One Simple Way to Improve Spine Patient Safety

It’s a simple thing all spine clinics can do to improve patient safety, according to a new study.

That “simple thing” is to document that the ICD-10 coding (International Classification of Diseases) accurately reflects the patient’s medical course. Why? Because, the study researchers found, it will lead to more accurate patient safety indicators—which, in turn, leads to improved patient safety.

This particular study was organized and designed by a research team from the Norton Leatherman Spine Center in Louisville, Kentucky, and it collected data from physicians and patients who had been part of the Hospital Acquired Conditions Reduction Program, which was designed to financially incentivize clinics to reduce Hospital Acquired Conditions.

According to the researchers, “Hospital Acquired Conditions scores are impacted by potentially preventable hospital-related events associated with harmful patient outcomes. Patient Safety Indicators are identified by using International Classification of Diseases coding; however, International Classification of Diseases coding does not always reflect the patient’s true medical course.”

Their study evaluated coding for patient safety indicators and then the effects of that on costs and clinical efficacy for patients who had undergone spine surgery at a single multi-surgeon tertiary spine center. The patients were evaluated over two 11-month periods.

The first 11-month period was the Control Phase. The second 11-month period was the Intervention Phase—which included a clinical documentation review process where researchers determined all Patient Safety Indicators attributable to spine surgery.

During the control phase, 61 Patient Safety Indicators were reported in 3,368 spine cases, representing a total of 3.6 Patient Safety Indicators a month.

During the intervention phase, there were 26 Patient Safety Indicators in 4,482 spine cases, resulting in a decrease of 1.5 Patient Safety Indicators per month.

Overall, the percentage of Patient Safety Indicators across all surgical cases attributable to spine surgery had a statistically significant decrease during the Intervention period compared to the Control period (16% vs. 10%, p = .034). The spine center was able to avoid a 1% Centers for Medicare and Medicaid Services cost reduction which meant an annual cost saving of approximately $3-4 million dollars per year.

“The implementation of a clinical documentation review process with clinician collaboration to ensure International Classification of Diseases-10 coding accurately reflects the patient’s medical course leads to more accurate patient safety indicator reporting, with the potential for substantial cost-savings for hospitals from Centers for Medicare and Medicaid Services reimbursement,” the researchers wrote.

The study, “Patient safety indicators from a spine surgery perspective: the importance of a specialty specific clinician working with the documentation team and the impact to your hospital,” was published in the October 2022 issue of The Spine Journal.

Leah Y. Carreon, M.D., MSc, Clinical Research Director at Norton Leatherman Spine Center in Louisville, Kentucky, told OTW that the most important take home message is that surgeons or someone on their team need to review the Patient Safety Indicators before they are submitted to ensure accuracy.

Study authors included John A. Buza, M.D., M.S., Leah Y. Carreon, M.D., MSc., Portia A. Steele, APRN, Ryan G. Nazar, M.D., CIME, EMHA, CSSGB, Steven D. Glassman, M.D., and Jeffrey L. Gum, M.D., all of Norton Leatherman Spine Center in Louisville, Kentucky. Ryan G. Nazzar, M.D., CIME, EMHA, CSSGB, of Norton Healthcare in Louisville, Kentucky, also contributed to the study.