{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:58:47Z","timestamp":1790816327414,"version":"4.1.0"},"reference-count":34,"publisher":"American Academy of Pediatrics (AAP)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                    <jats:p>We observed an increase in emergency transfers (ET) among post-operative patients at our health system\u2019s largest free-standing children\u2019s hospital. We aimed to reduce ET rates by 50%\u2014from 0.21 to 0.11 events per 10\u2009000 post-operative days\u2014on our 72-bed inpatient surgical unit within 1\u00a0year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Over an 8-year period\u20144\u00a0years of baseline and 4\u00a0years of intervention\u2014we included 17\u2009221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10\u2009000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/hpeds.2025-008778","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:02:12Z","timestamp":1784592132000},"page":"839-849","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Hospitalist Assisted REcovery 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