THE DEMOGRAPHICS OF INPATIENT PEDIATRIC ANESTHESIA - IMPLICATIONS FORCREDENTIALING POLICY

Study Objective: To examine the demographics of inpatient anesthesia c are for infants and children in a specific region to determine if ther e were sufficient numbers of procedures to permit credentialing to tak e place, as a first step in understanding the consequences of implemen ting credentialing policies based on caseload. Design: Retrospective c omputerized review of discharge abstracts. Setting: All hospitals in n orthern California. Measurements and Main Results: Surgical procedures and date of surgery were linked to create ''procedure-days.'' Each pr ocedure-day counted as one anesthesia case. Annual hospital caseloads (procedure-days) were tabulated for three separate age subgroups under six years of age. The proximity of hospitals with smaller surgical vo lumes to those with larger volumes was determined. Of the 205 hospital s in the region, 162 had at feast one procedure-day for children less than 6 years of age for a total of 14,435 procedure-days (anesthesia c ases). For each of three age groups studied-0 to 6 months, 7 to 24 mon ths, and 25 to 72 months-85%, 90%, and 81%, respectively, of hospitals had caseloads of 1 to 50 per year. When procedure days from all three age groups were totalled, 59% of hospitals had less than 20 cases per year and 72% of hospitals had less than 50 cases per year; 86% of hos pitals had less than 100 cases per year. Of hospitals with less than 1 00 cases per year, 75% were within 50 miles of a hospital with more th an 100 cares. Conclusions: Performance based credentialing for pediatr ic anesthesia based on caseload may be problematic for many hospitals due to the distribution of cases: a majority of hospitals care for a f ew children, and most children are cared for in a few hospitals.