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The Creation of a Pediatric Surgical Checklist for Adult Providers
Diana Rapolti1, Phyllis Kisa2, Martin Situma2
1University of Illinois Hospital and Health Sciences System.
Insights
Adult surgeons can now use a new pediatric surgical checklist to improve care for children. This checklist, based on current literature and expert interviews, enhances safety in emergency pediatric surgery.
Area of Science:
- Pediatric Surgery
- Surgical Safety
- Medical Checklists
Background:
- Pediatric surgery presents unique challenges requiring specialized care distinct from adult procedures.
- Existing resources for adult surgeons performing pediatric surgery are limited, especially in emergency situations.
- Surgical checklists have a proven track record of improving outcomes across various medical applications.
Approach:
- A comprehensive literature review of PubMed was conducted, including all papers on surgical checklists and their outcomes up to October 2022.
- Interviews with pediatric surgeons were integral to developing a relevant and minimally biased checklist.
- The methodology focused on gathering current literature and expert insights to address the need for pediatric surgical guidance for adult providers.
Key Points:
- The literature review encompassed 42 papers with over 8.5 million participants, highlighting the benefits of checklists on outcomes, cost, and team dynamics.
- Vital care checkpoints identified include antibiotic administration, anesthetic considerations, intraoperative hemodynamics, and postoperative resuscitation.
- The developed checklist is designed to be additive to existing World Health Organization (WHO) surgical checklists, specifically for adult surgeons operating on children in emergencies.
Conclusions:
- The study resulted in a practical checklist to standardize care for pediatric surgery performed by adult surgeons, particularly in low-resource settings.
- Further implementation and evaluation of the checklist are planned to assess its impact on emergency pediatric surgery outcomes.
- While literature outcomes are varied, the checklist aims to provide a nuanced approach to critical factors in pediatric surgical care.
Purpose:
To address the need for a pediatric surgical checklist for adult providers.
Background:
Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications.
Methods:
Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2022 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias.
Results:
42 papers with 8529061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies.
Conclusion:
The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes.
Funding:
Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.
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