The virtual pediatric perioperative home, experience at a major metropolitan safety net hospital

Abstract

Introduction: Successes from anesthesiologist-led perioperative surgical homes in the adult patient population have inspired similar initiatives by pediatric hospitals. Typically the care coordination for these perioperative homes is run through hospital-funded, on-site, preanesthesia clinics. Preliminary data from pediatric perioperative homes have shown promising results in improved patient outcomes and decreased length of hospital stay. The majority of pediatric surgeries within the country are performed in nonpediatric hospitals. Such centers may not have the infrastructure or financial resources for a freestanding pediatric preanesthesia clinic. Faced with this situation at the largest safety net hospital in New England, the authors present their experience designing and implementing a "Virtual Pediatric Perioperative Home," a telemedicine-based triage and preanesthetic optimization for pediatric patients at Boston Medical Center, Boston, MA. Methods:A retrospective chart review of all pediatric anesthesia cases at Boston Medical Center from February 1, 2019, to January 31, 2020, as well as the number of pediatric cases canceled or postponed on the day of surgery for any reason during the same time period was conducted.

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

“…The most common CCSRs, which cumulatively accounted for just over half of the increase in the MS-DRG weighting factor, in descending order of the point estimates, were spine fusion, heart valve surgery, colectomy, pulmonary resection, coronary artery bypass graft, and hip and knee arthroplasty (Table 3). These CCSRs include the surgical procedures commonly targeted for interventions to reduce complications [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], confirming the face validity of our method of using the MS-DRG weighting factor to measure incremental societal costs of complications. The impact of each additional case with an escalation in the MS-DRG differed greatly among the CCSRs.…”

“…Efforts to validate the cost-effectiveness of such expansion of anaesthesiologists' role outside the operating room proper have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This observation should not be construed as a criticism but rather reflects the complexity of PSH implementation within organizations and the relatively small numbers of surgeons within each surgical subspecialty at most individual hospitals.…”

“…Most studies of the PSH and ERAS protocols have involved one or only a few hospitals, which is likely to continue[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The consequence is that, in practice, interventions often have been applied principally to a few surgeons' patients.…”

Racial and Ethnic Disparities in U.S Children Undergoing Surgery for Congenital Heart Disease: A Narrative Literature Review

“…60 One recent study demonstrated a significant reduction in same-day surgery cancellations in children undergoing care at a safetynet institution in New England after introduction of a virtual PSH, suggesting that virtual evaluation was effective in identifying patients that were not medically optimized for surgery. 61 Virtual visits can similarly be used to address social and cultural impediments to care.…”

An In-Depth Analysis of Providers and Services of Cancellation in Anesthesia Reveals a Complex Picture after Systemic Analysis

“…One of the most disruptive events is an unexpected case cancellation, with a reported rate of between 0.34% to 44.2%, but diverse methodologies hamper comparisons between studies [2,. In most cases, cancellations occur within 24 h of surgery, but they also occur after induction of anesthesia [29]. Rescheduling cases may not necessarily lead to in-creased workload variability, but it does affect patient satisfaction and enterprise bottom line [30].…”