Consensus régional sur le parcours de soins de l’enfant handicapé en chirurgie

Abstract

IntroductionThe “Réseau Enfance et Handicap du grand Sud Ouest” (REHSO) was based (established) in November, 2015 to promote the pediatric reeducation on this territory and harmonize the practices within the participating structures. MethodIn May 2015, a study on the management of surgical projects for disabled children was realized by a questionnaire sent to the structures of pediatric PRM of the West. In June 2015, a working group composed by 17 surgeons, pediatrician and MPR practitioners discussed about their different practices and built a consensus on the steps to lead during a surgical project in disabled children. This consensus was next comforted by the literature data on the health care pathway of children in surgery. ResultsOn 12 requested, 7 centers answered the preliminary questionnaire. The positive results were that all the centers realized multidisciplinary consultations before the surgical acts, essentially in university hospitals, and that most of them performed a specific preparation for these interventions, but inconstantly standardized. The weak points of these heath care pathways were the pain evaluation, which was systematic but insufficiently standardized, the leak of precision of the pre- and postoperative transmissions, and the insufficiency of the support offered to families. The consensus proposed by the REHSO structures the surgical pathway of the child in preoperative cares, operative period, time of the discharge, and postoperative cares. It underlines the importance of the multidisciplinary preparation for the surgery, the information given to families, the treatment of the pain, and the quality of the transmissions and the follow-up. It recommends especially a systematic use of the transmission files edited by the AP–HP, and of the modified FLACC for the pain evaluation. ConclusionThe 17 authors of this regional consensus committed to diffuse it and apply it in their establishments.