Over the summer, the American College of Surgeons (ACS) Children's Surgery Verification (CSV) program announced the release of the second version of its Optimal Resources for Children's Surgical Care manual. The updated standards are intended to ensure programs can achieve a high level of continuous quality improvement for children's surgery patients from when they first enter a hospital setting until they are discharged.

The updated standards detail principles regarding hospital resources, quality improvement and safety processes, data collection, and the verification process. The CSV program evaluates three levels of care, aligned to the standards and expected scope of practice at the pediatric hospital.

The revision process, which began in 2019, aimed to identify new standards that would provide direct benefit to patients, clarify standards that were not achieving the intended result, and ensure that standards resulted in improved patient care. The latest version of the manual incorporates specialty hospital standards, a verification process overview, and the criteria quick reference guide, as well as the required Children's Surgery Safety Report. As a part of the new standards, centers seeking verification at all levels will be required to develop detection and reporting processes for all adverse events that occur in children's surgery and develop a process for improvement and prevention. Through compiling this data, centers will gain a better understanding of the overall quality of care in determining strengths, limitations, and costs of detection methods to be improved as the program evolves.

"The purpose of the revision was to incorporate all the lessons that we've learned from the more than 35 sites that have already been participating in the program," said Douglas C. Barnhart, MD, FACS, MSPH, Chair of the Children's Surgery Verification Committee. "What we did was try to take the lessons learned and incorporate them into consolidated standards, including more inclusive education standards, the catalyzation of optimal care, and incorporating specialty hospitals into the standards."

As a part of the revision, education standards have been clarified for non-academic hospitals in an attempt to remove barriers around education and research requirements for verification. Level I will continue to be a community resource, however, alternative pathways to verification have been created in order to accommodate hospitals without resident and fellow training within the department of surgery.

Additionally, the new standards set into place new expectations for patient care. Under the new standards, sites must utilize comprehensive clinical pathways that facilitate the standardization of patient care. Clinical pathways are a sequence of orders and therapies describing the routine care for patients from initial evaluation through long-term follow-up. The new patient care standards include new stewardship programs on opioid, perioperative antibiotic, and anesthesia use.

The revisions are based on the Nine Standards for Optimal Care (see box) that provide a uniform standard across all ACS quality programs while allowing variation within the individual ACS accreditation and verification Programs. The nine core standards reflect the most important resources for quality and safety and each of these standards include vital areas to be accessed in the ACS Accreditation and Verification Programs.

"Historically, the program had two major emphases: optimal resources and the ability of a center to recognize when they had a problem and create a performance improvement plan to demonstrate that they could close the loop to prevent future problems," said Barnhart. "These second version standards really bring in a much more specific standard, specifically around what good patient care looks like. These new standards begin to move us towards, not just what an excellent hospital looks like, but toward more excellent patient care."

The new manual was published on July 6 of this year, but the standards will not go into effect until July 1, 2022. All site visits after this date will be assessed under the new standards.

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Optimal Resources for Children's Surgical Care

Nine Standards for Optimal Care