102 - Pediatric Pelvis Surgery: A Coordinated, Multiphase Approach Across Institutions

Description: Managing complex pelvic fractures in pediatric patients presents unique challenges, particularly when surgical intervention must occur at an adult trauma facility. This presentation outlines a coordinated, step-by-step approach to pediatric pelvic surgery that spans multiple institutions, emphasizing seamless transitions through every phase of care.

Care is delivered across two primary sites: the Children's Hospital and the Adult Trauma Hospital. At the Children's Hospital, the care team includes the primary nurse, charge nurse, and pediatric medicine providers. Upon transfer, the Adult Trauma Hospital team — comprised of the Orthopedic Surgery Coordinator, preoperative nurses, perioperative nurses, PACU staff, anesthesia providers, and orthopedic trauma surgeons — ensures surgical intervention is safely and efficiently executed.

Preoperative planning hinges on robust interdisciplinary communication. Early coordination among pediatric and adult teams is vital to align logistics, anticipate complications, and ensure continuity of care.

Distinct care phases were identified — from initial consult and stabilization to transport, intraoperative management, and eventual transport and arrival to the pediatric facility. This phased model allows for structured assessment and quality checkpoints throughout the patient's journey.

On the day of surgery, coordination begins with the pediatric patient being transported from the Children's Hospital unit via ambulance to the Adult Trauma Hospital. Simultaneously, the perioperative team is executing parallel preparations. In the preoperative holding area, the receiving team assesses the patient and initiates safety checks. Meanwhile, the operating room staff prepares the surgical suite, ensuring all specialized instrumentation and implants required for complex pelvic fixation are present, sterile, and ready for use. The anesthesia team, trained in pediatric care, evaluates the patient and prepares for induction, carefully anticipating age-specific needs and potential complications associated with pediatric pelvic surgery. Once all preparations are complete and the patient is deemed ready, the surgical team transitions the patient into the operative suite for the procedure. Following surgery and extubation, the patient is transferred to a designated PACU space equipped for pediatric care. A pre-assigned recovery team, briefed on the patient's unique needs, ensures a safe and smooth postoperative course until the patient is transported back to the Children's Hospital for ongoing recovery and care.

Through this collaborative model, pediatric patients receive timely, expert surgical care for complex pelvic injuries. Post-case debriefs between institutions interdisciplinary teams are used to evaluate outcomes and refine workflows for continuous process improvement.

Perioperative nurses play a pivotal role in anticipating patient and procedural needs, especially when coordinating care across institutions. The ability to proactively prepare for both surgical procedures and potential complications is essential in optimizing outcomes for this vulnerable and unique patient population.