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The demographics of inpatient pediatric anesthesia: implications for credentialing policy
A Macario1, A Hackel, G A Gregory
1Department of Anesthesia, Stanford University School of Medicine, CA 94305, USA.
Insights
Pediatric anesthesia credentialing based on caseload is challenging. Most hospitals handle few pediatric cases, while a few centers manage the majority, impacting policy implementation.
Area of Science:
- Pediatric Anesthesiology
- Healthcare Policy
- Surgical Case Volume Analysis
Background:
- Implementing credentialing policies for pediatric anesthesia based on caseload requires understanding case distribution.
- Assessing the feasibility of caseload-based credentialing necessitates an analysis of hospital surgical volumes for pediatric patients.
Purpose of the Study:
- To analyze the demographics of inpatient pediatric anesthesia care in northern California.
- To determine if surgical procedure volumes are sufficient for caseload-based credentialing in pediatric anesthesia.
- To inform the consequences of implementing credentialing policies based on caseload.
Main Methods:
- Retrospective computerized review of hospital discharge abstracts in northern California.
- Tabulation of annual hospital caseloads (procedure-days) for children under six years, categorized into three age subgroups.
- Analysis of hospital proximity to determine the distribution of pediatric anesthesia cases.
Main Results:
- 162 out of 205 hospitals (79%) provided anesthesia for children under six, totaling 14,435 cases annually.
- A significant majority of hospitals (85-90%) handled 1-50 pediatric anesthesia cases per year across different age groups.
- 59% of hospitals had fewer than 20 cases, and 72% had fewer than 50 cases annually; 75% of low-volume hospitals were near high-volume centers.
Conclusions:
- Caseload-based credentialing for pediatric anesthesia presents challenges due to the uneven distribution of cases.
- A majority of hospitals manage a small number of pediatric anesthesia cases, indicating potential difficulties in meeting caseload requirements for credentialing.
- The concentration of pediatric cases in a few hospitals suggests that widespread implementation of caseload-based credentialing may be problematic.
Study Objective:
To examine the demographics of inpatient anesthesia care for infants and children in a specific region to determine if there were sufficient numbers of procedures to permit credentialing to take place, as a first step in understanding the consequences of implementing credentialing policies based on caseload.
Design:
Retrospective computerized review of discharge abstracts.
Setting:
All hospitals in northern California.
Measurements And Main Results:
Surgical procedures and date of surgery were linked to create "procedure-days." Each procedure-day counted as one anesthesia case. Annual hospital caseloads (procedure-days) were tabulated for three separate age subgroups under six years of age. The proximity of hospitals with smaller surgical volumes to those with larger volumes was determined. Of the 205 hospitals in the region, 162 had at least one procedure-day for children less than 6 years of age for a total of 14,435 procedure-days (anesthesia cases). For each of three age groups studied--0 to 6 months, 7 to 24 months, and 25 to 72 months--85%, 90%, and 81%, respectively, of hospitals had caseloads of 1 to 50 per year. When procedure days from all three age groups were totalled, 59% of hospitals had less than 20 cases per year and 72% of hospitals had less than 50 cases per year; 86% of hospitals had less than 100 cases per year. Of hospitals with less than 100 cases per year, 75% were within 50 miles of a hospital with more than 100 cases.
Conclusions:
Performance based credentialing for pediatric anesthesia based on caseload may be problematic for many hospitals due to the distribution of cases: a majority of hospitals care for a few children, and most children are cared for in a few hospitals.