title: The implementation and efficacy of the Northwestern High Risk Spine Protocol.
abstract: OBJECTIVE
  The aims of this study were to determine the efficacy and feasibility of implementation of the intraoperative component of a high risk spine (HRS) protocol for improving perioperative patient safety in complex spine fusion surgery.
  
  
  METHODS
  In this paired availability study, the total number of red blood cell units transfused was used as a surrogate marker for our management protocol efficacy, and the number of protocol violations was used as a surrogate marker for protocol compliance.
  
  
  RESULTS
  The 548 patients (284 traditional vs. 264 HRS protocol) were comparable in all demographics, coexisting diseases, preoperative medications, type of surgery, and number of posterior levels instrumented. However, the surgical duration was 70 minutes shorter in the new group (range, 32-108 minutes shorter; P < 0.0001) and the new protocol patients received a median of 1.1 units less of total red blood cell units (range, 0-2.4 units less; P = 0.006). There were only 7 (2.6%) protocol violations in the new protocol group.
  
  
  CONCLUSIONS
  The intraoperative component of the HRS protocol, based on two Do-Confirm checklists that focused on 1) organized communication between intraoperative team members and 2) active maintenance of oxygen delivery and hemostasis appears to maintain a safe intraoperative environment and was readily implemented during a 3-year period.
authors.affiliation: Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Carine
authors.initials: C
authors.lastname: Zeeni
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Louanne M
authors.initials: LM
authors.lastname: Carabini
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Gould
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Bebawy
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Hemmer
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Moreland
authors.affiliation: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Koski
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Antoun
authors.initials: A
authors.lastname: Koht
authors.affiliation: Department of Orthopedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schafer
authors.affiliation: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: dhanesh-gupta@northwestern.edu.
authors.forename: Dhanesh K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000592:standards; D002985:Clinical Protocols; D005260:Female; D005440:Fluid Therapy / Q000592:standards; D006487:Hemostasis; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards*; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000592:standards; D059035:Perioperative Period; D012306:Risk; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome
keywords: Checklist; Critical pathways; Hemostasis; Patient care team; Spinal fusion