salem Spine nurse navigators, and some have implemented similar programs, including Karen Lewis, RN, FNP-BC, MN, spine navigator at the Spine Center at Pardee in Hendersonville, N.C.
Its not until [we went and saw]the spine center and how it functions and the components that we knew what to set up at our facility, Lewis said.
For more info, visit salemhealth.org/spine-center/home.php