Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers
Jason Zamkoff1, Shannon N Acker2, Adriana Martin3
1University of Colorado School of Medicine, Department of Pediatrics, Section of Hospital Medicine, Aurora, Colorado.
Insights
Emergency transfers (ETs) in post-operative pediatric patients were significantly reduced through a quality improvement initiative. The Surgical Hospitalist Assisted REcovery (SHARe) model and safety interventions decreased ET rates to zero, improving patient care.
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).
- Introduced unit-level safety interventions focusing on safety culture, processes, patient placement, and care models.
- Defined ETs as unplanned ICU transfers requiring specific interventions within the first hour.
Main Results:
- Over 8 years (4 baseline, 4 intervention), 17,221 surgical encounters were analyzed.
- Hospitalist management increased from 7% to 27% of post-operative patients.
- The ET rate decreased from 0.21 to 0 events per 10,000 post-operative days, sustained over 4 years.
Conclusions:
- A multifaceted quality improvement initiative successfully reduced emergency transfers.
- Integration of the SHARe model with unit-level safety interventions led to sustained improvements in pediatric surgical patient safety.
Background And Objectives:
We observed an increase in emergency transfers (ET) among post-operative patients at our health system's largest free-standing children's hospital. We aimed to reduce ET rates by 50%-from 0.21 to 0.11 events per 10 000 post-operative days-on our 72-bed inpatient surgical unit within 1 year.
Methods:
An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts.
Results:
Over an 8-year period-4 years of baseline and 4 years of intervention-we included 17 221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10 000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET.
Conclusions:
We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.
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