Purpose of Study: In 2015, the American College of Surgeons (ACS) created a new hospital designation to improve the efficiency and performance of care for children in American Children’s Hospitals. The Children’s Surgery Center (CSC) verification is achieved when a hospital system demonstrates excellence in its infrastructure and in its operations toward the pediatric-specific care of patients. Several important elements include 24-hour, 7-day a week availability of Pediatric surgical subspecialties, Pediatric Nursing, and Pediatric Anesthesia teams, access to pediatric beds, quality improvement programs, and hospital quality enhancements. Efficient care of pediatric femur fractures is representative of the highest level of care for pediatric trauma patients. The study was performed at one of six ACS pilot sites for the ACS CSC verification, to determine the designation’s effect in improving the efficiency of managing orthopaedic trauma patients.
Methods Used: A retrospective analysis was performed on pediatric orthopaedic trauma patients with femur fractures treated at a busy, suburban academic center for two 5-year intervals before (2010-2014) and after (2015-2019) the implementation of policies and enhanced infrastructure designed to meet the guidelines for ACS verification of a Children’s Surgery Center. For each patient, efficiency parameters defined as total narcotic administration (in morphine equivalents), time from admission to surgery, duration of surgery, time from wound closure to exit time in OR, and duration of hospital stay were compared between time periods. Welch’s t-test was used to compare normative data.
Summary of Results: Of 287 traumatic femur fractures analyzed, 94 (32.75%) occurred before the implementation of policies meeting ACS CSC criteria and 193 (67.24%) occurred after. The implementation of Pediatric-specific Orthopaedic care led to a 34.49% increase in referrals for femur fractures. Patients received less morphine equivalents in all time periods after ACS CSC verification – admission to OR entry (32.49 vs 21.78; p<0.01), OR exit to discharge (111.91 vs 60.08; p<0.01), and total duration of hospital stay (144.40 vs 81.87; p<0.01). In addition, patients treated within the first 24 hours of each 5-year interval demonstrated a decrease in mean wait time for surgery from admission (13.98 hours before and 11.08 hours after; p<0.01), and total length of hospital stay (101.25 hours before and 72.72 hours after; p<0.01). There was a marginal increase in duration of surgery (1.80 hours before and 2.10 after; p<0.05) and no significant change wait time from surgery closure to OR exit (0.24 hours before, 0.25 hours after; p=0.64).
Conclusions: Implementing hospital infrastructure and policies requisite for ACS Children’s Surgery Certification is associated with increased efficiency and decreasing narcotic administration in treating Pediatric trauma patients by reducing narcotic administration throughout the entire hospital stay and decreasing the time elapsed from admission in the emergency department to the start time of surgery and overall time of hospitalization.
