When some families walk into Aurora-based Children’s Hospital Colorado’s Center for Children’s Surgery, they are met with surgeons, anesthesiologists — and now, psychologists.
The hospital is transforming the way it delivers surgical care by embedding psychosocial providers — psychologists, social workers and child-life specialists — into select surgical teams. The aim of the initiative is to reduce the mental strain of surgical procedures on children. The program first screens families before surgery, then offers interventions and resources and, finally, follows patients for up to two years afterward to measure recovery and quality of life.
Cindy Buchanan, PhD, director of surgical psychology and behavioral health, told Becker’s the initiative began in a few specialty areas, such as bariatric and transplant surgery, where national guidelines already called for psychosocial evaluation. But as families and surgeons saw the benefits, the program expanded to the Center for Children’s Surgery, she said.
“Ultimately, our goal is to have a comprehensive behavioral health team on every single one of our surgical subspecialty teams so that we can do this proactive, preventative work and support kids along their journey, during their surgical recovery,” Dr. Buchanan said.
The presurgical checklist includes completing psychosocial screenings and patient-reported outcome measures — including the National Institutes of Health Promis 25 profile — to identify risk factors, whether they are emotional, behavioral or social challenges that might complicate recovery, she said.
Then, concerns are addressed through the implementation of behavioral strategies, such as guided imagery and deep breathing, brief interventions or cognitive-behavioral strategies before surgery, she said. Throughout this process, families meet with specialists as needed and are connected to the hospital’s behavioral health team or community resources for a continuum of care.
In the colorectal center, the behavioral health providers attend rounds, discuss upcoming surgeries with the medical team and provide screening tools to families, she said. This gives the team an opportunity to connect individually with patients and identify concerns prior to surgery.
“[Surgeons] partner with the psychologist on the team to say, ‘Are there some things that we can do in advance of their surgery to make sure when these kids come in, that we’re reducing their medical trauma and we’re supporting their coping with the procedures?’” she said.
Dr. Buchanan is seeing results in her pediatric urology pre-op clinic where the team is also integrated.
“Kids that go through this process and have this partnership have a shorter length of stay in the hospital. They have less reported pain symptoms post-operatively and kids are going home with less opioid for pain management,” she said.
To track outcomes, the hospital is developing a dashboard that links behavioral and surgical metrics, including pain interference, functionality and length of stay.
“The build of the dashboard was a big feat,” she said. And in six months, she hopes to have “more data than anybody’s going to have available to them in this space.”
The hospital’s surgical departments have contributed financial resources and time to sustain the embedded behavioral health staff, which she said reflects the strong buy-in from surgical leadership.
A steering committee — composed of surgeons, advanced practice providers and psychosocial providers — drives the vision of the project forward and provides a model for other teams to follow.
Dr. Buchanan said her long-term vision is for the program to set a new benchmark for pediatric outcomes. “It’s not about recognition,” she said. “It’s about helping kids heal better and live healthier lives after surgery.”
