Spinal service improvements
Clinical Oversight and Governance
Clinical Directorate Structure
Clinical directors in a hospital play a key leadership role, balancing medical expertise with administrative responsibility.
As of 7th April 2025, the Chief Executive of Children's Health Ireland has begun the restructure of the Clinical Directorates.
The three existing Clinical Directorates in Children’s Health Ireland will have job descriptions revised and updated.
Clinical Specialty Leads
Children's Health Ireland has reviewed the job description for clinical specialty lead to reflect management responsibilities as well as a leadership role. The recruiting of clinical specialty leads is ongoing.
Medical Device Committee (MDC)
The management of all medical devices within Children's Health Ireland is done according to the Medical Device Management System. The Medical Device Management System is in place to ensure all medical devices are;
- bought right
- used right
- maintained right
- disposed of right
A single CHI-wide Medical Device Committee is in place to oversee the implementation of the Medical Device System Policy. The Medical Device Committee (MDC) is the single route for the control of all aspects of medical device acquisition and use within Children's Health Ireland. It is the point of contact, governance and oversight between all Children's Health Ireland departments who have responsibilities in relation to medical device management. It also seeks reassurance on behalf of the Executive Committee that the medical device management, which is in place across the organisation, is working effectively.
The new electronic ‘Medical Device Request Form’, which staff can use to make submissions requesting acquisition of Single Use Medical Devices, Medical Device Implants, Medical Equipment and Medical Device Software, is now embedded across Children's Health Ireland. Over 130 requests have been submitted since go live and passed for processing to the relevant MDC sub committees.
MDC Sub-committees
Operating as part of the MDC arrangements are three sub-committees, which manage pan-hospital activity that is not the sole responsibility of any one single department.
MDC Medical Device Single Use Acquisition Sub-committee - manages the acquisition of Single Use Class I, IIa and IIb medical devices.
MDC Medical Equipment and Implants Acquisition Sub-committee - manages the acquisition of all reusable medical devices regardless of class, and single use class III medical devices.
MDC Medical Device Quality Risk and Safety Sub-committee - manages actions arising from safety alerts or adverse incidents relating to medical devices and medical equipment, this includes management of Corrective Action Prevention Actions (CAPA) projects.
Information on the activities managed by these three sub-committees can be found on Children's Health Ireland’s staff intranet pages.
Quality Safety Risk Management Executive Group
Role of this group is to ensure there are appropriate and effective quality systems in place across Children's Health Ireland for the oversight, assurance, and monitoring of:
- Feedback from service users and staff
- Enterprise Risk Management processes
- Quality and Patient Safety Programme
- Incident Management Programme
- Open disclosure processes
- Relevant legislation, national standards, and regulations
- Learning from Excellence
- Relevant National and Joint Commission International standards
- Clinical Audit Programme
- Implementation of recommendations from internal and external reviews, audits and reports
- QPS functions
- Performance of other programmes and committees reporting to the Executive through an agreed reporting schedule.
Significant Incident Review Group (SIRG)
A SIRG has been in place across Children's Health Ireland since January 2021 to manage
Category 1 (extreme harm) and Category 2 (moderate harm) events.
In 2024, Children's Health Ireland fully implemented a Single Incident Reporting System across all sites. This has led to the standardisation of incident reporting and effective management of incidents.
Children's Health Ireland’s Spinal Surgery Management Unit (SSMU)
Established in 2024, this Unit's aim is to build a safe and world-class spinal service, which treats children and young people in a timely and patient-centred way.
The Spinal Surgery Management Unit is committed to the continued improvement of quality and safety in spinal surgery services in Children's Health Ireland, the continued optimisation of outcomes for our patients and continued engagement with patients and families.
This includes recruitment across the spinal service in Children's Health Ireland, increasing surgical activity, decreasing waiting times for access to services, and options for the safe insourcing (using capacity in Ireland) and outsourcing (treatment abroad) of clinically suitable patients for spinal surgery.
Progress updates and reports can be found at www.childrenshealthireland.ie/spinal
Weekly Perioperative Meetings
At these weekly meetings, all cases planned for surgery are considered by the spinal team, and all of the previous week’s spinal cases are reviewed.
Multi-disciplinary team meetings
A multi-disciplinary team meeting (MDT) is a weekly or monthly meeting that takes place between health care professionals, to discuss individual patient cases. Complex Spinal MDT meetings are in place, which consist of inter-disciplinary staff.
Morbidity and Mortality Meetings
These monthly clinical review meetings allow departments/ specialties to review the quality of the care that is being provided to patients and present and discuss findings with their colleagues. Structured Morbidity and Mortality meetings are now taking place on both sites. The orthopaedic morbidity and mortality meetings are open to all Orthopaedic Consultants, NCHDs, Physician Associates and the Nursing Team. They are often attended by the clinical director and CMO.
Patient outcome and operational performance data are presented for both spinal and orthopaedic departments at these meetings. This KPI data is regularly reviewed and presented to the Orthopaedic and Spinal teams The data not only highlights potential risks, it also drives quality improvement projects that can improve the patient experience, clinical outcomes and access to care.
Concerns and risks are flagged and discussed with the Quality Consultant and Lead and, depending on the level of risk, are escalated appropriately. Any incidents are logged into the Quality, Safety and Risk Management Committee (QSRM) National Incident Management System (NIMS).
RCSI Code of Practice for Surgeons
All Spinal Surgeons in Children's Health Ireland must adhere to the RCSI Code of Practice for Surgeons 2018, including section “2.2 New surgical techniques”.
Quality Assurance and Standardisation of Care
Standardised CHI policies and procedures
Children's Health Ireland has standardised policies and procedures in relation to procurement, medical device management, decontamination, and theatre governance in line with best practice. The cross-site theatre governance group is chaired by a Clinical Director.
In addition, as part of the commissioning process for the new children’s hospital, all hospital policies, procedures and guidelines are being reviewed (85% complete) against joint commissioning international standards.
Integrated Care Pathways (ICP)
A Care Pathway is a step-by-step plan that helps healthcare professionals provide the best possible care for patients with a specific condition. It outlines what treatments, tests, and actions should happen at each stage of care, ensuring that everything is well-coordinated. It is a roadmap for a patient’s journey through the healthcare system, making sure they get the right care at the right time from the right professionals. This helps improve patient outcomes, reduce delays, and ensure consistency in treatment. Children's Health Ireland has developed a complex and non-complex pathway for spinal patients:
Complex Care Spinal Surgery Pre-Operative Pathway
Developed to standardise pre-assessment workflows, communication and referral pathways, this pathway is in the process of being implemented across Children's Health Ireland and regional hospitals. This includes:
- Complex Care Spinal Meetings are in place across CHI.
- The development of a patient questionnaire, which will be sent out when the patient is added to the waiting list, for families to complete and send back to the team. These details will provide the team with specific information about their current condition (mobility/feeding/psychosocial etc) and other stakeholders involved in their direct care. This information will assist the Spinal Service in preparing the patient for surgery and improve the communication with the patient’s key stakeholders.
Integrated Care Pathway (ICP) for Adolescent Idiopathic Scoliosis (AIS)
An ICP for Posterior Spinal Fusion (PSF) in Adolescent Idiopathic Scoliosis (AIS) is at the final stages of development. Priorities for 2025 include decreasing average length of stay to the 3-day target and improving patient education and experience.
Internal Safety Learning Notice Pathway
Children's Health Ireland launched an Internal Safety Learning Notice Pathway in February 2025. Safety learning notices are intended to provide relevant patient safety information to staff to raise awareness and to share learning in the organisation.
A need for an internal safety learning notice may be identified from analysis and review of incidents, risk assessments, reports from services, or new evidence / clinical guidelines.
Halo Gravity Traction (HGT)
Both CHI at Crumlin and CHI at Temple St have new HGT equipment, including CE-marked HGT wheelchairs and walker systems. This improves perioperative* care for children undergoing long periods of traction. A new Guide to Halo Gravity Traction has been developed for families in collaboration with the Patient Panel for Spinal Services also.
* Refers to the care given to a patient before, during, and after surgery.
Updates to surgery consent form
Children's Health Ireland has established a multi-professional CHI Consent Form Development Group, which includes parents. A new CHI consent form for treatment and investigations has been designed in line with HSE National Consent Policy.
An implementation plan for staff awareness and training regarding this new form is being rolled out. Thereafter, this will be audited and assessed in compliance with the HSE National Policy.
CHI Clinical Ethics Support Service (CES)
The CHI Clinical Ethics Support Service (CES) provides guidance and support for healthcare professionals facing ethically complex situations in paediatric care. The CES helps clinicians navigate ethical challenges in patient care by providing:
- Support in ethically complex cases.
- First-stage review of innovative or compassionate therapies. These include new devices, implants, medications, biologics, or procedures. Further review is conducted by the MDC or D&T as needed.
The review can be for a specific patient, a group of patients, or a broader process.
Any clinician with an interest in the wellbeing of the child, or group of children, in question can ask for a clinical ethics review.
Key roles for complex care and patient safety
A Consultant in Orthopaedics for the spina bifida complex care team attends spina bifida clinics twice per month to review patients with spinal issues. This arrangement has been in place since the 5th of September 2024.
A Clinical Nurse Specialist (CNS) in Spinal Disorders for Temple Street has joined the existing Spinal CNS team, to support patients and families. The Clinical Nurse Specialists for Spinal Disorders are nurses on the orthopaedic team who have special training and focus on helping patients with scoliosis and other spinal disorders.
A dietitian is now in post to provide appropriate care for orthopaedic patients. The dietician meets all spinal surgery patients before their surgery.
Spinal Clinical Practice and Quality Clinical Nurse Manager (CNM3)
This role (cross-site in Crumlin and Temple Street) is responsible for the continued improvement in departmental governance, risks and outcomes. They aim to understand the gaps, risks and areas to prioritise for improvement, as well as aligning with report recommendations. They promote safe standards with targeted education for clinical staff across CHI. They work closely with QSRM to report incidents to improve health outcomes for children with spinal disorders.
Patient safety programme manager
A new Programme Manager was appointed to the Quality Improvement and Patient Safety Programme in March 2024. 2024 priorities included the development of:
- Cross-site Clinical Audit Programme
- CHI Clinical Handover policy
- Communications strategy
- CHI’s quality data framework.
A workshop was held in November 2024 for staff on defining organisational priorities in relation to quality improvement and patient safety. In October 2024, a QSRM Coordinator was assigned to CHI at Temple Street to provide incident and risk management expertise to the local teams.
Recruitment
Children's Health Ireland has received funding approval for new staff positions to enlarge the Spinal Team. Recruitment is currently underway for a Clinical Nurse Specialist, an Advanced Nurse Practitioner in Tissue Viability and an Occupational Therapy Specialist.
Culture
Promoting a culture of questioning within and across Children's Health Ireland is a priority for the new CEO and Executive Team. The CEO met with Joe Ryan, National Director of Public Involvement, Culture and Risk to discuss further options.
Children's Health Ireland Mentorship Project
The CHI Professionalism Team secured funding for a CHI Mentorship Project, which invites all interns, NCHDs and recently appointed consultants in all specialties to join. It runs from July 2024 to June 2025. Children's Health Ireland has, and will continue to, offer mentorship to consultants needing support with technical and/or non-technical issues.
Speaking up for safety programme
Children's Health Ireland’s speaking up for safety programme successfully commenced in September 2024. The first cohort of Children’s Health Ireland trainers completed the Train-The-Trainer course and are now preparing for accreditation by the Medical Protection Society.
Promoting Professional Accountability (PPA) programmes
Children's Health Ireland engaged the services of an external specialist to deliver an interactive workshop for senior managers, Executive and Board members to facilitate implementation of the Promoting Professional Accountability Programme.
Engagement with patients and families
Dedicated support teams are in place to address patient concerns and provide information.
Spinal Patient Advocate Liaison Coordinator
The purpose of this post is to enable increased Patient Advocacy and patient and family partnership. This person is working to build and strengthen relationships with patients, their families, Patient Advocacy Groups, Charities and staff through the delivery of a number of actions designed to enable patient partnership and improved outcomes for patients. This builds on the current support provided by the Children's Health Ireland’s Patient Feedback and Support Services team.
Communications Project Manager and Communications Plan
This has been developed by the Communications Project Manager for Spinal Services, in collaboration with the Paediatric Spinal Taskforce. This plan is currently being implemented to improve communications for families attending Children's Health Ireland for spinal services and to ensure that patients' voices are heard and valued.
A scoliosis information hub has been developed on www.childrenshealthireland.ie/scoliosishub