Spine Division | Quality & Safety
每年，我们每年治疗数百名患有需要手术的复杂脊柱病症。我们与这些患者的目标是执行highest quality surgery在保持和培养一个culture of safety。在护理的各个方面，在手术的每个阶段，我们坚持严格的一套准则，以确保最高的质量和患者安全性。
经验促进质量
外科术语从熟练的临床团队开始，特别是对于医疗问题通常需要特定专业知识的脊柱患者。我们的外科团队包括外科医生，麻醉家和护士，每个人都有专门的作用，以保护患者的安全。
- Our脊椎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
我们的团队审查了在手术日前几次与其他临床医生的手术计划。这包括脊柱教育回合的介绍，术前访问，如果需要，与放射科医师在咨询中审查最新的成像，并在外科手术会议上。这种强烈的焦点对规划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照顾。软件辅助手术规划
欧宝彩票平台波士顿儿童医院是第一个和唯一只使用术前软件计划的唯一和唯一的儿科医院的医院之一。该软件可实现精确的脊柱仪器和脊柱轮廓的外科手术规划，从而提高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护理医疗复杂程序的儿童。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，我们在手术室拍出了一段时间，以查看任何和所有患者安全问题，如过敏，抗生素管理和脊柱仪器的大小（用于稳定脊柱的杆和螺钉）。本标准程序有助于确保手术的每个成员都充分了解任何患者安全问题，双重检查设备，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.防损预防
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
手术部位感染可能对患者产生毁灭性的后果。我们的质量和安全计划在预防脊柱患者中的手术部位感染方面表现出了成功。
- 我们的高风险计划已显示有效减少患者外科遗址感染，这些患者患有独特的医疗问题，使它们有感染风险。
- 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
波士顿儿童拥有使用手术导航技术的长期，成功的历史，以确保安全，精确地放置脊柱仪器（用于稳定患者刺的螺钉和杆）。
2019年，脊柱部门成为该国的第一个儿科医院，以利用Mazor X隐形机器人导航系统。在术前规划期间，机器人系统支持准确，有效的规划。在手术期间，系统的机器人臂和实时成像导向外科医生在患者刺的脊柱上放置脊柱仪器时发现精确的位置和角度。在精度绝对必要的复杂程序中，已显示该技术提高准确性和增强患者安全性。
术中CT扫描
自2015年以来，我们的外科医生使用了一个往立的CT扫描，称为O形臂，使外科团队能够确认脊柱仪器的正确放置，导致更高的准确性和患者安全。
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.
