Multidisciplinary Quality Improvement in Pediatric Surgery

Project start and end dates: 2018 – 2022

Background:
Postoperative opioid exposure poses significant risks in children. Variation in prescribing practices was common.

Objectives:

• Reduce postoperative opioid utilization
• Engage families in pain assessment
• Develop multidisciplinary prescribing guidelines

Research Topics & Methods:

• Quality improvement methodology
• Family-reported outcomes
• Multidisciplinary guideline development

Implications:
Led to reduced opioid exposure and informed institutional pain management standards.

Funders:

• Blue Cross Blue Shield (BCBS)

Collaborators:
Surgery, nursing, psychology, social work, patient-family partners.

Key Publications:

• Vargas GM, Gunaseelan V, Upp L, Deans KJ, Minneci PC, Gadepalli SK, Englesbe MJ, Waljee JF, Harbaugh CM. High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Ann Surg. 2023 May 1;277(5):761-766. doi: 10.1097/SLA.0000000000005193. Epub 2021 Aug 27. PMID: 38011505.
• Harbaugh CM, Vargas G, Sloss KR, Bohm LA, Cooper KA, Thatcher AL, Zopf DA, Chua KP, Waljee JF, Gadepalli SK. Association of Opioid Quantity and Caregiver Education with Pain Control after Pediatric Tonsillectomy. Otolaryngol Head Neck Surg. 2020 May;162(5):746-753. doi: 10.1177/0194599820912033. Epub 2020 Mar 24. PMID: 32204656.
• McGee LM, Kolli A, Harbaugh CM, Howard RA, Englesbe MJ, Brummett CM, Waljee JF, Gadepalli SK. Spillover Effect of Opioid Reduction Interventions From Adult to Pediatric Surgery. J Surg Res. 2020 May;249:18-24. doi: 10.1016/j.jss.2019.11.021. Epub 2020 Jan 6. PMID: 31918326.
• Harbaugh CM, Vargas G, Streur CS, Li GY, Thatcher AL, Waljee JF, Gadepalli SK. Eliminating Unnecessary Opioid Exposure After Common Children's Surgeries. JAMA Surg. 2019 Dec 1;154(12):1154-1155. doi: 10.1001/jamasurg.2019.2529. PMID: 31483452; PMCID: PMC6727673.