September 4, 2014

With Levels I through III, hospitals get classified for pediatric surgery

Daily Briefing

    Surgeons have created a new classification system to standardize pediatric surgical centers by the level of care provided, much like the system trauma centers use, Laura Landro writes for the Wall Street Journal.

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    Nearly five million infants and children undergo surgery annually, and studies show there are fewer complications, increased survival rates, and shorter hospital stays when surgery is done at a center with pediatric experts. Such experts include specialized pediatric anesthesiologists, radiologists, and ED physicians.

    However, about 50% of pediatric surgeries are conducted at adult-centric general hospitals, which often lack these specialized resources and staff. As a result, many children do not receive the best care and may face greater postoperative risks, says David Hoyt, executive director of the American College of Surgeons.

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    In March, Hoyt and a team of other physicians developed new guidelines outlining the resources hospitals need to perform safe pediatric surgeries. Modeled after trauma center designations, the guidelines create three levels of pediatric care centers:

    • Level I: This is the highest level, offering the most comprehensive care. These centers can perform complex surgical procedures in infants and children, including those with the most severe conditions. They employ around-the-clock pediatric specialists, offer a Level IV NICU, and operate a transport service.
    • Level II: These centers provide advanced surgical care for children with moderate-risk conditions. Surgeries at these centers generally involve a single organ system. The centers have 24/7 access to pediatric surgeons, anesthesiologists, and radiologists, with others available for consultation. They also offer a Level III NICU and an ICU with the capacity for pediatric critical care. They can stabilize critically ill children and transfer them to Level I centers.
    • Level III: These centers perform low-risk surgical procedures on children older than six months and employs regular staff with pediatric expertise. They include a pediatric resuscitation and a pediatric rapid response team and have the ability to transport critically ill children to Level I or Level II centers.

    According to Hoyt, about 200 hospitals will participate in the first round of the verification process. The hospitals will pay about $10,000 annually to participate.

    The American Pediatric Surgical Association and other medical societies have endorsed the new guidelines. According to the Journal, the American Academy of Pediatrics is considering an endorsement; earlier this year it released its own set of guidelines for pediatric surgery (Landro, "The Informed Patient," Wall Street Journal, 9/1).

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