Bob Underwood, MD (Host): The Children's Health System is the first in the nation to have multiple sites receive a Children's Surgery Verification. The Dallas campus once again received a Level I Children's Surgery Verification from the American College of Surgeons. And the Plano campus received its first Level I Surgical Designation, being the first hospital to get any designation from the College of Surgeons in the Northern Market.

 This is Pediatric Insights Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. I'm your host, Dr. Bob Underwood. And today, we'll hear how important these certifications are to providing exceptional pediatric care. With us today are two leading experts, Michelle Matthews, R.N., Senior Director of Surgical Quality at Children's Health, and Dr. Adam Alder, Chief of Surgery at Children's Medical Center Plano, and Associate Professor of Surgery at UT Southwestern. Michelle, Dr. Alder, thank you so much for being with us today.

Adam Alder, MD: Thanks for having us.

Michelle Matthews: Yeah. Thank you.

Host: Yeah, absolutely. So, Michelle, can you tell us a little bit more about these certifications? I mean, what requirements are needed to be met and how often do these happen?

Michelle Matthews: Yeah, absolutely. The American College of Surgeons was developed back in 2017, where they started with pilot sites. To meet the verification requirement, we must meet very rigorous standards that are outlined in the American College of Surgeons Optimal Resources for Children's Surgery Manual. This manual defines three different levels of verification, Level I being the highest level care for pediatric patients.

The requirements for verification involve improving the quality of care our surgical patients receive and measuring our outcomes. So, to give a few examples, we are required to participate in the National Surgical Quality Improvement Program, which is called NSQIP. And this program includes many other hospitals who participate. And what we do is we benchmark our surgical outcomes with others. We look for opportunities to improve care and share our great successes with others.

Some other requirements that the verification include are a Process Improvement Patient Safety Committee, or what we call our PIPS Committee. And this committee is internal within our own organization. And what we do is it's multidisciplinary and it involves representatives from all surgical services, ICUs, the emergency department, radiology, nursing, and so on. This committee meets monthly and we review surgical cases that have opportunities for improvement. There's a great participation and open dialogue at these meetings. It's really brought our surgical services together, so we're not acting in silos anymore and we work well together. We also review relevant data pertaining to patient care at these meetings and we've had great success with our PIPs committees. Verification is required every three years. And so, this involves completing our application process, which provides documentation on how our organization meets the required standards. And it also involves surveyors coming on site to do an on-site visit for two days. The Dallas campus just received or did receive their initial verification in 2020 and has been re-verified, as you said, and the Plano campus just received their first verification as a Level II campus.

Host: The PIPS Committee sounds really exciting. I mean, the, overcoming silos within healthcare organizations is a huge feat for you to be able to do that. Can you expand a little bit more about the Plano campus? I mean, what's the certification that they received and why is it such a milestone?

Michelle Matthews: So, like I said, the Plano campus received their Level II verification and this is a great achievement for the Plano campus. It's the first American College of Surgeons Children's Surgery verification for a pediatric hospital in the northern market. So, this is a huge milestone for them and for the Northern Market patients.

As they grow and expand at the Plano campus, this achievement shows our commitment to providing the best surgical care for the Northern Market patients. Families will be able to now feel confident that bringing their child to the Plano campus, they'll be receiving the safest and most competent surgical care.

Host: It's absolutely phenomenal and wonderful for patients and families alike. Dr. Alder, from a pediatric surgeon's perspective, why are these certifications so important?

Adam Alder, MD: There's multiple reasons why these are important for a hospital. To me, the probably first and foremost is thinking from a patient's perspective. If I put myself in the thought process of a new family moving to an area and then having a child that needed care, and I think, "Okay, how am I going to figure out where to go?" There's marketing, you know, you've driven through the city and seen advertisements for this place has this. You might talk to your pediatrician. But how do you really know where the resources are available to take care of whatever problem your family has? And that's where an organization like the American College of Surgeons can create a program that's specific for the care population that we're talking about, pediatrics. And they can then go as a third party and verify that that center, that hospital, that surgery center, whatever, they've got the resources to care for my family in a safe and high quality way.

So again, for me, I think that patient's perspective is probably the first and foremost. Now, as a surgeon, when I talk to families, I am commonly asked questions like, "Is this the best place to get this done? Where should we go for the safest kind of care?" And I can tell them without any qualms, "Hey, The American College of Surgeons, which everyone's heard of, they verified us as having the resources that are required to safely care for your family. And we review all of our cases and push to make sure that the quality is as good and as high quality as we can make it.

Speaking about those PIPS Committee meetings, that's where the real work gets done in this program. That's where we have conversations where maybe something happened on the cardiac service or on the ENT service, but it's an important lesson for me that's going to affect the care of patients I take care of. Because we've broken down those silos, it's a great way for those lessons to get to the entire hospital staff and affect the care we provide at all the hospitals. And so, participating in a program like this and having a hospital system that's committed to providing those resources, it has really been a great opportunity for us to provide high quality care to families in this region.

Host: Yeah, that's absolutely terrific. It really is. So, as a pediatric health system, how does having these certifications really raised the bar for surgical care overall?

Adam Alder, MD: The American College of Surgeons, when they created this program, they were trying to wrestle with a couple of different competing interests. I think that there's a component of what it means to be a pediatric surgeon. We work on some of the most rare and infrequent types of problems that exist in medical care in the country, right? So, something that only happens once every few years among millions of people. And so, as they considered, how do we safely create a program that allows families to know where to go for care, but also allows people to get care in a place that's not that difficult to get, right? So, it's this contrast between accessibility, regionalization, and then ensuring high quality. So, they created this hub and spoke type model. And as the first system to have a Level I and a Level II, we're sort of demonstrating that that's a really viable way to set things up. So, as a surgeon, I know at a Level II that maybe the most complex patient isn't best to get care here at my facility, but I've got a relationship with a Level I where they'll absolutely get the best care. But not everybody needs to go there, right? I don't need to uproot every family that needs high quality care, even for a relatively complex patient. Because the resources are available here, we can care for those families, and they can stay at home, and they can come in to visit their family member. So, I think that's really the key thing that participating in the program brings to the system and specifically to the Plano campus.

Host: That's really, really just amazing work. Now, earlier you mentioned that cases are reviewed. So, does Plano have a standardized method for reviewing cases and processes? And how does this help streamline that coordination you were talking about and communication across the perioperative service?

Adam Alder, MD: Yeah, it's been a real revolution in Medicine over the past 20 years. I think if you look at the experience at the College of Surgeons or even just at a hospital, I did my residency, finished 15 years ago and then did my fellowship and started on the faculty in 2012 here in Dallas at UT Southwestern. We always ran a morbidity and mortality conference, but it was always just within the department or within the specific division. As this concept of value care has spread around, meaning not just how much does stuff cost, but is the stuff we're buying the best stuff available? And so, weighing quality and cost to create this value equation that's been really taking on a much bigger importance in the last 10-15 years.

Now, people, being as smart consumers of medicine, they're being much more proactive about trying to identify things like, "Hey, where is the place to get quality?" So, your specific question about how do we review cases, or why do we do that, people are smart now. They know that just going to any place because the facade on the building looks fun and nice, that's not really where the tires meet the road anymore. And so, we have multiple processes to try to identify events where we think care could be improved. And those processes include hospital system-based things where we have different committees. We have infection control committees. We have individual service lines or divisions and departments that run their own quality processes. All of those things report up through the structures into this PIPS Committee. And so, the structure within that committee allows us to review input from all of those streams.

Michelle mentioned that we participate in a National Surgical Quality Improvement Program. That actually started at the VA, but the college took it over a few years ago. And that's another way in a really standardized methodology that allows us to review specific events and specific cases. Now, what's interesting to me is the program, this Children's Surgery Verification Program that we've been talking about today, it actually mandates review of very specific kind of high-risk or high-impact events. And so, as we are able to then review our experience and what's happening in each of those events, we're able to get the lessons that we've learned from reviewing those and get them out to the people who are doing the work for the patients in that one on one way.

And so, this revolution, this quality revolution has really taken the hold of kind of everything we do. And so, there's not many days I don't spend some time at least, and usually a lot of time thinking, "How does this affect how we're running things in the hospital? How does it affect the quality? What lessons can we learn? And then, how do we get those lessons out to people so that, 'Yeah, it affected me and a patient of mine, but it's going to help you and a patient of yours?'"

Host: Yeah, I think that that's phenomenal. And then, and being able to maximize that coordination. And I think that you point out something that's true in lots of healthcare organizations, is that there's a lot of behind the scenes coordination that happens that impact the patient more in an indirect way. So, I think that it's great work that you're doing. So, is there anything else that you'd like to share as we kind of get through?

Adam Alder, MD: Yeah. There's one thing I wanted to bring up. I think many of us are used to having a facility where-- and this is how things are set up in Dallas. UT Southwestern is pretty much the employer of almost all the physicians that work at that campus. And UT Southwestern, as an internationally recognized, high-quality medical provider and research center. We've got six Nobel laureates and all that. There's a tremendous amount of infrastructure to do this quality work. What's different about the Plano campus, and this is where we've really had to be creative and think outside the box, and this is where Michelle's really been a fantastic partner as we've worked through this. It includes UT Southwestern faculty, but it also has this open staffing model that allows anyone who meets the criteria for credentials to come and work on the campus, and so we have multiple private providers.

In human nature, being the way it is, if UT Southwestern is one employer comes in and says, "Hey, we need to do it a certain way." You know, there's a little bit of pushback with that. Something like this program where it's not me, it's not UT, it's not the private folks. It's not even Children's. This is the American College of Surgeons and the optimal resources for children's surgical care that's requiring we act in a particular way, we report in a particular way, we think about quality in a particular way. So, what attaining this verification at one hospital in this region has done is it's really raised the level of all of the care that's being provided in this region, because everybody knows this is the standard. And so, that's been a really hugely impactful thing as it relates to working in this community and providing optimal care for children right here at home.

Host: No, it all sounds incredible. Really great work. Thank you to both of you so much for your time with us today.

Adam Alder, MD: Thanks.

Michelle Matthews: Thank you.

Host: And to our audience, thanks for listening to Pediatric Insights, Advances, and Innovations with Children's Health, where we explore the latest in pediatric care and research. You can find more information at childrens.com. And if you found this podcast helpful, please rate and review or share the episode. And please follow Children's Health on your social channels.