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Advice for your pediatric anesthesia policy

Ambulatory Safety Monitor, September 1, 2005

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Your pediatric patients need special considerations regarding their anesthesia. During the Federated Ambulatory Surgery Association (FASA) annual meeting in May, Raafat S. Hannallah, MD, professor of anesthesia and pediatrics at George Washington University Medical Center in Washington, DC, shared tips on what surgery centers should include in their anesthesia policies.

Children are excellent candidates for ambulatory surgery, said Hannallah, who is also chief of anesthesiology at Children's National Medical Center in Washington, DC. "The key to success of a [pediatric anesthesia] practice lies in careful selection, screening, and preparation of prospective patients," he said.

Some of Hannallah's must-haves for your pediatric anesthesia policies:

Medical staff

1. Designate the operative procedures you will perform.

2. Categorize pediatric patients who will go under anesthesia by age and by risk (e.g., asthmatics and seizures).

3. Decide on an annual minimum case volume necessary for anesthesia providers to maintain clinical competence. (Note: The medical director should determine this figure.)

Clinical privileges

1. Determine regular clinical privileges.

2. Require a fellowship and documented/demonstrated historical and continuous competence for special clinical privileges.

Patient selection and screening

1. Determine whether the patient is a status I, II, III, or IV. Physical status I or II denotes a healthy, candidate for elective surgery. Category III is moderately healthy and category IV is too sick to undergo surgery. In category III, the patient must be well-evaluated and well-controlled, and you must require a consult prior to surgery.

2. Accept patients on an individual basis.

3. Ask parents to call the center the morning of the surgery for a phone assessment. Ask whether the child has a runny nose. If so, you may want to reschedule for one to two weeks later. If the child has flu-like symptoms, you may want to reschedule for four to six weeks later. "Asking before the patient arrives saves time for everyone," Hannallah said. "When everyone is at the center and ready to go, it's tempting not to reschedule."

Preparing pediatrics psychologically

1. Open your surgery center on Sunday afternoons or after work hours to offer tours for children who scheduled to undergo surgery. Let them put on gowns and masks and see all the rooms they will visit. This interactive approach will make them feel as though the environment isn't so strange when surgery day arrives.

2. Show pediatric patients a video before the procedure explaining what will happen.

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