One-Stop Surgery for pediatric outpatients

Thanks to a new streamlined system at MUSC Children's Hospital, pediatric patients in need of a variety of ambulatory surgical procedures can now receive their preoperative evaluation and surgical procedure on the same day. Called One-Stop Surgery, the system eliminates the need for an initial, separate appointment with the pediatric surgeon prior to the day of surgery.

“Consolidating several visits into one makes everything so much more convenient for the family,” said Ed Tagge, M.D., the MUSC pediatric surgeon who led the development of the system. “Many of these families come from towns located hours away from the Children's Hospital. One-Stop Surgery saves them at least one round trip, and that can mean a lot in terms of lost work days, school days and general inconvenience. For that matter, One-Stop Surgery provides conveniences even for families that live in the Tri-County area.”

Development of the system required collaboration with a team that includes pediatric surgeons Andre Hebra, M.D., and H. Biemann Othersen Jr., M.D., as well as pediatric anesthesiologists Frank Overdyk, M.D., and Napoleon Burt, M.D.

According to Hebra, One-Stop Surgery is the logical next step after the development of outpatient surgery and same-day work-up protocols.

It makes the specialized resources of MUSC's pediatric surgical practice available to a much larger number of the state's residents by decreasing the “hassle factor” while maintaining the highest quality care. “It makes it so much simpler,” Hebra said. “The primary care provider makes the referral with just one phone call; the child is evaluated quickly and the operative procedure is handled that same day. The result is increased patient satisfaction, excellent care and decreased cost.”

Consolidating steps

Tagge stressed that One-Stop Surgery enables families to have board-certified pediatric surgeons and pediatric anesthesiologists manage their children's surgical problems, no matter how simple—all without traveling multiple times to the Children's Hospital.

He cautioned that combining an initial work-up and the surgery itself into a single visit is possible only for children with straightforward surgical problems who have been referred from their primary practitioner. Common One-Stop Surgery indications include inguinal hernia and hydrocele repair, simple cyst removals and circumcisions.

“Children in need of more complex procedures or problems that call for extensive imaging, labs and pre-surgical assessment still need to be scheduled in the usual fashion,” he said.

Pre-surgical visit

“Much of the discussion that used to take place in the pre-surgical visit can be handled through contact with the referring pediatrician and a phone call to the family,” said Overdyk. “When we see the patient on the day of surgery, we double-check the medical history and compliance with patient instructions. The child is then evaluated the same way as before. The only difference is that, barring complications, the child can proceed directly to the operating room.”

Phone follow-up

Since complications following such routine surgical procedures are rare—less than one percent for the procedures available through One-Stop Surgery—Othersen and his surgery service developed several years ago a protocol for follow-up via a formatted telephone call to the family. This step has worked extremely well. In five years and many hundreds of cases, no major problems have been missed, and follow-up surveys of the families indicate an overwhelming positive response to the system.

As Tagge noted, “Combining our time-tested phone follow-up system with this new One-Stop Surgery, the standard three visits to the pediatric surgeon for a minor surgical procedure can be reduced to one, while providing ‘state of the art’ care.

One-Stop Surgery Indications

To date, the following procedures have been incorporated into the One-Stop Surgery system:

  • Inguinal hernia and hydrocele repair
  • Umbilical hernia repair
  • Simple cyst removal
  • Circumcision
  • Others, depending on circumstances

For consultation or referrals, call MUSC Health Connection at 792-1414.

Editor's note: The article is reprinted from MDialogue newsletter, a physician liaison program publication.

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