Patient satisfaction is an important indicator of surgical success following spinal fusion surgery. Patients undergoing spinal fusion surgery frequently have dealt with chronic pain and related health issues that lead to dissatisfaction and high usage of the healthcare system in attempts to improve their quality of life. Sometimes there can be simple and inexpensive solutions to the complex problem of improving patient outcomes.
At the Saint John Regional Hospital members of the orthopedic care team, Donna Eastwood (Orthopedic Nurse), Richard Paixao (Physical Therapist) Tracy Underwood (Occupational Therapist), Dr. Neil Manson and Dr. Edward Abraham (Orthopedic Surgeons) designed and implemented a two-hour class to include patients and their families. One of the many focuses of this class is making sure the patient and their family understands they play an important role in their health care team prior to undergoing spinal fusion surgery.
“The aim of the class was to help patients understand what to expect coming into their surgery, what to expect at the time they’re being discharged, how they were going to feel, and to give them an opportunity to ask questions and meet members of the team,” Eastwood said. “It was very much emphasized that they were a very important part of our healthcare team.”
Pre-operative information is usually limited to a one-way communication of a generic pamphlet from the surgeon to the patient. The latest healthcare research has highlighted the importance of engaging patients as an important part of their healthcare team, and the creation of interactive multidisciplinary classes creates this opportunity.
The sessions are offered to patients 3 to 6 weeks before their surgery. To date, approximately 400 patients have taken part in the class.
“People come in thinking that when they open their eyes, the pain is going to be all gone and they should stay in bed until they’re feeling all better. We address their expectations, and discuss best post-operative health practices” Eastwood said.
Researchers at the Canada East Spine Centre (CESC) in Saint John did a retrospective study on the class in 2018 to look into the benefits of engaging in the class developed by the healthcare team had on patient outcomes 12 weeks following their surgery.
The research showed that this low-cost class has been effective in managing patients’ expectations, increasing their satisfaction after surgery, reducing reported back pain and reducing their visits to the emergency department by approximately 50% in the 12 weeks after their surgery.
“We found patients who attended the class, in comparison to a similar group that didn’t, actually had their expectations met for their improved daily activity when they went home,” Eastwood said.
CESC Head of Research Erin Bigney, who has a psychology background, said managing expectations is key.
“Sharing knowledge between the healthcare team and patients and empowering patients on what to expect and the timelines for recovery creates more synergy between the surgeon, the healthcare team and the patients.”
She said this project allows the surgeons and stakeholders to see how important and cost-effective such a small change can be.
“It fits within [the instructors’] work mandate already, and the cost is just for the handouts, but it’s making an impact on emergency department visits, on patient satisfaction, and on patients’ back pain severity. It’s these things, directly benefiting our patient’s lives that I think are the wins,” she said.
Manson said the class makes his life easier, too.
“At the end of the day, a happy patient is a super easy patient to look after,” he said. “If the patient’s educated about what they’re getting, there’s a better chance they’re going to be satisfied with the end result.”
He said simply making the patient aware of what kind of back pain is normal in the weeks following their spine surgery could help them decide to skip the emergency room visit and wait to call the surgeon’s office the next morning.
“Those savings in time, resources, and ultimately, finances, are redirected to hopefully care for other patients,” he said.
This project was presented at the 18th Annual Scientiﬁc Conference of the Canadian Spine Society and at the 33rd Annual North American Spine Society conference. The study was published in the Spine Journal in 2019. Since then, other sites in Canada and the U.S. are looking to start a similar class at their hospitals and work with the Saint John team on larger research projects looking at the benefits of the class.
The Canada East Spine Centre and its’ healthcare collaborators are dedicated to pursuing research that improves patient outcomes and raises the quality of life for their patients. The team, which includes, Dr. Manson, Dr. Abraham, Donna Eastwood, Richard Paixao, Tracy Underwood, Erin Bigney, Eden Richardson and Mariah Darling, has been named the August Research Team of the Month by the New Brunswick Health Research Foundation (NBHRF) for their work.
“One of the things that this team in Saint John has shown is that every member of our healthcare team is interested in knowing what impact our jobs have on the outcome of patients. We were interested in working together, coming up with an idea, and seeing it through” Eastwood said.
“Sometimes people get the wrong idea that because Saint John’s a small city, about how impactful we can be” Bigney said. “Our patients’ generous participation in our research has allowed New Brunswick to play a major role in spine research in Canada. We are the third largest contributors (out of 21 sites) to the national registry database Canadian Spine Outcomes and Research Network(CSORN) run by the Canadian Spine Society, meaning our patient experiences are helping informing research on a national level. It is important to know that impactful medical research is happening right here in New Brunswick.”
This story was sposnsored by the New Brunswick Health Research Foundation. This is part of an ongoing series about the NBHRF’s research teams of the month. Visit the NBHRF page for links to stories dating back to last January.