The Global Initiative for Children's Surgery (GICS) is composed of children’s surgical providers who passionately believe that every child deserves the best surgical care when they need it, without causing the impoverishment of their families.
The first GICS meeting took place at the Royal College of Surgeons in London, UK on 27-28 May 2016, and included 27 providers of surgical and perioperative care for children from 18 low- and middle-income countries. The aim was to identify solutions to problems in children’s surgery, drawing upon the expertise and experience of practitioners from around the world.
The second GICS meeting took place at the American College of Surgeons in Washington DC, USA on 7-8 October 2016. This meeting included providers from 40 different countries focused on addressing the gaps and priorities of the inaugural GICS meeting. While the working groups of the first meeting focused on identifying priorities for improvements in infrastructure, service delivery, training, and research, the aim of the second GICS meeting was to integrate was to define the outcomes of these working groups in terms of first, second, third, and national children's hospitals.
Four working groups of providers were then created to prioritize solutions to children’s surgical care. The priorities from the first day were refined on the second day, with a different group of participants. Consensus solutions included:
First Level Hospital:
Human resources should include clinical officers comfortable with resuscitation, screening for congenital anomalies and providing primary care for injuries, burns, and infections. Additionally first-level hospitals should include anesthesia providers comfortable obtaining intravenous access, airway management, and providing pediatric anesthesia for basic procedures.
Infrastructure requirements include a designated OR and a referral system with ambulance capabilities.
Training at a first level hospital should focus on recognizing basic surgical conditions, practicing resuscitation for emergency cases, and a focus on appropriate transfer of patients to a higher level when indicated.
Research objectives should include prevalence of surgical conditions in the community, epidemiology of injury, and the development of surgical indicators.
Second Level Hospitals:
Human resource requirements at second and third level hospitals should include an anesthesia provider and general surgeon with some pediatric experience.
Infrastructure requirements include the ability to provide radiology and ultrasound services, blood banking, some critical care capacity and efficient transportation for transfer.
From a research standpoint these hospitals should employ dedicated data collection personnel in order to track surgical case volume and patient outcomes.
third level hospitals:
Human resource requirements should include a trained pediatric surgeon, trained pediatric anesthesiologist, and a nursing staff with pediatric experience. Additionally, hospitals at this level should employ a pathologist.
From an infrastructure perspective, third level hospitals should include fluoroscopy, neonatal and pediatric intensive care, the ability to provide parenteral nutrition, and necessary infrastructure for multidisciplinary patient management.
Third level hospitals should employ personnel for both data collection and data management. In order to assist providers at third level hospitals in the collection and analysis of data.
National Children's Hospital
- The national children's hospital should provide support for other hospitals within the health system to meet the minimum requirements for each level outlined above.
- The national children's hospital should employ physical resources that not only include specialized fields such as palliative care and specialist surgery, but should ensure that the other hospitals within the health system are aware of the types of patients that warrant referral.
- National children's hospitals should be physically part of a larger national hospital,and affiliated with a university. Despite these recommended affiliations the hospital should retain administrative autonomy.
- The national children's hospital should serve as an accrediting body for other hospitals within the health system.