BestPractice
February 5, 2016

“High-value care” may be a buzz phrase, but to the children treated in the new surgical extended care unit (SECU) at All Children’s Hospital and their parents, it translates to a superb care experience that gets kids home faster — much faster, in many cases.

The SECU has reduced average length of stay from 30 hours to 14 for low-complexity patients, such as those getting a tonsillectomy. It frees up hospital beds for the acutely ill kids who need them. It uses fewer nurses than the post-anesthesia care unit (PACU), saving costs. And most important, it has won enthusiastic praise from parents.

Open since July and consisting of 12 beds in previously unused PACU space, the SECU is designed for patients who need more than four but less than 24 hours after surgery to be ready for discharge, says Jonathan Ellen, president of All Children’s Hospital, part of Johns Hopkins Medicine. “Some of our patients were staying 24 to 48 hours as inpatients when they could have been sent home much earlier,” he says. “That was not patient-centric, and it was inefficient. The success of the SECU demonstrates that if you do the right thing for the patient, you can create value.”

Discharge When the Child Is Ready

Children undergoing tonsillectomy, adenoidectomy and other relatively simple surgeries can sometimes go home soon after waking from anesthesia. But some require longer to recover. Admitting them is costly and unnecessary, and may require a child’s parents to miss an additional day of work.

Says Brigitta Mueller, the hospital’s vice president of medical affairs: “We realized that these patients could go home sooner if we focused on them, but that is difficult in an acute care unit. The SECU allows that focus.”

The unit handles about 25 patients a week and is open from Monday morning to Saturday afternoon. Children and their families stay in individual bays separated by privacy curtains. Discharges happen around the clock. “We will discharge a child at 11 p.m. if that child is ready to go home,” says Tracy West-Grubb, quality advisor on the project. “The parents are grateful to have the child home and sleeping in his or her own bed.”

Most patients are identified as SECU candidates before they enter surgery, although occasionally a child in the PACU who is taking longer to recover postoperatively than expected will be moved to the SECU, says emergency medicine specialist Joseph Perno, the physician lead on the project.

The SECU is staffed by physicians, nurses and other care providers from the Emergency Department and from surgery. The bed-to-nurse ratio is 1-to-6, whereas the PACU has a 1-to-4 ratio. Direct-care costs have dropped from $2,015 to $1,506 for low-complexity patients treated in the SECU versus the PACU. And family satisfaction as measured in surveys remains very high, at 98 percent.

“The impetus behind the unit’s creation was the principle of treating patients in the right bed in the right care and cost setting,” says Roberta Alessi, vice president and chief operating officer for All Children’s Hospital.