Room for Improvement: Pediatric ambulatory centers could benefit from guidelines, panelists say

At the Children’s Hospital Boston at Waltham satellite facility, there is a small inpatient unit that allows for overnight stays if necessary and a pharmacy on site, along with radiology services and a hospitalist. The hospitalist is available 24 hours a day Monday through Saturday for both patient care and emergencies and can be reached, along with the anesthesia staff, via a stat-call system with special two-way SpectraLink phones.

Constance Houck, MD, clinical director of the hospitalist program at Children’s Hospital Boston at Waltham and a member of the panel, said many surgery cases are now transferred to the Waltham facility. She added that this approach is possible at other institutions as well.

“An increasing amount of pediatric ORL surgery seems feasible in an ambulatory or satellite setting if careful attention is paid to patient selection, the ability to rescue, pediatric-specific PACU [post anesthesia care unit] care and family education,” she said.

Not all surgery centers, however, have the same tools available, Dr. Arjmand pointed out. “These facilities vary quite a bit in terms of their resources,” he said. “Some have imaging on site, have a pharmacy, maybe have emergency blood available. There’s a lot of variability in what the facility offers.”

Everyone on the panel stressed the importance of patient selection and not doing more than the facility allows.

“You have to know what’s appropriate to do at the facility and what the resources are,” Dr. Arjmand said. “And have some guidelines, and develop and follow them.”