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Published on: January 17, 2011
The creation of a pediatric surgical checklist for adult providers
Diana Ioana Rapolti1, Phyllis Kisa2, Martin Situma3
1University of Illinois, Chicago, IL, USA.
Insights
A new checklist helps adult surgeons safely perform pediatric surgery in emergencies. This tool, based on literature and expert interviews, addresses unique pediatric needs and aims to improve care standards.
Area of Science:
- Medical Sciences
- Surgical Innovation
- Pediatric Care
Background:
- Pediatric surgery presents unique challenges requiring specialized approaches distinct from adult care.
- Existing resources for adult surgeons performing pediatric surgery are limited, particularly in emergency situations.
- Surgical checklists have a proven track record of improving outcomes across various medical applications.
Purpose of the Study:
- To develop a pediatric surgical checklist specifically designed for adult providers.
- To address the gap in resources for adult surgeons operating on children, especially in emergencies.
- To enhance the safety and standardization of pediatric surgical care provided by non-specialists.
Main Methods:
- Conducted a comprehensive literature review of pediatric surgery resources and surgical checklist outcomes up to October 2023.
- Performed interviews with pediatric surgeons to ensure checklist relevance and minimize bias.
- Synthesized findings to create an additive checklist for adult surgeons performing emergency pediatric procedures.
Main Results:
- Included 42 papers encompassing over 8.5 million participants, confirming the positive impact of checklists on outcomes, cost, and team dynamics.
- Identified critical care checkpoints: antibiotic administration, anesthetic considerations, intraoperative hemodynamics, and postoperative resuscitation.
- Developed a supplementary checklist to aid adult surgeons in emergency pediatric surgery, complementing existing WHO checklists.
Conclusions:
- While literature shows varied outcomes, highlighting the complexity of pediatric surgical care, the developed checklist offers a practical tool.
- The checklist is intended to establish a standard of care for emergency pediatric surgery in low-resource settings performed by adult surgeons.
- Further evaluation of the checklist's impact on emergency pediatric surgery outcomes is planned.
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 2023 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:
Forty-two papers with 8,529,061 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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