The Future of Multidisciplinary Health Care

When Mindy Cohen​, MD, assistant professor of anesthesiology, came onboard at Children’s Hospital Colorado, it didn’t take long before she was considered an asset to the team.

Since then she has been tirelessly seeking to optimize care in the spine surgery patient population, something for which Mark Erickson​, MD, chairman of pediatric orthopedics and medical director of Children’s Colorado’s Spine Center, is particularly grateful.

“When we needed to establish a core team of anesthesiologists to ensure the safest and most optimal care for our patients, Mindy stepped up and led the charge,” he said. “Her involvement has led to partnerships in education, research and clinical care. She has pushed us to excellence in each of these areas, and we are very fortunate to have her on our team.”

The Move Toward Perioperative Medicine

Such interdisciplinary partnerships are at the heart of Dr. Cohen’s approach, where continuity of care is key to optimal patient care.

“In the anesthesia world we’re really trying to focus on the role of perioperative consultant,” Dr. Cohen said. “It’s about taking care of the whole process, from meeting with the patient a few days before surgery right through to seeing them post-op.”

Achieving this new level of care, however, required a great deal of attention to process improvement.

“I realized there was high variability in spine surgery anesthesia,” Dr. Cohen said. “Surgeons wanted to be able to tell patients and their families what to expect when the patient came out of surgery, but since this type of anesthesia is very specialized and most anesthesiologists don’t perform it very often, there was a lot of room for mistakes.”

“Some patients were receiving too much anesthetic and taking longer to wake up, while others were in extreme pain upon waking.”

Yet optimizing such a complex procedure would prove a challenging task. Dr. Cohen began by inviting her fellow anesthesiologists to join a spine fusion workgroup.

Decreasing Variation

“We started with 15 anesthesiologists – those who were interested enough to join a 6:15 a.m. meeting. The goal was to come up with a protocol for spine fusion patients, to decrease variation so that everyone along the care chain knew what to expect at each stage,” said Dr. Cohen.

As part of the optimization process, Dr. Cohen was deeply involved in analysis. “I reviewed every single case to see how things went and to assess whether antibiotics were given correctly,” she said. “I gave immediate feedback and in a monthly email updated everyone on how we did over the last month. I made a point of naming every anesthesiologist who performed the procedure correctly.”

The spine fusion workgroup now numbers 19, and meets every one to two months.

“We have extended our reach and recommended a new pain control regimen that extends from medications before surgery through pain medications during the days after surgery,” said Dr. Cohen. “This makes patients’ experiences more consistent and helps standardize their care after they leave the operating room.”

Getting Results

Although Dr. Cohen states that she needs to do more research to corroborate her initial findings, the results are promising. “We are seeing many patients pass their post-surgery physiotherapy goals half a day earlier, and many have a half-day reduction in length of stay,” she said.

Lisa McLeod, MD, assistant professor of hospital medicine at Children’s Colorado, explains that she now has patient families who have built such relationships with anesthesiologists in pre-operative clinic that they request specific doctors to perform anesthesia for their children.

“Mindy represents the future of multi-disciplinary patient-centered health care,” Dr. McLeod said. “She has strengthened the relationship between the surgical, anesthesia and intensive care services, and helped our spine program achieve truly integrated care.”

Goals for the Future

Dr. Cohen is currently undertaking the Institute for Healthcare Quality, Safety and Efficiency (IHQSE) Certificate Training Program – IHQSE’s most rigorous professional development program for clinical unit and program leaders. She explains that one of her team’s goals for the future is to standardize the methods of resuscitation, blood transfusion and care provided in the ICU post-surgery.

“We’d like to make the condition in which patients leave the operating room more predictable, in terms of their hemoglobin levels and the expectations on the ICU doctors,” she said. “A lot of this is about education and communication.”

Dr. McLeod explains how Dr. Cohen is setting the standard for shared communication about patients prior to surgery and what happens to them through the process. “That’s how we learn as a team,” she said. “By asking the important questions about why we do what we do and how we can do it better.”

“Mindy pursues these important questions with much sacrifice of her own time,” Dr. McLeod said. “She has broken down a lot of walls that have kept us from truly understanding how we can improve our practices and achieve better outcomes.”

For more information about the IHQSE Certificate Training Program, click here​.