Is Your Hospital Accredited?

Abstract

Dr Iqbal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Within the next year, hospitals delivering pediatric surgical care will be able to seek accreditation through the American College of Surgeons (ACS) based on the complexity of pediatric care they provide.1 The Task Force for Children’s Surgical Care was supported by the ACS and the Children’s Hospital Association to put forth guidelines for center designation based on the best available evidence and expert opinion. Over the course of 3 years, the Task Force, comprising pediatric surgeons, pediatric anesthesiologists, epidemiologists, and other pediatric specialists, developed a 3-tiered system similar to the ACS trauma designations, where level I centers provide the most comprehensive pediatric care, level II provide advanced care, and level III provide basic care. In addition to endorsement from the ACS, the American Pediatric Surgical Association and the Society of Pediatric Anesthesia have also endorsed the guidelines.1 According to Dr. Keith Oldham, Chairman of the Task Force, “the goal is to see that every child in the United States receives care in a surgical environment matched to their individual medical, emotional, and social needs.”2The body of literature demonstrating worse outcomes for specific populations of pediatric patients continues to grow. Neonates, children requiring intensive care, the traumatically injured child, and children with congenital heart disease have all been shown to be vulnerable in less specialized environments when they require complex surgical procedures.1 Much of this vulnerability seems to be related to the risk of anesthesia, which is higher in the pediatric patient, but can also be related to lack of other pediatric specialists or nursing care familiar with the care of the pediatric patient and their unique needs.3,4 These special needs for children undergoing complex surgical procedures have been recognized by multiple societies and professional organizations including the American Academy of Pediatrics, the American Pediatric Surgical Association, the Royal College of Surgeons, the Society of Pediatric Anesthesia, and the United Kingdom Health Services. Each of these organizations has previously published guidelines on the delivery of pediatric surgical care.5–8What impact will these guidelines have? They could mean additional travel or even temporary relocation for families. There will be costs for hospitals going through the accreditation process and looking to maintain their accreditation status. On the other hand, these changes will allow families to recognize the capabilities of a particular institution and give them greater confidence in their children’s care. Additionally, hospitals may be motivated to broaden their spectrum of pediatric care, making more specialized services available to their patients and ultimately improve care. If the new guidelines impact outcomes to a similar degree that the trauma center designation did, then our children will benefit greatly.