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The air traffic controllers of healthcare: How nurse navigators improve outcomes and position an organization for episodes of care

Adding a nurse navigator or a care coordinator to a center's staff is an expense that could reap massive benefits when done correctly.

Theresa Stern, nurse patient navigator and program director for the Orange Coast Memorial Center for Spine Health at Orange Coast Memorial Medical Center, in Fountain Valley, Calif., made the decision to become a navigator after she suffered a neck injury resulting in herniated cervical discs.

Now Mrs. Stern is an integral part of the center. She is an advocate for patients, and a necessity for physicians.

Spine center development company Prizm Development's President Bob Reznik described the position best through an analogy: navigators are the air traffic controllers for surgery centers.

Air traffic control ensures airports run smoothly and effectively by having the right planes land on the right runways. "You put the single engine planes on the outside of the airport and you save the big runways for the 747s," Mr. Reznik says.

The nurse navigators operate at spine centers around a similar idea; they serve as the first point of contact in a patient experience. Nurse navigators are the front-line of spine and ambulatory surgery centers. The navigator can ask diagnostic question and prioritize patients to ensure a physician makes the best use of their time. Similar to how you wouldn't land a 747 on a runway for a single engine plane, patients with emergency symptoms need to be seen the same day to prevent lifelong problems.

"With back and neck problems, if the patient tells the RN he or she has weakness or numbness in a hand or foot — or worse, loss of control of bowel or bladder — that person needs to be seen immediately to prevent permanent paralysis of those nerves,” Mr. Reznik explains. “It's no different than an airport matching the inbound planes to the right runways. A person with serious herniated disc symptoms is better matched with a spine surgeon, while less serious strain is better managed by a physical medicine physician who can try non-surgical treatment options.”

Some organizations call these RNs “nurse navigators” and others call them “clinical coordinators” but the function is the same.

In the centers Prizm develops, Mr. Reznik has "never had an organization regret bringing in a clinical coordinator. If you put a person like this in who is smart and well trained, they will have an impact on the organization far beyond basic scheduling. Sadly, healthcare in the past has done poorly by putting the least trained, least knowledgeable person at the front lines. The future of healthcare — with bundled case rates for episodes of care — will require more expertise at the front end to ensure the patient flows through the system efficiently."

Mrs. Stern is that person for her facility. She uses her experience as a physical therapist and a former patient to help patients with their decisions. Before a physician sees a patient, she collects complete medical histories for providers, conducts functional assessments and coordinates physical examinations to create propose an individualized treatment plans.

After a physician sees the patient, and diagnoses them, she pivots and focuses entirely on the patient. She helps educate them on their diagnosis. She assists with setting up the appointments with specialists or surgeons and she follows up with them at one, three, six and 12 months intervals to ensure their recovery goes according to plan.

"The idea of the nurse navigator is that the patient has somebody from the minute they call the spine center," Mrs. Stern says.

A nurse navigator was part of the conceptual idea for her facility. Mrs. Stern was the candidate center owners wanted to help them craft a navigator program. She said the center saw the nurse navigator program as a market differentiator.

In addition to her work with patients, Mrs. Stern is also the first contact for physicians because she can efficiently communicate medical information accurately. Her position can eliminate fragmented communication between providers and center employees.

The facility is seeing positive results too. Since Ms. Stern stepped into the center, it has received more positive feedback from patients over their experience, and clinical outcomes levels have positively progressed.

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