The American College of Surgeons has issued new standards aimed at ensuring surgical facilities achieve optimal outcomes in young patients by meeting the medical, emotional and social needs of children and infants.

The standards categorize facilities by level of resources, similar to the classification of trauma centers:

• Level I facilities are at the highest level of preparedness. They're equipped to perform complex and non-complex procedures on children of all ages, are staffed around the clock with credentialed pediatric surgeons, anesthesiologists, radiologist and ER docs, and have Level IV NICUs.
• Level II facilities are capable of providing advanced care for children of all ages, including those with comorbid conditions, typically in a single surgical specialty. A certified pediatric surgeon, anesthesiologist and radiologist must be on staff, with other pediatric specialists available for consultation. Facilities must have a Level III or higher NICU and be able to stabilize and transfer critically ill children to a hospital with higher-level resources.
• Level III facilities have the resources to perform common, low-risk procedures in otherwise healthy children older than 1 year. A general surgeon, anesthesiologist and emergency physician with pediatric experience must be on staff. These facilities must have a Level I or higher NICU and be able to stabilize and transfer critically ill children to a hospital with higher-level resources.

Additionally, all facilities hosting pediatric patients must have at least 1 pediatric surgical nurse on staff, must develop a pediatric rapid response team that's available at all hours and have an in-house physician certified in Pediatric Advanced Life Support. They must also be equipped for the resuscitation of pediatric patients in all clinical care areas.

Ambulatory surgery centers are held to additional standards: They must have pre- and post-op areas dedicated to the care of pediatric patients, and employ a pediatric anesthesiologist to administer and supervise general anesthetics or sedatives to all patients younger than 1 year.

The standards were developed in conjunction with the American Pediatric Surgical Association, the Society of Pediatric Anesthesia and the Task Force for Children's Surgical Care.

Daniel Cook