How Best to Design Surgical Comanagement Services for Pediatric Surgical Patients?

In this issue of Hospital Pediatrics, Dr David Rappaport and colleagues report on the outcomes and costs associated with implementation of a surgical hospitalist comanagement service for medically complex children undergoing spine fusion surgery at Nemours/Alfred I. duPont Hospital for Children (duPont) that was started in September 2005.¹ This report is of great personal interest because it is the first on the topic of pediatric hospitalist comanagement of spine fusion surgery patients after our study at Children’s Hospital in Denver at the same time.² Since then, a substantial number of surgical hospitalist comanagement services have been initiated across the nation. Because very little evidence exists to guide the organization of such services, a diversity of approaches to comanagement have been implemented.

As with the program at duPont, numerous surgical hospitalist comanagement services at tertiary care pediatric hospitals have been initiated after sentinel events. Although rare, sentinel events result in action and are frequently the most effective initiator for change in the real-world setting. However, the ability of these new services to reduce an already rare number of sentinel events is limited. Instead, we might expect surgical comanagement …