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(File image) Children who received the spinal surgery returned to the operating theatre 11 separate times on average. Alamy Stock Photo
Spina Bifida

Reviews into spinal surgeries in Temple Street found one child returned to operating theatre 33 times

Both the internal and external review into complications with spinal surgeries in the hospital were published, in full, today.

CHILDREN’S HEALTH IRELAND (CHI) has published its full internal and external reviews into complications with its spinal surgery programme for patients with Spina Bifida in Temple Street Children’s Hospital.

The hospital group bowed to pressures from the families to release the full reviews, after they accused it of not being transparent enough, with CHI having previously said it would not do so.

The reviews found that children who received a particular spinal surgery in the hospital had to return to the operating theatre 11 separate times on average, with one child returning on 33 occasions.

The surgery in question, instrumented posterior spinal fusions, was conducted four times and was found to have the largest amount of complications in regards to wounds which required additional surgeries.

Patients who underwent the type of surgery, which requires a surgeon to use instruments such as rods, plates, and screws to help bones in the spine fuse, spent the longest time on wards, the second longest time in ICU and spent the longest time under anesthetic.

The external review found that the majority of patients, 13 out of 16, who underwent spinal surgery in the hospital – of which there are four types – required additional surgery due to postoperative complications.

The reviews published do not deal with the issue of unauthorised devices being implanted into children. CHI commissioned a separate report on this issue last week.

Full recommendations

Patient advocates and a lawyer working with a number of families whose children suffered adverse outcomes have called for the scope of an additional external review, commissioned by the HSE on Monday, to be extended to cover other branches of CHI.

It is now understood that provisions in the terms of reference on “service capacity and access, including the delivery of the current agreed plans” will allow for these elements to be examined.

Although the HSE said on Monday that the “primary focus” of the review would be “the clinical care provided by an individual consultant based at CHI at Temple Street”, the review is expected to assess other CHI hospitals including Crumlin.

It remains unclear whether surgery at the National Orthopaedic Hospital Cappagh will also be examined.

Parents of the affected children criticised CHI for not being as open and transparent as possible on this matter. Both reports were made available to the public today in the interest of doing so, CHI said this evening.

The internal review includes details around complications of metal work surgeries, infections as well as the average length of stay, theatre visits and surgical times.

The internal review recommended that there should be “widespread encouragement across all specialties” to improve the documentation of these surgeries, after not all data was available to be collected.

It also recommended that that the data that it did retrieve should be used when seeking consent from parents of the patients for surgery.

In the ‘Key Themes’ found by the external review, it suggests that the hospital should “provide safe, effective, patient-centered, timely, and efficient care in order to optimize clinical outcomes” if CHI at Temple Street decides to continue to offer spinal surgery.

It also stressed the importance for the hospital to continue to provide training, quality metrics, and support and guidance to existing staff to maintain a culture of safety in the organisation.

The external review also suggested that the hospital ensure that it has the correct criteria to carry out spinal surgeries “given the high incidence of spina bifida in Ireland”.

While waiting lists were found to not have any impact on the rate of  postoperative complications it did state remind the organisation that high complexity surgery “requires significant resources and therefore if these surgeries are going to continue to be done at CHI at Temple Street these resources need to be available”.

The review suggested to CHI leadership that if they believe the hospital does not have the correct resources to do so, it may want to “consider and assess the opportunity to offer some or all these surgeries at another CHI facility”.

In regards to concerns over the outcomes of surgeries for the children, it recommended that programmes designed to evaluate outcomes “should be established and reviewed regularly”.

Solid governance structure with clinical leadership, enhanced interdisciplinary forums, and a quality improvement programme were recommended to provide a “unified programme” in regards to the care given to the children with spina bifida.

The external review also states that more attention is needed to “create a culture where all members of the care team are encouraged and comfortable sharing safety questions and concerns”.

To truly create a highly reliable safety culture, CHI at Temple Street should look at other high reliability paediatric institutions that have successfully developed environments focused on patient safety and quality,”

It suggested that leadership in the hospital should “carefully be proactive in addressing any and all concerns whether raised by clinical or other staff, families, regulators or others” in the future.