Local Focus, National Perspective
SpecialtyCare is uniquely positioned to innovate and advance the practice of medicine within our core competencies. Our clinicians work in a wide range of settings and partner with thousands of surgeons all across the country. In doing so we collect rich, expansive data and gain exposure to techniques that typically are not seen in isolated medical facilities and by other providers with a more limited scope.
These data, gathered from more than 1,200 hospitals nationwide and 375,000 procedures annually, enable us to maintain the largest multi-institutional clinical database of its kind. The clinicians and statisticians in our medical office perform analyses on the aggregated data and then communicate the scientific findings across our network of clinical professionals so that the evidence-based trends, techniques, and best practices can be shared with surgeons and OR teams to drive improvement and innovation at the local level.
Innovating through Research
Our perfusionists participate in more than 100,000 surgeries annually. Research on this vast dataset continues to reveal important insights. For example, we have learned that there are unintended consequences to over-reducing cardiopulmonary bypass circuit prime volume. Contrary to the current trend of reducing prime volume in the heart lung machine to avoid blood transfusions during cardiac surgery, reducing the volume too much can actually increase transfusions. When used efficiently, red blood cell transfusions may save lives, but these same transfusions are also associated with significant patient complications.
We’ve also released findings on the application of goal-directed therapy for the use of concentrated antithrombin for heparin resistance during cardiac surgery. The maintenance of anticoagulation in patients undergoing cardiopulmonary bypass is dependent upon a number of factors, including plasma heparin concentration and adequate circulating antithrombin (AT) levels. Subadequate anticoagulation increases the risk of thrombosis and jeopardizes vascular and circuit integrity. Our study was designed to evaluate a goal-directed approach for the administration of concentrated AT in cardiac surgery patients who were resistant to heparin, and we found that utilization of a goal-directed algorithm is safe and effective for these patients.
You will find abstracts of these studies and other perfusion research in the Clinical Research & Innovation section of our Resource Library.
SpecialtyCare’s intraoperative neuromonitoring (IONM) clinicians also have a rich history of research and innovation that has led to numerous refinements in IONM, including the use of transcranial electric motor evoked potentials (tceMEPs). For example, we were among the first to introduce routine use of tceMEPs in monitoring both spine and intracranial surgery. We were also among the first to articulate and advocate a multimodality approach to neuromonitoring, such as multimodality monitoring techniques for robotic surgeries of the spine and thyroid.
Our clinicians have developed and published findings on a spinal cord mapping technique for guiding placement of dorsal column stimulators, and are developing new mapping techniques for deep brain stimulation surgery using local field potentials to help guide stimulator placement.
We have also developed customized anesthesia protocols for optimized tceMEP recording and techniques for monitoring nerve root function during spine surgery, brachial plexus function during shoulder reconstruction, and sciatic nerve function during acetabular/pelvic surgery. We also used empirical research and clinical trials to study the influences of the most commonly used anesthetics on neurophysiologic signals. As a result, we have developed tailored anesthesia protocols that meet the specific goals of the anesthesiologist without compromising the quality and power of the intraoperative neuromonitoring (IONM) data, thereby ensuring greater clarity and speed in the interpretation of significant neurophysiologic change.
Our latest intraoperative neuromonitoring (IONM) research abstracts can be found in the Clinical Research & Innovation section of our Resource Library.
In addition to clinical advancements uncovered through our research, we also utilize the expertise of advisory boards that include innovative clinicians and industry-leading physicians, surgeons, and anesthesiologists. Together, they work closely with our chief medical officer, members of our medical office, and SpecialtyCare management to provide:
- Insight into the perfusion, neuromonitoring, surgical assistance, and clinical technician service environments
- Recommendations to advance clinical systems, including quality indicators, procedural guidelines, and improvement initiatives
- Guidance to ensure exemplary service to our customers
- Assistance in developing and maintaining positive relationships with the medical, perfusion, surgical assistance, and clinical technician communities–collaborations that include ideas for growing the hospital’s business and for improving recruitment and retention of clinical staff
- Ongoing input for our continuing education programs.