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Pediatric Orthopaedic Practitioners Society POPS

Question from member Leslie Rhodes

Posted over 2 years ago by Suzanne Hilt

Which facilities send non-complicated, healthy, AIS PSF patients from OR to PACU to a med-surg floor? We are currently revising our post-op pathway to include admission directly to the floor and have had some concerns come up with administration. I would like to see how other facilities handle these patients to show our administration that it is safe and effective. Any input is greatly appreciated!

Leslie Rhodes, DNP, PPCNP-BCPediatric Nurse Practitioner

Division of Orthopaedic Surgery

Le Bonheur Children's Hospital

Memphis, TN


Susan Laham about 2 years ago

We used to send all of our patients to the PICU but now almost all go straight to the floor. Some neuromuscular kids, some of our bleeding disorder kids, or any kid with a larger than average blood loss will go to the PICU. We have only had 1 kid transferred from the floor to the PICU in the last year and that was due to respiratory depression, mostly due to narcotics.

Sue Laham, MS, PA-C
Helen DeVos Children's Hospital
Grand Rapids, MI

Hi to Jeff!

Colleen Ditro about 2 years ago

We send all ours to the floor

Denise Lopez about 2 years ago

we send all ours to the floor as well barring complications or co-morbidities.

Kathleen Doyle about 2 years ago

Hi, at Boston Childrens, all of our healthy AIS PSF go right from the PACU to the floor on "protocol" for the first 12 hours, which requires more frequent vital signs and monitoring.

Sharon Farrell about 2 years ago

Children's Hospital of Philadelphia: all of our healthy AIS patients go to the floor (as long as they are having no post op complications).

Tracy Curtis about 2 years ago

UCSF: healthy AIS patients go to our transitional care floor (between PICU and med/surg) due to q2h neuro and vitals check per our hospital protocol. we'd love to send directly to our med-surg ward but we've run into some roadblocks with that. we only send to the PICU if there are complications or significant comorbidities

Lyndsey Battaglia about 2 years ago

Hi! At AFCH in Madison, WI we are now sending all AIS PSF pts to our universal care unit and have 1:1 staffing with closer monitoring overnight.

Suzanne Hilt about 2 years ago

We used to send all of our AIS patients to the PICU for one night but we changed it 1-2 years ago. Now we only send the AIS kids to the PICU if they have some comorbidity such as bad pulmonary dz. Our patients have done very well going straight to the floor and we have not had any issues. Suzanne

Leslie Rhodes about 2 years ago

Thank you all for your input! It helps being able to go to administration with what other facilities are going straight to the floor. We have developed what our "protocol" will look like but if anyone is willing to share your protocol, that would be very helpful. We have Atlanta's and Children's Hospital of Los Angeles.

Thank you all again!

Amanda Mccullough about 2 years ago

Leslie, we in Jackson, MS just rolled out this new protocol this past summer. There were a lot of meetings between admin and our surgeons. Our admin seemed to like the idea bc the PICU's are usually at capacity alert during the summer, and this helped free up some of their beds/better utilize resources.

There were numerous exclusion criteria for a healthy AIS: received more than 1U PRBC or 1U FFP, had any neuro changes intra-op, MAP <60 at closing, etc.... that would make the patient have to go to the PICU for closer monitoring at least overnight.

We met with our med/surg staff and manager prior to rolling this out to get their feedback, and address concerns. Our spines had to be 3:1 on the floor so we had to have support for increased staffing from the manager and admin. We also required Q2 vitals/neuro checks which is not customary for the floor but for this specific population, it was allowed.

We also got our peds hospitalist team to follow along those first 24 hours to help the night call team with boluses if they were stuck in a trauma etc and weren't readily available.

We had a great success this past summer but it was definitely a team effort and admin has to buy into it. We looked at some data this past summer (LOS, blood loss, lowest BP, MAP at closing) and we really stuck to the protocol and had no adverse effects.

Amanda Mccullough about 2 years ago

**MAP<60 at closing is that that is supposed to say in previous message!

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