Set Up for Success in Spine

The patient underwent a revision decompression with a two-level front-back fusion first thing in the morning and was up and moving about by evening. “That was definitely an adult swim case,” says Richard Kube, MD, FACSS, FAAOS, CIME, who performed the grueling surgery at the Prairie Spine & Pain Institute in Peoria, Ill. “Generally, there aren’t many procedures I don’t feel comfortable performing in the ambulatory setting on appropriately selected patients.”

This month marks the 10th anniversary of the Prairie Spine & Pain Institute, which Dr. Kube founded and now runs as its CEO. He decided to strike out on his own and build the center when his former orthopedic partners weren’t interested in letting him focus exclusively on spine. The facility’s single OR is 484 square feet, large enough to accommodate multilevel instrument trays, a spine table, an anesthesia workstation and a C-arm for intraoperative imaging. “It’s outfitted with the same equipment that’s in the hospital across town,” says Dr. Kube.

He also built a room adjacent to the pre- and post-op bays where patients can remain for up to 23 hours, which is in accordance with Illinois state laws. Incorporating an overnight observation room into the design of the facility allows Dr. Kube to assess patients multiple times before they’re discharged. He checks on them between cases, before he leaves at the end of the day and again first thing the next morning before they’re discharged. “I see them three or four times before they go home,” says Dr. Kube. “I’m able to get a strong sense of how they’re recovering. They receive one-to-one care, which they couldn’t get at the local hospital.”

The extended stay space is filled with luxurious amenities, including a cushy reclining chair, a pullout Tempur-Pedic bed for loved ones of patients who want to spend the night and a high-quality set of table and chairs. Patients can watch a full line-up of cable channels on a 65-inch ultra-high-def television while relaxing by the room’s fireplace. The private bathroom features a granite-topped vanity, high-end fixtures and a walk-in shower with a 15-inch rainfall shower head.

Dr. Kube designed the facility by marrying regulatory requirements with the style he wanted to make patients feel comfortable and perhaps even pampered. He believes the facility is built to handle the future demand of outpatient spine cases as reimbursements evolve into cash-based and bundled pricing models. “The barriers to outpatient spine are being broken, but further education is needed to show what’s possible in the space,” says Dr. Kube.

They receive one-to-one care, which they couldn’t get at the local hospital.
— Dr. Richard Kube

Advances in the management of post-op pain will help push more cases to the ASC setting, according to Dr. Kube, who points to the developing use of IV Tylenol, ketamine and other analgesics as allowing providers to control pain more effectively. Increasing competition will also motivate surgeons of independently owned surgical facilities to make sure they perform safe and effective care. “My practice is based completely on referrals,” says Dr. Kube. “If I don’t push the envelope on high-quality care or continue to have a great reputation in the community, I’m extinct.”

Pierce Nunley, MD, is part of a group of physicians who are in the process of building the Spine Center of Excellence in Bossier City, La. The state-of-the-art facility, which is scheduled to open in September, will include an ASC with four ORs (two larger rooms are 530 square feet and two smaller rooms are 439 square feet), four chronic pain management rooms and an imaging center. 

Dr. Nunley, one of the nation’s foremost leaders in minimally invasive spine, says surgeons prefer to work in uncluttered sterile fields, free of booms and excess equipment that can impede their access to the patient. “We’ve taken a minimalistic approach in the design of the new ORs,” he adds. “The rooms will be outfitted with two booms, each of which will house a surgical light and large video monitor. Anesthesia workstations will be built into OR walls. Streamlining the equipment needs has been key to cutting down on the cost of building the new spaces.”

Money saved in the design of the ORs was poured into what will be an expansive sterile processing department. The decontamination area was designed to be 400 square feet and the wrap-and-pack area will be 500 square feet — large enough to accommodate future growth. More than 1,000 square feet of additional space will be built to store large equipment such as surgical tables and C-arms.

Initially, says Dr. Nunley, the ASC will focus on one- and two-level micro decompressions, injections to treat chronic pain and lumbar radiofrequency thermocoagulation. His team is perfecting anesthesia practices and surgical techniques — such as transverse abdominis plane (TAP) blocks and endoscopic approaches — at the hospital where they currently operate that will allow them to provide advanced care at the new ASC, which will have four overnight rooms to accommodate 23-hour stays following more complex cases.

Dr. Nunley’s group will open the facility with two ORs up and running with plans to bring the other two online when case volumes increase. “The only way we could grow and match the demand for spine surgeries was to create a dedicated ASC,” says Dr. Nunley. “There’s no doubt ambulatory surgery is the future of medicine and cost containment.” OSM

Note: This three-part article series is supported by Stryker.