Date: 10/01/2016

It’s one of the greatest challenges for a health care institution that treats diverse cases at many locations: How do you ensure that every patient receives the best care by the most appropriate specialists at the right clinical site? Clinical communities, which connect specialists from different departments and across 49 Johns Hopkins sites, are designed to do just that.

The Armstrong Institute for Patient Safety and Quality is home to 20 clinical communities at Johns Hopkins. These physician-led, self-governing networks gather clinicians from across the health system to determine best practices and implement those protocols across departments so every patient receives optimal care.

Says Jay Khanna, an orthopaedic spine surgeon and one of the leaders of the Spine Clinical Community: “If I see a very complex spine patient that I think would be best served at a different location, I have strong ties and the ability to easily refer the patient within the network so they can be treated by a surgeon who does 50 or 100 cases of that type a year.”

The Spine Clinical Community, also led by spine surgeon David Cohen and neurosurgeons Jean-Paul Wolinsky and Joshua Ammerman, meets monthly to analyze issues at each site, identify ways to improve efficiency and ensure optimal patient outcomes. By working together, they develop pathways for routine cases and ensure that complex cases, such as spine patients requiring vertebral column resection, are treated by the most experienced teams.

Khanna explains how the pathway for anterior cervical decompression and fusion (ACDF) changed as a result of the close collaboration. “The surgeons at Sibley Memorial Hospital and Suburban Hospital had a very streamlined, safe and efficient pathway for their ACDF procedures. They were using surgical drains less often, which was helping to decrease the length of stay because patients could go home on the same day, and they weren’t having problems with hematomas,” he says. “We’ve been able to translate some of those efficiencies from the community hospitals to the larger hospitals and vice versa.”

Peer learning helps physicians standardize quality care. “At one hospital,” says Khanna, “we had a pain management protocol using medications we can give to the patient before surgery that helps get them home more quickly. At another hospital, we were able to evaluate intensive care unit utilization for complex spine patients. We are continuing to look at which factors should lead to an intensive care unit stay after surgery and which patients can go directly to a typical floor bed and get mobilized sooner to help avoid events like deep venous thrombosis, pulmonary embolism and pneumonia.”

Khanna continues: “That’s an example of how we’ve been able to learn from each other and continue to provide the best care possible for patients who seek to have their spine condition treated at a Johns Hopkins facility.”

Additionally, the knowledge gained in one clinical community is shared with other clinical communities, says Ammerman, chief of surgery for Sibley Memorial Hospital and one of the leaders of the Spine Clinical Community. “At Sibley, we’re borrowing some of the protocols from the Enhanced Recovery After Surgery (ERAS) pathway developed by the Colorectal Clinical Community and applying them to spine surgery, in an effort to reduce narcotic use, length of stay and readmissions.”