Standardizing Follow-Up Care for Non-Operative Cervical and Thoracolumbar Spinal Fractures

Introduction: Significant variation exists in follow-up clinic visits and imaging recommendations for non-operatively managed cervical and thoracolumbar spinal fractures. This lack of standardization potentially reduces the quality of care for these patients. This study aimed to increase the proportion of patients meeting a standardized follow-up protocol.

Methods: A multidisciplinary team composed of stakeholders, including neurosurgery and orthopedic spine surgeons, residents, nurse practitioners, physician's assistants, and a Quality Improvement (QI) advisor, conducted this study at St. Mary's Hospital, Mayo Clinic, from August 2020 to August 2023. Institutional Review Board approval was deemed unnecessary for this study. Following the Standards for Quality Improvement Reporting Excellence guidelines, the study employed the Define-Measure-Analyze-Improve-Control paradigm and the Awareness-Desire-Knowledge-Ability-Reinforcement framework for QI initiatives. The process was defined using a quality gap analysis and the Suppliers-Inputs-Process-Outputs-Customers+Requirements tool. Data were analyzed with an Ishikawa diagram and Root Cause Analysis.

Results: Based on medical record review, baseline protocol adherence was measured at 30% in a random sample of ten patients over a four-year period and thereafter a goal of 55% was formed. Root causes for lack of protocol adherence included daily distractions, knowledge gaps, equipment malfunctions, and scheduling challenges. To reduce the detrimental impact of daily distractions and knowledge gaps, the team developed an Electronic Medical Record tool and conducted an educational campaign to increase compliance. This led to a remarkable improvement, achieving 100% adherence within three years, far surpassing the goal. Ultimately, operational management of the process was successfully transitioned to an operational manager.

Conclusion : This QI strategy maximized protocol adherence for non-operatively managed cervical and thoracolumbar spinal fractures. Adherence to the standardized protocol exceeded the initial goal. This approach is likely replicable in other healthcare institutions to standardize follow-up care.