Studies indicate that newborns and children who undergo surgery in environments with pediatric expert resources have better outcomes, fewer complications, and shorter hospital stays when compared with those cared for at non-specialized centers. “Millions of children undergo surgery in the United States each year, but some of these patients receive surgical care in environments that are not matched to their needs,” says Keith T. Oldham, MD, FACS. “This can affect how children fare after operations.”
In 2014, the Task Force for Children’s Surgical Care published an article that defined the resources U.S. surgical facilities need to perform surgery effectively and safely in infants and children. The document, published in the Journal of the American College of Surgeons, was approved by the American College of Surgeons (ACS), the American Pediatric Surgical Association, and the Society of Pediatric Anesthesia. “The intent of these standards is to ensure that all infants and children receive care in a surgical environment that matches their individual medical, emotional, and social needs,” says Dr. Oldham, who chaired the task force that developed the document.
The proper surgical environment for children was defined as one that offers all of the facilities, equipment, and—most importantly—access to providers who have the appropriate background and training to optimize care. “To accomplish this mission, clinicians must balance the issues of access, available manpower, and the need to improve value,” Dr. Oldham says. Levels of resources are designated similarly to how ACS has done for trauma centers, with the goal of prospectively defining optimal training and experience.
To achieve Level I status, hospitals must have adequate resources to provide comprehensive surgical care and perform complex and non-complex operations in newborns and children of all ages, including those with the most severe health conditions. Level I institutions must also be staffed with properly credentialed pediatric specialists around the clock. They must have a Level IV neonatal ICU, the highest level of critical care for newborns. Level II and III surgical centers have somewhat different characteristics but must be able to stabilize and transfer critically ill children to hospitals with higher-level resources. Additional standards were also proposed for outpatient surgical centers to manage pediatric patients.
Aiming for Quality Improvement
The document relied on scientific evidence and expert opinion, but Dr. Oldham says more work is ongoing. For example, plans are underway to develop criteria for evaluating existing facilities that perform children’s surgery. “The overriding goal is to ensure that the appropriate level of care is available for children and infants with any surgical need,” says Dr. Oldham. “With these clearly defined standards, providers and parents may be more able to act in the best interests of children undergoing surgery.”
Readings & Resources (click to view)
Task Force for Children’s Surgical Care. Optimal resources for children’s surgical care in the United States. J Am Coll Surg. 2014;218:479-487. Available at: http://www.journalacs.org/article/S1072-7515(13)01194-0/abstract.
Oldham KT. The right stuff. J Pediatr Surg. 2014;49:1-12.
Oldham KT. Optimal resources for children’s surgical care. J Pediatr Surg. 2014;49:667-677.
Stolar C. Best practice for infant surgery. J Pediatr Surg. 2008;43:1585-1586.
Coran A, Aronsson DD, Denslow DT, et al. American Academy of Pediatrics Guidelines for Referral to Pediatric Surgical Specialists-Committee on Fetus and Newborn. Pediatrics. 2011;110:187-191.
Cosper GH, Hamann MS, Stiles A. Hospital characteristics affect outcomes for common pediatric surgical conditions. Am Surg. 2006;72:739-745.
Chen AY, Schrager SM, Mangione-Smith R. Quality measures for primary care of complex pediatric patients. Pediatrics. 2012;129:433-445.
McAteer J, LaRiviere C, Drugas GT. Influence of surgeon experience, hospital volume and specialty designation on outcomes in pediatric surgery: a systematic review. JAMA Pediatr. 2013;167:468-475.