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The New Tiers of Children’s Surgical Care


Laura Landro with the Wall Street Journal reports that the American College of Surgeons has created a three-tier classification system that should help hospitals and parents make better decisions when it comes to children’s healthcare in acute cases (“Programs Aim to Standardize Surgical Care for Children“).

About Healthcare Classification Systems

As Landro points out, the trauma-center classification system was developed in the 1970s and the new tiers of children’s surgical care mirror this system.

Trauma centers, according to Wikipedia, came from the realization that trauma (such as that which comes from accidents or violence) is itself a kind of disease or illness. Patients need the help of specialists and a multidisciplinary approach.

Similarly, pediatric cases often require specialists and a multidisciplinary approach to care. This prompted a national task force to write new guidelines for classification. These, as Landro reports, were published in March 2014, and doctors expect a couple of hundred hospitals and centers across the country to receive a Level I, Level II, or Level III designation.

What Is the Purpose of Tiers or Classifications?

Landro quotes surgeon Keith Oldham: “The goal is to see that every child in the United States receives care in a surgical environment matched to their individual medical, emotional and social needs.”

A Level I center, for example, would be capable of delivering the highest, most comprehensive level of care for children, just as Level I trauma centers provide the most comprehensive level of care for people injured in accidents or victimized by acts of violence.

According to a 2005 study published in the Annals of Surgery, Level I trauma centers tend to have better outcomes and lower mortality rates. Given the apparent success of the classification system among trauma centers, perhaps a similar system may help improve children’s healthcare, esp. as various hospitals and centers strive to achieve Level I status.

Does Level I Mean Perfection in Healthcare?

Absolutely not: if you’re a patient in a Level I center, this does not mean that you aren’t at risk of being hurt by a medical mistake. Doctors, nurses, and other healthcare providers are only human. We all make mistakes. It’s likely that very few providers, especially in Level I centers, have any interest other than the patient’s health and safety in mind in the delivery of healthcare. But Level I does not mean perfection.

What Is an Adverse Event?

An “adverse event” is any of a number of reportable negative outcomes that can happen to a patient in a hospital – even Level I trauma centers. An adverse event, according to the American Academy of Orthopaedic Surgeons, is defined as “one that causes an injury to a patient as the result of a medical intervention rather than the underlying medical condition.”

Sometimes this means medical malpractice. However, despite the fact that healthcare delivery is not perfect and patients are sometimes injured as a result of human error, that doesn’t mean the American College of Surgeons isn’t on to something when it comes to its classification system for children’s surgery centers.

If it results in better outcomes and lower mortality rates among kids, more power to the American College of Surgeons.