Study Design: Historically controlled clinical trial. Objectives: Patients presenting for correction of adolescent idiopathic scoliosis (AIS) by posterior spinal fusion may benefit from structured clinical pathways. We studied the effects of implementing a published clinical pathway for the perioperative care of patients with AIS that required intraoperative use of methadone at our institution. Methods: We performed a historically controlled clinical trial of patients undergoing posterior spinal fusion for AIS by comparing a retrospectively collected control group of 25 patients with a prospective experimental group of 14 patients receiving methadone, gabapentin, propofol, and remifentanil as part of a new clinical pathway. Results: Use of the pathway decreased average pain scores evaluated by the Numeric Rating Scale in the 24 hours following surgery (4.8 [4-6] to 3.4 [2-4], P = .03 [−2.6 to −0.2; t = −2.3]) and postoperative opioid consumption by 76% (41 [29-51] mg to 10 [4-17] mg, P < .001 [−45 to −15; Welch’s t = 4.9]) during the same period. Improved analgesia and reduced reliance on opioids facilitated other postoperative elements of the clinical pathway and shortened the average hospital length of stay by 1 day (4 [3-6] days to 3 [3-5] days, P = .001 [−2 to −1; U = 67, Z = −3.3]). Conclusions: Multimodal analgesia and a clinical pathway add value in the perioperative care of patients undergoing posterior spinal fusion for AIS by improving analgesia and shortening hospitalization. The prospective arm of the trial was registered at clinicaltrials.gov under NCT02481570.

The authors developed a process to produce a reliably fitting face mask from materials that were immediately available to health care workers, to reduce the risk of infection. Multiple materials and designs were developed to produce face masks that focused on ease of production, the ability to generate a reliable facial seal, and the ability to tailor the mask for those who did not fit commercially available N95 masks. Two final designs were selected. Mask components were assembled into kits and distributed to community sewists. Plan-Do-Study-Act cycles were developed for quality improvement. A process was successfully developed to produce 5000 face masks in a period of 3 weeks that fit almost all (95%) health care workers who did not fit in a commercially available mask. The process was able to produce quality face masks with specific attention paid to developing masks that would pass qualitative fit testing.

Impact of preoperative hematocrit, body mass index, and red cell mass on allogeneic blood product usage in adult cardiac surgical patients: report from a statewide quality initiative.

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