Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers

Area of Science:

• Pediatric Surgery
• Quality Improvement
• Patient Safety

Background:

• An increase in emergency transfers (ETs) was observed in post-operative patients at a large children's hospital.
• The baseline ET rate was 0.21 events per 10,000 post-operative days.

Purpose of the Study:

• To reduce emergency transfer rates by 50% within one year.
• To decrease the ET rate from 0.21 to 0.11 events per 10,000 post-operative days.

Main Methods:

• Implemented a hospitalist surgical co-management model (Surgical Hospitalist Assisted REcovery - SHARe) for children with medical complexity.
• Introduced unit-level safety interventions focusing on safety culture, processes, patient placement, and care models.
• Defined ETs as unplanned ICU transfers within the first ICU hour requiring specific interventions (vasopressors, intubation, high-volume fluids).

Main Results:

• Over an 8-year period (4 years baseline, 4 years intervention), 17,221 surgical encounters were analyzed.
• Hospitalist management of post-operative patients increased from 7% to 27%.
• The ET rate decreased from 0.21 to 0 events per 10,000 post-operative days, with a sustained period of 7,552 encounters without an ET.

Conclusions:

• A multifaceted quality improvement initiative successfully reduced emergency transfers in post-operative pediatric patients.
• Integration of a hospitalist surgical co-management model (SHARe) with unit-level safety interventions led to sustained improvements in patient safety.