Spine Division | Quality & Safety
每年，我们都会治疗数百名需要手术的复杂脊柱疾病的患者。我们与这些患者的目标是执行highest quality surgery同时维持和培养culture of safety。在护理的各个方面，在手术的每个阶段，我们都遵守一套严格的准则，以确保最高标准的质量和患者安全。
体验促进质量
手术质量始于熟练的临床团队，特别是对于脊柱患者通常需要特定专业知识的脊柱患者。我们的手术团队包括外科医生，麻醉学家和护士，每个人都扮演着保护患者安全的敬业角色。
- Our脊柱外科医生负责确保所有外科手术符合安全和质量的科学标准。
- Our麻醉学家devote much of their practice to spine patients and have great experience managing the most complex medical conditions.
- Ournursing staffplays a large role in ensuring safety standards and making sure the surgical procedure is as efficient as possible.
脊柱手术前的质量措施
术前评估
All patients scheduled for spine surgery have a thorough review of their medical status one week before surgery. This includes an evaluation by the anesthesia team and a face-to-face meting with their surgeon to make sure all medical issues have been addressed. The family also has the opportunity to ask questions and be sure they understand the planned procedure at this time.Surgical planning and consultations
我们的团队在手术当天之前几次审查了每位患者的手术计划。这包括在脊柱教育巡回赛中的演讲，术前访问，如果需要，请与放射科医生协商，并在外科研究员会议上进行审查。这种对计划的强烈关注确保，当手术日到来时，一切都到位，手术团队准备为患者提供最佳护理。软件辅助手术计划
欧宝彩票平台波士顿儿童医院是第一家也是唯一与Mazor X Stealth机器人导航计划一起使用术前软件计划的儿科医院之一。该软件可以针对脊柱仪器和脊柱轮廓进行精确的手术计划，从而改善了患者的安全性和结果。High-risk spine surgeries
复杂的医学病例,患者高risk program conducts weekly multidisciplinary meetings of surgeons, anesthesiologists and pediatric hospitalists from the护理医学复杂性计划的儿童。We review each case individually during these meetings to assure each child is ready for surgery. This innovative program has been shown to lead to better outcomes in patients with complex scoliosis. The program has also fostered research that has led to a significant reduction in the number of surgical site infections.Quality and safety measures during surgery
Time out
在每次手术开始时，我们在手术室里花费时间来审查任何和所有患者安全问题，例如过敏，抗生素给药和脊柱仪器的大小（将用于稳定脊柱的杆和螺钉）。该标准程序有助于确保该团队的每个手术中的每个成员都完全了解任何患者安全问题，并进行了双重检查，并采取了所有必要的预防措施以确保安全程序。Neuromonitoring
Neuromonitoring is a routine part of every spine surgery at Boston Children’s that helps prevent any potential neurologic injury for the patient. Our surgical team routinely monitors the motor and sensory portion of the spinal cord as well as individual nerve roots throughout surgery. In addition, we have a dedicated team of neuromonitoring technicians who closely observe the electrophysiologic activity of the patient’s spinal cord during surgery.预防失血
Preventing blood loss is a top priority to avoid postoperative complications and prevent the need for transfusions after surgery. We recently performed a randomized prospective trial using a medication called TXA (tranexamic acid). The study showed the medication was associated with a lower blood loss and prevented the need for transfusions in patients with idiopathic scoliosis. The study was awarded the Hibb’s award at the Scoliosis Research Society meeting for the best basic science study.Infection prevention
手术部位感染可能会对患者产生毁灭性后果。我们的质量和安全计划表明，在防止脊柱患者的手术部位感染方面取得了成功。
- 我们的高风险计划已证明可以有效减少出现独特医疗问题的患者外科手术部位感染，从而使他们处于感染风险。
- Our time-out program has led to a 100 percent rate of antibiotic compliance in spine patients, one of the single greatest factors in reducing surgical site infections.
Quality-enhancing technologies
Robot-assisted surgery and navigation
波士顿儿童的使用手术导航技术有悠久而成功的历史，以确保安全，精确的脊柱仪器放置（用于稳定患者脊柱的螺钉和杆）。
In 2019, the Spine Division became one of the first pediatric hospitals in the country to use the Mazor X Stealth robotic navigation system. During preoperative planning, the robotic system supports accurate, effective planning. During surgery, the system’s robotic arm and real-time imaging guide surgeons in finding precise locations and angles as they place spinal instrumentation in patients’ spines. In complex procedures in which precision is absolutely essential, this technology has been shown to improve accuracy and enhance patient safety.
术中CT扫描
自2015年以来，我们的外科医生使用了称为O-ARM的术中CT扫描，该扫描使手术团队能够确认脊柱仪器的正确放置，从而提高准确性和患者的安全性。
We recently published a series of case studies of complex cervical spine patients who underwent spinal surgery in which the O-arm was used. This series confirms that the use of O-arm in pediatric patients is an effective way to verify screw placement and can prevent incorrect positioning that could cause potential neurologic harm.
