Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers

BACKGROUND AND OBJECTIVES We observed an increase in emergency transfers (ET) among post-operative patients at our health system’s largest free-standing children’s hospital. We aimed to reduce ET rates by 50%—from 0.21 to 0.11 events per 10 000 post-operative days—on our 72-bed inpatient surgical unit within 1 year. METHODS An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts. RESULTS Over an 8-year period—4 years of baseline and 4 years of intervention—we included 17 221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10 000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET. CONCLUSIONS We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.