Spinal IPU

By Saudi German Health

The Spinal-IPU initiative at Saudi German Hospital (SGH) – Riyadh represents a paradigm shift in the way spinal-related conditions are approached. Unlike traditional models of care, which often operate in silos and focus solely on clinical outcomes, our initiative incorporates a comprehensive pathway using a value care delivery chain (VCDC), interdisciplinary collaboration, standardized clinical practice guidelines (CPG), and patient-centered care. Patient value was measured using clinician-reported outcome measures (CROMs), disease-specific patient-reported outcomes (PROMs), and patient-reported experience measures (PREMs). This comprehensive approach underscores our uniqueness and commitment to excellence in spinal care delivery.

The main aim of the initiative was to redesign the care delivery model for spinal-related conditions through an integrated approach (i.e. IPU) that focuses on commitment, collaboration, and outcome measures. The initiative’s relevance lies in its ability to deliver comprehensive and personalized care tailored to individual patient needs. As well, it is relevant to the volume of patients seeking spinal-related care in our general hospital. In this, neurosurgeons, nurses, physical therapists, and other healthcare professionals pooled their expertise to provide comprehensive care to patients with spinal conditions, including medical, physical, and social needs.

A key pillar of the initiative is the implementation of a standardized protocol to treat patients with spinal-related conditions. The protocol was developed collaboratively and taken a step forward by translating it into a care delivery value chain (CDVC). Another pillar was the patient-centered approach of the initiative. From the moment a patient walks through our doors, they are greeted, respected, and assessed to understand their needs. Thereafter, shared decision-making was strengthened using educational materials, open communication, and participation in measuring outcomes (i.e. PROMs).

SGH Riyadh treats more than 1000 patients with spinal-related conditions annually. Hence, the initiative impacted a large number of patients with spinal-related conditions and is expected to potentially impact a larger number as we are planning to recruit four new sub-specialized neurosurgeons. This volume encouraged us to leverage technological solutions to enhance patient care and outcomes. For instance, mHealth was used to provide patients with convenient access to their health information, electronic health record was used to assist the medical team in documenting treatment plans consistently, and e-PROM assisted our patients in assessing outcomes electronically.

The preliminary results from our initiative are promising (Table 1). Overall, patients report higher satisfaction with their care experience by 7% (from 79% to 86%), with multiple cited testimonials of their experienced care. Clinical outcomes, as measured by CROMs, showed a significant reduction in the rate of surgical site infection (SSI) by 50% (from 2.8% to 1.4%) and an improvement in medical record documentation by 9% (from 79% to 88%). Furthermore, PROMs indicated that patients are experiencing improved quality of life, better functional status, and less pain by 22%, 18%, and 67%, respectively. It should be acknowledged, however, that the survival, rehospitalization, and intraoperative complications rates did not show significant improvement in our initiative. The number of patients and the short-term follow-up could explain, in part, why these measures were not improved. Accordingly, the spinal IPU has decided to expand the follow-up duration.

Our initiative represents a transformative approach to spinal care delivery. The interdisciplinary collaboration, standardized protocols, patient-centered care, and measuring outcomes were driving factors that enabled us to redefine the standard of excellence in spinal care.