Report on Spinal Surgery for Patients with Spina Bifida in Children’s Health Ireland at Temple Street Summary of Findings and Recommendations

Overview

Children’s Health Ireland (CHI) has collated the findings and recommendations from two clinical reviews into spinal surgery for patients with Spina Bifida in CHI at Temple Street and a summary of researched publications on post-operative spinal surgery complications into a single CHI Report into Spinal Surgery for Patients with Spina Bifida in CHI at Temple Street (August 2023)

Read the report here CHI Report for Spinal Surgery Services

A CHI Spinal Surgery Programme Implementation Plan to improve spinal surgery services for patients with Spina Bifida has been developed. This plan is based on the findings and recommendations of the reviews with actions tracked to ensure the recommended changes are being implemented within agreed timelines. It is therefore an iterative document and will be updated regularly.

Findings and Best Practice Recommendations from Reviews

1) Findings from the Reviews

CHI at Temple Street should continue to leverage its strengths and internal capabilities, as well as, implement change with focus and intent in the following key areas:

• Clinical: Optimise clinical care using evidence-based surgical techniques and consider surgical sub specialisations, if volume permits. Provide intensive, ongoing support in clinical oversight, standardisation of care, and education.
• Programme: Foster a multi-disciplinary, programmatic quality centric mindset, in both governance and amongst individual Clinicians. Include representatives from the Spina Bifida MDT in the quality improvement programme.
• Culture: Emphasise a culture of high reliability that values safety, quality, and efficiency. Ensure that all members of the Spina Bifida MDT are encouraged to speak up without any fears.

2) Key Themes Identified in the Reviews

• Supporting a sustainable, high quality Spinal Surgery Programme / MDT for patients with Spina Bifida is important.
• Given the high incidence of Spina Bifida in Ireland, and the increased risk of neuromuscular Scoliosis with Spina Bifida, careful consideration must be taken when addressing the high demand for spinal surgery.
• There were concerns raised regarding the outcomes of paediatric spinal surgeries in children with Spina Bifida.
• A unified programme structure / governance around care for children with Spina Bifida is important.
• As CHI at Temple Street cares deeply about the quality of care, more attention is needed to create a culture where all members of the care team are encouraged and comfortable sharing safety questions and concerns.

3) Summary of Best Practices

a) Governance

• Identify and support a Clinical Specialty Lead for Orthopaedics.
• Establish an Operating Theatre Governance Committee (to include Surgeon, Anesthesia, Nursing).

b) Hospital Reporting / Quality and Patient Safety

• Develop a quality improvement team that includes a Surgeon, Nurse and Quality Improvement Director.
• Strengthen a quality improvement programme that routinely collects and tracks metrics (unplanned reoperations, infection, neuro deficits, death).
• Implement structured Monthly Surgical Morbidity and Mortality (M & M) Rounds.
• Increase utilisation of the formal adverse event reporting system.
• Establish a culture of high reliability that demonstrates consistent excellence in quality and safety across the Spina Bifida MDT.

c) Spina Bifida MDT Process

• Encourage full team MDT participation in decision making and case conferences with the lead being a Neurodisability Clinician.
• Consistently follow processes for all patients with Spina Bifida requiring spine surgery.
• Develop pre- and post-operative standardised, evidence based clinical guidelines and checklists.

d) Evidence Based Surgical Techniques / Processes

• Expand clinical team to assist in cases (Neurosurgery for dissections and nerve decompressions (in place), Plastic Surgery for wound closures).
• Incorporate the latest knowledge from high quality research studies and collaborate with other paediatric spine centres where clinicians care for high numbers of patients with Spina Bifida. This should include:
• Utilisation of standard length constructs for corrections of spinal curvature, including Kyphosis.
• Availability of intra-operative imaging of all surgical implants in multiple planes, including implants going to the pelvis.

e) Review / Triage of Waiting List

• Closely monitor the patient waiting list and continue to prioritise children based on acuity.