Programs Aim to Standardize Surgical Care for Children<http://www.wsjsmartkit.com/wsj_redirect.asp?key=OM20140904-02&mod=djem_jiewr_OM_domainid> by: Laura Landro
Sep 02, 2014
PICS: Design of Work Systems, Process Documentation

SUMMARY: Surgeons have developed a new classification system for pediatric surgical centers according to the level of care they provide, similar to the one that classifies trauma centers. Meanwhile, hospitals are offering new programs to help demystify the risks and benefits of pediatric surgery.

QUESTIONS:
THE PROBLEM
Studies show there are fewer complications, better survival and shorter hospital stays when newborns and children undergo surgery in hospitals with expert resources for pediatric patients. Because of their anatomy and growth stage, children have unique needs including specialized pediatric anesthesiologists, radiologists and emergency physicians. Yet close to half of pediatric surgeries take place in adult-focused general hospitals, which often lack dedicated pediatric staff and resources. That means children often don't receive optimal care and could face more postoperative risks, according to David Hoyt, executive director of the American College of Surgeons.

1. (Introductory) Describe the new classification system. What is this designed to accomplish? Do you feel that this will have the intended effect? Why or why not?
Though the guidelines may prompt some families to travel farther from home for optimal surgical care, Dr. Hoyt says he expects some smaller community hospitals to add pediatric specialists to get a higher-level designation and offer more comprehensive services.
"The goal is to see that every child in the United States receives care in a surgical environment matched to their individual medical, emotional and social needs," said Keith Oldham, chairman of the task force that developed the new standards and surgeon in chief at Children's Hospital of Wisconsin, Milwaukee, which would qualify under the guidelines as a Level I center.
Dr. Hoyt says he expects about 200 hospitals initially to participate in the verification process, which would require them to pay an administrative fee of about $10,000 a year. Other medical societies, including the American Pediatric Surgical Association, have endorsed the American College of Surgeons' plan. The American Academy of Pediatrics is considering an endorsement and earlier this year released its own guidelines to help pediatricians refer patients for surgery.

Amy Wagner, a pediatric surgeon, removed the tumor when Grace was 4 days old. It had caused nerve damage to Grace's bladder, and when she was 3 months old, a pediatric urologist at Children's performed a surgical procedure to help her urine drain. Grace has had several other procedures and is being followed by pediatric oncologist Meg Browning. A test last week for tumor recurrence was negative.
Dr. Wagner discovered the tumor before Grace was born, when Ms. Wroblewski was about 18 weeks pregnant. Ms. Wroblewski says it was a great relief to know if the baby had needed surgery immediately at birth, she would have been quickly transferred from the hospital's birth center to a pediatric operating room in the same complex.
Before the six-hour surgery, Dr. Wagner was "very open about the risks, and what they had in place to deal with them and they always made us feel like we could ask questions," Mr. Peterson says.
Studies show parents often don't understand how complex operations will benefit their child or fully grasp the risks. But they fare better when provided with educational materials that explain surgery in simple language and images. More hospitals are helping families get comfortable with the process before admission by offering preoperative surgical tours, as well as videos that explain specific procedures, such as what happens during anesthesia.
Medical groups and hospitals are developing new standards for children’s surgical care to help the parents of the millions