Editor’s Note: Jenny is the mother of two children with special healthcare needs and a Patient and Family Advisor at her local children’s hospital. In addition to her lived experience, Jenny calls upon her professional experience as a social worker and ministry leader to help her write blogs from her home in Wisconsin. - Cara L. Coleman, JD, MPH, Associate Editor, Pediatrics
Family Connections with Pediatrics
When my daughter was just six weeks old, we found out that her spinal cord was stuck at the bottom. By the time she was six months old, we were frequent flyers at our children’s hospital and getting ready for major spine surgery.
On the day of the surgery, we took many pictures to someday share with our daughter. When we look back, what stands out the most is the wide range of people in those pictures: nurses giving kisses to her beloved toys, lab technicians singing silly songs, anesthesiologists telling us about the sedation process, and neurosurgeons answering our hard questions. For me, the day was a blur. But behind the scenes there were dozens of people working together to make sure our daughter was well cared for.
This month, Pediatrics is sharing a clinical report titled, “Comanagement of Surgical Pediatric Patients in the Acute Care Inpatient Setting” (10.1542/peds.2023-064775). Let’s take a closer look at this report to see how it impacts the patient and family experience when your child requires surgery.
What does “comanagement” mean?
In the past, children who had surgery in a hospital were taken care of by a small surgical team, with other experts brought in to consult on certain parts of the child’s care as needed. Now, hospitals are trying to have all providers work together as a care team with the family included as part of that team to manage the patient’s care. According to the report, this process of comanagement includes:
- Shared decision-making, responsibility, leadership, and follow through. For example, the care team and family should all give input to decide how best to care for the child’s pain, medicine, discharge plan, recovery, etc.
- Active participation from the care team and the child’s family. For example, each person’s role is equally important in the care of the child.
- Clear and consistent communication. For example, all on the child’s care team should be on the same page, working together toward a common goal.
Overall, the purpose of comanagement is to provide smooth, quality care using all the knowledge and skills available on the entire care team, including families.
What is in the report?
The authors asked 25 experts from around the country what they think a good comanagement program includes. This report shares their opinions, as well as some ideas to use when building or refining a comanagement program. Here are some of the best practices from the report for hospital leaders to consider as they plan for surgeries with pediatric patients:
- Find people in the hospital and the community who want to start a comanagement program.
- Make sure everybody understands the purpose of comanagement and the different roles.
- For each patient, create a comanagement team that includes doctors, nurses, social workers, therapists, primary care providers, and the child’s regular support network and family.
- Discuss the child’s care plan with the whole team, including the family. This includes setting goals, writing orders, making decisions, managing pain, and planning for transitions.
- After the surgery, ask the patient, family, doctors, and nurses how the experience went for them.
- Measure the success of the program, especially related to pain management and safety.
What can you do with this article?
Comanagement programs may look different, depending on the hospital location, the needs of the child, providers involved, and the available resources. However, one of the most important aspects of any comanagement program is the intentional involvement of patients and families. Here are some ways that you can use these best practices if your child requires surgery:
- If your child is getting ready for surgery, read this report and share it with your doctors. Ask them who will be a part of your child’s care team before, during, and after the surgery, and what role families play on this team.
- While in the hospital, do not be afraid to speak up if something seems off, or you are not sure why a certain decision has been made. Even if your hospital does not yet use a comanagement system for surgery patients, you are a vital part of your child’s care team, and your voice matters!
- After the surgery is done and you are back home, reflect on the best practices shared in this report and see if they match your experience in the hospital. Share feedback with your child’s care team leaders and think about how the process could be improved if your child requires future surgery.
- If you are part of an advisory board for your hospital, bring up this article and ask if they use a comanagement framework for surgery patients. If they do not, ask what steps can be taken to start moving in this direction.
