Hospital pediatrics · 2026
Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Zamkoff Jason, Acker Shannon N, Martin Adriana, Anderson Lauren, Bennett Heather, Thysens Jessica, Thomas James J, Conant Miriam, Kurtz Molly, Gupta Rachita, Scarberry Jacquelyn, Burke Meghan, Koehler Richele, Rolison Elise, Whitney Gina, Ziniel Sonja I, Carney Kevin P, Wilcox Duncan, Lockwood Justin M
Аннотация
BACKGROUND AND OBJECTIVES: We observed an increase in emergency transfers (ET) among post-operative patients at our health system's largest free-standing children's hospital. We aimed to reduce ET rates by 50%-from 0.21 to 0.11 events per 10 000 post-operative days-on our 72-bed inpatient surgical unit within 1 year.
METHODS: An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts.
RESULTS: Over an 8-year period-4 years of baseline and 4 years of intervention-we included 17 221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10 000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET.
CONCLUSIONS: We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.
METHODS: An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts.
RESULTS: Over an 8-year period-4 years of baseline and 4 years of intervention-we included 17 221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10 000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET.
CONCLUSIONS: We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.