The American College of Surgeons (ACS) Children’s Surgery Verification™ (CSV) Quality Improvement Program officially opened its verification process in January with the goal of ensuring that pediatric surgical patients have access to high-quality care. This new program defines the resources necessary to achieve optimal patient outcomes for children receiving surgical care at certain health care facilities. The CSV program is administered by the ACS and the ACS CSV Committee and offers institutional verification to sites that meet the prescribed standards.
A pressing need
The ACS has a long history of activities directed toward the improvement of surgical care. The ACS developed the CSV program because a large proportion of children’s surgical care in the U.S. is provided in nonspecialized environments. Some of the procedures provided in these facilities are relatively simple, but others are done on high-risk patients and are of greater complexity.1 A specialized environment is associated with better clinical outcomes for these children, particularly high-risk patients needing congenital heart surgery, trauma care, and neonatal surgery.2-5
Furthermore, specialized pediatric anesthesia is critical for safe, contemporary children’s surgery.6-8 A specialized children’s environment also is important to achieve optimal outcomes at a population level for some relatively simple pediatric surgical problems such as intussusception, pyloric stenosis, and appendicitis in children ages five and younger.6,9
The CSV program evaluates applicant centers to verify that optimal children’s resource standards are met and matched to the expected scope of practice at the hospital. Centers may provide Level I, Level II, or Level III children’s specific resources.
To qualify as a Level I children’s surgical center, the hospital must be a regional, tertiary-care facility that is central to the children’s health care system. This facility must have the capability of providing leadership and comprehensive care for all aspects of children’s surgical needs. To fulfill this central role, the Level I center must have adequate depth of resources and personnel. For Level II designation, the children’s surgical center is expected to provide initial children’s surgical care, regardless of the complexity of the case, and definitive care when appropriate. The Level III children’s surgical centers serve communities that do not have immediate access to Level I or Level II institutions. These centers should be capable of providing prompt assessment, resuscitation, emergency operations, and stabilization and should be able to arrange for possible transfer to a facility that can provide definitive surgical care. To access the standards, visit the ACS website.
A collaborative effort
This program is the result of the work of the Task Force for Children’s Surgical Care, a multidisciplinary group of leaders representing all aspects of the children’s surgical community. The task force began meeting in the spring of 2012 to develop best practices and approaches to optimize children’s surgical care. From these meetings, the task force collaborated with the ACS Division of Research and Optimal Patient Care to develop the requirements for verification. These standards are the nation’s first and only multispecialty benchmarks aimed at improving surgical care for infants and children.
“The vision is to see that every child in need of surgical care will receive this care in an environment with resources optimal for his/her individual needs,” said Keith T. Oldham, MD, FACS, Chair, Children’s Surgery Verification Quality Improvement Program, and surgeon-in-chief, Children’s Hospital of Wisconsin, Milwaukee.
The CSV pilot program launched in April 2015 at six sites of various sizes, types, and verification levels. All of the sites were visited, and the pilot was concluded successfully in the fall of 2016. The ACS CSV Committee finalized the standards manual and pre-review questionnaire (PRQ) based on lessons learned in the pilot phase of the program. A number of changes were identified in this process, such as the need for defined alternative training pathways for pediatric anesthesiology, pediatric emergency medicine, and pediatric radiology.
Applying for verification
Centers seeking verification must first submit a pre-application. The pre-application and PRQ must be submitted via the online application portal.
After submitting an application, centers seeking verification undergo an extensive site visit by a team of ACS surveyors, comprising experienced pediatric surgeons, pediatric anesthesiologists, and pediatric nurses who review the center’s structure, process, and clinical outcomes data. The Optimal Resources for Children’s Surgical Care manual drives the application and is used as a guide in conducting the survey.
The CSV program has garnered key endorsements from multiple specialty societies including the American Academy of Pediatrics, American Pediatric Surgical Association, and Society of Pediatric Anesthesiology. Verified centers are listed on the ACS website. For more information, contact firstname.lastname@example.org.
- Somme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics. 2013;123(6):e1466-1472.
- Chang RKR, Klitzner TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics. 2002;109(2):173-181.
- Pasquali SK, Dimick JB, Ohye RG. Time for a more unified approach to pediatric health care policy?: The case of congenital heart care. JAMA. 2015;314 (16):1689-1690.
- Sathya C, Alali AS, Wales PW, et al. Mortality among injured children treated at different trauma center types. JAMA Surg. 2015;150(9):874-881.
- Kastenberg ZJ, Lee HC, Profit J, Gould JB, Sylvester KG. Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis. JAMA Pediatr. 2016;169(1):26-32.
- McAteer JP, Richards MK, Stergachis A, et al. Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy. J Ped Surg. 2015;50(9): 1549-1555.
- Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Pediatr Anesth. 2004;14:218-224.
- Auroy Y, Ecoffey C, Messiah A, Rouvier B. Relationship between complications of pediatric anesthesia and volume of pediatric anesthetics. Anesth Analg. 1997;84:234-235.
- McAteer JP, Kwon S, Lariviere CA, Oldham KT, Golding AB. Pediatric specialist care is associated with a lower risk of bowel resection in children with intussusception: A population based analysis. J Am Coll Surg. 2013;217(2):226-232.