American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

About Children’s Surgery Verification


The American College of Surgeons (ACS), in collaboration with the Task Force for Children’s Surgical Care, developed standards to improve surgical care for children surgical patients. These standards have led the development of the Children’s Surgery Verification Program and are the nation’s first and only multispecialty standards for children’s surgical care.


To improve the quality of children’s surgical care by creating a system that allows for a prospective match of every child’s individual surgical needs with a care environment that has optimal pediatric resources.




In 2013, the Task Force for Children’s Surgical Care was created with the support of the ACS. The task force was composed of a multidisciplinary group of leaders in children’s surgical care and participation of ACS leadership. The group assembled in-person to develop standards on four different occasions. This effort was driven by the observation that while children’s surgical care delivered today is often excellent, quality can be inconsistent. Suboptimal outcomes do occur periodically and perhaps systematically related to a mismatch between an individual child’s needs and institutional resources.


The focus of the task force was to develop optimal resource standards to yield improvements in outcomes associated with children’s surgical care. These standards were based on published evidence when available and expert consensus when not. The task force concluded its work following the initial draft of the standards document in late 2014. These standards were supported by the American Pediatric Surgical Association and the Society of Pediatric Anesthesia. This document went through substantial and detailed revision subsequently, incorporating input from across the provider and institutional spectrum. Following the release of the draft standards document, a pilot phase was launched in the spring of 2015. The final standards document Optimal Resources for Children’s Surgical Care was published on the ACS website in December 2015.

Pilot Phase

The pilot launched in April 2015. The six volunteer pilot centers were diverse organizations that expressed an early interest in undergoing the pilot process: three of these centers were freestanding children’s hospitals, two were hospitals within hospitals, and one was a potential Level II center. Pilot site visits were conducted by members of the Verification Committee and four additional surveyors. The pilot surveyor teams consisted of between two to four children’s surgeons, a pediatric anesthesiologist, and, at times, a pediatric nurse. The information derived was used to help finalize the Optimal Resources for Children’s Surgical Care document. The lessons learned during the pilot phase and the standards document are the basis for a Pre-Review Questionnaire, which serves as the data collection platform and application for the ACS Children’s Surgery Verification Program. The pilot phase concluded in 2016.

Program Launch

In January 2017, the ACS CSV Quality Improvement Program officially released its verification program with the goal of ensuring that pediatric surgical patients have access to high‐quality care. The CSV program is administered by the ACS and the ACS CSV Verification Committee and offers institutional verification to sites that meet the prescribed standards. The CSV program evaluates three levels of care, aligned to the standards and expected scope of practice at the pediatric hospital.

Specialty Hospital Option

In July 2019, the ACS CSV Quality Improvement Program officially released its specialty hospital option.  A children’s specialty hospital is defined as a children’s hospital that provides a limited range of services specific to various conditions or related to a specific disease process. Program leadership met with leaders from oncology and musculoskeletal specialty hospitals to assess how specialty hospitals can apply to CSV. The need for standards specific to specialty hospitals will be addressed by adjusting current CSV standards to fit the narrow scope of these specialty hospitals. The modified Level I standards will be applied and will allow specialty hospitals to apply to the CSV program and achieve a designation of Level I Specialty Oncology or Level I Specialty Musculoskeletal hospital.

Version 2021 Standards

Discovery for the second version of these standards began in fall 2019 with a re-categorization of the original standards into nine categories of standards common to all the ACS quality programs within the various accreditation and verification programs. Revision of the standards was completed by chapter workgroups composed of members of the CSV Verification Committee and representatives of the Children’s Surgery Data Committee. The goals of the revision were to add new standards that would provide a direct benefit to patients, clarify and/or eliminate standards that were not achieving the intended result. Additional content updates include clarification of areas of confusion, improved detail of vague standards, improved description of levels, inclusion of the Specialty Hospital category, and a collapse of redundant standards.