The virtual pediatric perioperative home, experience at a major metropolitan safety net hospital

Article type: Retrospective observational study.

Summary: This work takes a look back at the implementation of a pediatric perioperative surgical home model with two features distinct from other publications in the area: the hospital is not a tertiary paediatric hospital, and the model relies mostly on a virtual model rather than visits to a clinic setting.

Distinctly positive features of this look-back across 12 months (February 1, 2019 to January 31, 2020) which incorporated 1483 children in the population of interest include demonstrated reduction in same-day cancellation (9.4% in period 2 vs 13.7% prior to the introduction of the program) in a patient population from a socially disadvantaged group with a high proportion of health issues. They also managed to get every consent requiring input by community services completed prior to surgery, rather than having this group of patients experience delays.

The process of building the program is very well described and a lot of that work would be translatable to any setting. The analysis is relatively simple which seems appropriate to this type of article. The authors themselves note a limitation in that the pre-implementation data is not available to fully interrogate the meaningful differences in process. In addition to this, sections of the discussion are highly specific to the US healthcare system and therefore not so relevant to a wider audience.

Bottom line: The paper describes in good detail the development of this paediatric perioperative surgical home model in a non-tertiary setting which, on this data, has resulted in an observed difference. Those interested in this area will find multiple elements transferrable to whatever setting they are in.

Reviewed by Dr Andrew Weatherall