Regional consensus on the heath care pathway of disabled children in surgery

Abstract

The réseau enfance et handicap du grand Sud-Ouest (REHSO) as founded in November 2015 to promote pediatric PRM on this territory and to standardize the practices within the establishments participant. In May 2015, a study on the management of surgical projects in disabled children was realised 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. On 12 centers interrogated, 7 answered the preliminary questionnaire. The positive results were that all the centers realised 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 was 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 post-operative 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. The 17 authors of this regional consensus committed to diffuse it and apply it in their establishments.