Dragonfly Project – Ward based high care for postoperative idiopathic scoliosis patients
Sashin Ahuja, Consultant Spine Surgeon, Cardiff and Vale University Health Board
Introduction
Adolescent Idiopathic Scoliosis (AIS) affects 2-3% of adolescents, leading to severe spinal curvatures requiring complex surgery. Intra and post-operative risks include bleeding and neurological issues, necessitating high-level post-op care previously provided by Paediatric High Dependency Units (PHDU).
Increased PHDU demand led to significant surgery cancellations, impacting waiting lists, patient mental health, and incurring high costs. To address this, the team explored setting up a high care area within the Paediatric Surgical Ward, benchmarking with other trusts for solutions.
Methods
Together with spinal consultants, the paediatric medical team, anaesthetists, and the Owl Ward nursing team, we established the ‘Dragonfly Project,’ creating a surgical high care area within Owl Ward. This involved setting up a four-bedded area for close observation and arterial monitoring and upskilling staff with the help of our practice education team. The project required extensive staff training, educational days, and competency assessments.
The senior nursing team conducted risk assessments to ensure gold standard care, while the Owl Ward manager managed staff and service requirements. Collaboration with spinal, paediatric, and anaesthetic teams was crucial for developing communication channels and safety pathways.
Collaboratively, all teams created a detailed framework and admitted the first patients to Dragonfly Bay in June 2023. Communication channels, escalation plans, operating procedures, and patient flow pathways were established. Training needs were identified, and nurses were trained to deliver the specialist care required.
Care for scoliosis patients, previously delivered in Paediatric High Dependency, was now provided by highly skilled nurses on Owl Ward, including invasive blood pressure monitoring via arterial lines. The care was overseen by spinal, anaesthetic, and paediatric doctors.
Outcomes
- Big impact on waiting list times, significantly reduced theatre cancellations and strain on children’s high dependency units.
- Cancellations due to lack of PHDU/PICU beds were at 40% in 2022. For AIS patient, we are now seeing no cancellations.
- Marked improvement in patient satisfaction and timely access to needed services.
Learnings
- Learned from other trusts through benchmarking and hospital visits.
- Collaboration within the multidisciplinary team was key.
- Earlier introduction of the initiative could have prevented waiting list build-up.
- Required substantial input, emphasising safe and timely implementation.
What next?
- Continue running Dragonfly project with regular evaluations.
- Improve service using feedback from staff, patients, and relatives.
- Expand initiative to reduce waiting times and cancellations.
- Potentially apply framework to other paediatric surgical services.
