The Brigham and Women’s Hospital Spine Center, a collaborative effort among orthopaedic surgeons, neurosurgeons, pain medicine specialists and physiatrists, launched in July 2021. The team is focused on delivering world-class spine care while making it as easy as possible for patients and referring physicians to navigate the process.
The Spine Center offers multidisciplinary treatment for spine conditions due to back pain, disease or injury, including disc herniation, spinal stenosis, degenerative disc disease, spinal and nerve tumors, and spinal deformity/scoliosis. In addition to the specialists listed above, the team includes neurologists, radiologists, rheumatologists and experts in chiropractic and integrative therapies.
Patients can be seen at any of 10 Greater Boston locations. While all surgeries take place at the Brigham’s main hospital campus in Boston, patients can visit a location closer to home for an initial evaluation, follow-up visits and treatments such as injections.
Triaging Patients to Optimize Spine Care
Navigating a large academic medical center can be intimidating and confusing for patients and referring providers alike. In a worst-case scenario, a patient ends up seeing a series of specialists across departments who aren’t working together to optimize care. The Spine Center is designed to alleviate these concerns, said director Christopher J. Gilligan, MD, MBA.
“We have a centralized call center and carefully designed triage algorithms to get the patient to the right specialist at the right time,” Dr. Gilligan said. “Does the patient need to see a surgeon? Do they need to see a non-surgeon, like a physiatrist or pain medicine specialist? Starting with their first visit, the patient receives coordinated, multidisciplinary care that aligns with their preferences and those of their referring provider.”
Dr. Gilligan and his colleagues put in a great deal of effort to create a triage system that could precisely determine whom the patient needs to see and in what timeframe as well as what tests are needed. They also hired and trained three full-time physician assistants to assist with triage.
“We don’t want to have a patient wait a couple weeks to come in only to discover they’re seeing the wrong specialist or getting an MRI that they didn’t actually need,” Dr. Gilligan said. “We’re able to make the care more precise and appropriate.”
Lessons Learned Through Leading the Spine Center
Based on his experience planning and launching the Spine Center, Dr. Gilligan offers this advice for other hospitals looking to implement similar programs:
- Collaboration, not competition: The Spine Center has committed to establishing a collaborative environment, even among specialists who might be competitive in some cases (e.g., orthopaedic surgeons and neurosurgeons, pain medicine specialists and physiatrists). “It’s crucial to agree that we’re not going to compete with each other,” Dr. Gilligan said. “We’re centering care around the patients and working together as one big team of spine specialists who want to deliver the best possible patient care.”
- Clear expectations for participation: Physicians who want to participate in the Spine Center must be able to see patients in a timely fashion. “We can’t have providers who will keep patients waiting an unacceptably long time,” Dr. Gilligan said.
- Breeding trust through transparency: Participating physicians must view the system as fair, which requires allowing open access to information about where referrals are being assigned and why. “If a patient or referring provider requests a specific physician at the Spine Center, we respect that,” Dr. Gilligan added. “We don’t stand in the way of those types of requests, which I think is important.”
- Standardized pathways: The Spine Center providers collaborated to write detailed pathways of care — including nonsurgical and surgical treatment, imaging, physical therapy and medications — for common spine conditions. “We didn’t take outside guidelines but rather agreed as a group that we will follow these pathways, which we reached by consensus,” Dr. Gilligan said. “As a result, there’s some standardization of care if a patient with one of these conditions comes to the Spine Center.”
“We’re trying to make things simple: If your patient has a spine issue, you don’t need to figure out which person or specialty should see them. You can just direct them to the Spine Center,” Dr. Gilligan concluded. “We’re making it much easier for the referring physician and a much better experience for the patient.”
To refer a patient to the Spine Center, please call 877-777-2134.