How level I children’s surgery verification is improving outcomes for children

Over the past two decades, there has been an exponential increase in the number of pediatric surgical facilities in the U.S., which has created a substantial problem. With so many available centers, how can patients, their families and providers feel confident that the hospital they select will provide the best surgical care? The American College of Surgeons developed the Children’s Surgery Verification Program to provide clarity on this issue – and Children’s Medical Center recently became the first children’s hospital in Dallas to receive a Level I Children’s Surgery Verification.

The Surgery Verification Program verifies the capabilities and expertise of pediatric hospitals – designating a facility as Level I, II or III – and requires the hospitals to practice standardized quality improvement and data collection processes to track, review, and ultimately, improve overall pediatric clinical care and surgical outcomes. Children’s Medical Center Dallas was required to meet 269 stringent standards to become a Level I surgery center.

“Now patients, their families and providers can feel confident that we’ve met the most rigorous standards to deliver the highest level of care for all pediatric surgery patients – from the most complex cases to common conditions,” says Dai Chung, M.D., Surgeon-in-Chief and Chief Medical Officer of the Joint Pediatric Enterprise for Children’s Health℠ and UT Southwestern.

Raising the Bar on Pediatric Surgical Care

The Children’s Surgery Verification Program was developed based on other quality and patient safety programs by the American College of Surgeons. These programs, such as the Pediatric Trauma Verification Program, have been successful in measurably improving patient outcomes nationwide.

To become a Level I Children’s Surgery Center, Children’s Medical Center Dallas had to meet standards that include having highly qualified expertise from every perioperative specialty, as well as pediatric emergency medicine physicians and anesthesia services available at all times. Additionally, a Level I center must have a Level IV (highest designation) NICU and a PICU that provide highly coordinated clinical care to infants and children with complex critical care needs.

As a leader in pediatric surgical care, Children’s Medical Center Dallas met these essential requirements, among many others before beginning the verification process. Level I centers are also required to implement a standardized system to collect real-time patient data and use that data to guide quality improvement initiatives.

“We saw that as an opportunity to raise the bar even higher for the surgical care we provide, and to set an example for other centers to follow,” Dr. Chung says.

Data-Driven Multidisciplinary Collaboration

Children’s Medical Center Dallas established an electronic system to log all surgical and procedural cases and categorize the outcomes based on four levels. In the one-year time period for the verification, the team logged more than 26,000 surgical cases to identify trends and opportunities for process improvements.

“We’re a large academic institution with 18 perioperative services, and we’ve always had a multidisciplinary collaboration for personalized clinical care,” Dr. Chung says. “But this verification program has allowed us to use data and insights to collaborate on processes that improve all perioperative service lines. We’re not operating as silos. This is an organized, department-wide effort to help everyone be the absolute best at what they do.”

Every month, there’s a multidisciplinary group that meets solely to review the case data. The group includes representation from every perioperative service as well as the emergency department, PICU, NICU and our transport services.

With this monthly meeting, all providers who serve surgical patients can give their input on specific cases and collectively discuss better ways to implement processes and protocols.

“Of course, we’re tracking the outliers and reviewing those cases in-depth, but we’re also tracking the cases with the best outcomes,” Dr. Chung says. “There’s always an opportunity to improve, or for other disciplines to learn processes that are working well for partnering surgical services.”

This standardized way to review cases and processes has resulted in better coordination and communication across perioperative services.

“There’s a greater understanding across disciplines and we’re able to spot opportunities to improve and take action faster,” Dr. Chung says. “For example, we’ve seen a measurable improvement in the time it takes for a patient to go into surgery. That’s a direct result of clearly analyzing the data and coordinating together to change processes for the betterment of patients.”

Becoming a Level I Children’s Surgery Center during a pandemic

After implementing the quality improvement and data collection processes for 12 months, the next step to earn Level I Children’s Surgery Verification was to have a site visit from the American College of Surgeons. Since that site visit was scheduled in December 2020, in the heart of the pandemic, Children’s Medical Center Dallas was selected to be the first facility to complete a virtual site review.

For two days, Dr. Chung and his colleagues gathered in virtual meetings with American College of Surgeons surveyors, walking them through the hospital and reviewing the 269 standards in place.

“The virtual visit added some logistical challenges, but we were determined to achieve this verification to improve the processes that help us provide the best care,” Dr. Chung says.

Improving Care Today and Tomorrow

general surgery photo

The Children’s Medical Center Dallas Perioperative Services include more than 60 renowned surgical and procedural specialists, who are also on the faculty at UT Southwestern, as well as the entire perioperative team – anesthesiologists, pediatricians, pediatric specialists, intensivists, radiologists and nurses.

An IT team and administrative staff support the providers with the infrastructure that makes it possible to continuously identify and implement department-wide improvements.


“With the processes we put in place through the verification program, we’re working together more effectively than ever before to provide seamless care,” Dr. Chung says. “We’re seeing, in real-time, that these processes are helping us provide the best possible outcomes. And these processes will help us continue to improve over time.”

Learn more about our Level I Children’s Surgery Center >>

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