Optimizing resources for the surgical care of children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee consensus statement.
The United States' healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved have unfortunately become divisive. Our goals, therefore, are 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105. Electronic address: adam.goldin@seattlechildrens.org.
Adam B
AB
Goldin
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039.
Roshni
R
Dasgupta
Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX 75235.
Li Ern
LE
Chen
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232.
Martin L
ML
Blakely
Division of Pediatric Surgery, University of Florida College of Medicine, Gainesville, FL 32610.
Saleem
S
Islam
Division of Pediatric Surgery, Hiram C. Polk, Jr. M.D. Department of Surgery, University of Louisville, Louisville, KY 40202.
Cynthia D
CD
Downard
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115.
Shawn J
SJ
Rangel
Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108.
Shawn D
SD
St Peter
Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226.
Casey M
CM
Calkins
Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226.
Marjorie J
MJ
Arca
Division of Pediatric Surgery, University of Utah, Salt Lake City, UT 84113.
Douglas C
DC
Barnhart
Division of Pediatric Surgery, Washington University, St. Louis, MO 63110.
Jacqueline M
JM
Saito
Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226.
Keith T
KT
Oldham
Division of Pediatric Surgery, Johns Hopkins University, Baltimore, MD 21287.
Fizan
F
Abdullah
D000758:Anesthesia / Q000592:standards; D002648:Child; D006295:Health Resources / Q000592:standards*; D061847:Hospitals, High-Volume / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000592:standards*; D012041:Regional Medical Programs / Q000592:standards; D013043:Specialties, Surgical / Q000592:standards*; D014481:United States
Clinical outcomes; Optimization; Quality; Resources; Safety; Volume-related outcomes