A paradigm for achieving successful pediatric XXXX verification in the absence of pediatric surgical specialists while ensuring quality of care.

@entity1 @entity130
INTRODUCTION: Pediatric @entity130 centers (PTC) are concentrated in urban areas leaving large areas where @entity1 do not have access. Although adult @entity130 centers (ATC) often serve to fill the gap, disparities exist. Given the limited workforce in pediatric subspecialties, many adult centers which are called upon to care for @entity1 cannot sufficiently staff their program to meet the requirements of verification as a PTC. We hypothesized that ATCs in collaboration with a PTC could achieve successful American College of Surgeons (ACS) verification as a PTC with measurable improvements in care. This manuscript serves to provide an initial description of this collaborative approach. METHODS: Beginning in 2008, a Level I PTC partnered with three ATC seeking ACS-PTC verification. The centers adopted a plan for education, simulation training, guidelines, and performance improvement support. Results of ACS verification, @entity1 volumes, need to transfer @entity1 , and impact on solid organ injury management were evaluated. RESULTS: Following partnership, each of the ATCs has achieved Level II PTC verification. As part of each review the collaborative was noted to be a significant strength. Total pediatric @entity1 volume increased from 128.1 to 162.1 a year (p=0.031) and transfers out decreased from 3.8% to 2.4% (p=0.032) from pre-partnership to post-partnership time periods. At the initial ATC partner site, 10.7 @entity1 /year with solid organ injury were treated pre-partnership and 11.8/year post-partnership. Following partnership we found significant reductions in LOS, number of images, and lab draws among this limited population. CONCLUSION: The collaborative has resulted in ACS Level II PTC verification in the absence of onsite pediatric surgical specialists. This paradigm may serve to advance the care of injured @entity1 at sites without access to pediatric surgical specialists through a collaborative partnership with an experienced Level I PTC. Further risk adjusted analysis of outcomes will need to be performed in the future. Level IV : Retrospective comparative study.
