The Virtual Pediatric Perioperative Home, Experience at a Major Metropolitan Safety Net Hospital.

Conley, Christopher; Facchin, Mark; Gu, Qingrou; Mukerji, Shivali; Cohen, Robyn; O'Brien, Sharon; Nurhussien, Lina; Ferrari, Lynne

INTRODUCTION Successes from anesthesiologist-led Perioperative Surgical Homes in the adult patient population have inspired similar initiatives by pediatric hospitals. Typically the care coordination for these perioperative homes is run through hospital-funded, on site, pre-anesthesia clinics. Preliminary data from Pediatric Perioperative homes have shown promising results in improved patient outcomes and decreased length of hospital stay. The majority of pediatric surgeries within the country are performed in non-pediatric hospitals. Such centers may not have the infrastructure or financial resources for a free-standing pediatric pre-anesthesia clinic. Faced with this situation at the largest safety net hospital in New England, the authors present their experience designing and implementing a "Virtual Pediatric Perioperative Home," a telemedicine-based triage and pre-anesthetic optimization for pediatric patients at Boston Medical Center, Boston, MA. METHODS A retrospective chart review of all pediatric anesthesia cases at Boston Medical Center from February 1st, 2019, to January 31st, 2020, as well as the number of pediatric cases canceled or postponed on the day of surgery for any reason during the same time period was conducted. RESULTS From February 1st, 2019, to January 31st, 2020, 1546 anesthetics were performed in children 18 years and under. Of those, 63 were designated as emergent and hence excluded from our analysis. 153 of the total 1483 (9.4%) of non-emergent bookings were canceled or postponed on the day of surgery. The largest reason for case cancellations (41.8%) was due to the patient suffering from acute illness and thus not medically optimized for surgery. Cancellation rates varied from month to month, with the highest cancellation rate of the year in September 2019 (18.8%). The departments of Podiatry and Gastroenterology represented the highest cancellation rates as a denominator of their case volumes, 15.4% and 15.2% respectively. Younger children had 2.4 times the odds (95% CI: 1.720, 3.4) of cancellation compared to older children. CONCLUSION The authors describe the design and successful implementation of a telemedicine-based pediatric pre-anesthesia triage and medical optimization service at a large safety net hospital. By creating a communication network of pediatric subspecialists, the anesthesiologists were able to, at minimal institutional cost, coordinate care for children with a variety of comorbidities leading up to the day of surgery. This yielded a 9.4% same day cancellation rate in a complex, socioeconomically disadvantaged pediatric patient population at a general hospital.