Abstract
The United States’ healthcare system is facing unprecedented pressures: the healthcare
cost curve is not sustainable while the bar of standards and expectations for the
quality of care continues to rise. Systems committed to the surgical treatment of
children will likely require changes and reorganization. Regardless of these mounting
pressures, hospitals must remain focused on providing the best possible care to each
child at every encounter. Available clinical expertise and hospital resources should
be optimized to match the complexity of the treated condition. Although precise criteria
are lacking, there is a growing consensus that the optimal combination of clinical
experience and hospital resources must be defined, and efforts toward this goal have
been supported by the Regents of the American College of Surgeons, the members of
the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia
(SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the
concepts involved have unfortunately become divisive. Our goals, therefore, are 1)
to provide a review of the literature that can provide context for the discussion
of regionalization, volume, and optimal resources and promote mutual understanding
of these important terms, 2) to review the evidence that has been published to date
in pediatric surgery associated with regionalization, volume, and resource, 3) to
focus on a specific resource (anesthesia), and the association that this may have
with outcomes, and 4) to provide a framework for future research and policy efforts.
Key words
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Article info
Publication history
Published online: February 28, 2014
Accepted:
February 17,
2014
Received in revised form:
February 16,
2014
Received:
November 20,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
