scholarly journals Survey of General Paediatric Surgery Provision in England, Wales and Northern Ireland

2008 ◽  
Vol 90 (3) ◽  
pp. 193-197 ◽  
Author(s):  
JK Pye
Keyword(s):  
Northern Ireland ◽  
Elective Surgery ◽  
High Volume ◽  
District General Hospital ◽  
Paediatric Surgery ◽  
Subtle Change ◽  
Tertiary Centre ◽  
The Future ◽  
Tertiary Hospitals ◽  
Current Provision

INTRODUCTION A survey was carried out to ascertain the current provision of general paediatric surgery (GPS) in all hospitals in England, Wales and Northern Ireland with 100% return rate. The provision of GPS is at a crossroads with a drift of these cases to the overstretched, tertiary referral hospitals. METHODS The regional representatives on the council of the Association of Surgeons of Great Britain and Ireland (ASGBI) obtained data from their regions. Any gaps in the data were completed by the author telephoning the remaining hospitals to ascertain their current provision. RESULTS A total of 325 acute hospitals are potentially available to admit elective and/or emergency paediatric patients, of which 25 hospitals provide a tertiary paediatric surgical service. Of the remaining ‘non-tertiary’ hospitals, 138 provide elective GPS and 147 provide emergency GPS. The ages at which GPS is carried out varies considerably, but 76% of non-tertiary hospitals provide elective GPS to those over the age of 2 years. The ages of emergency cases are 24% over the age of 2 years and 51.5% over the age of 5 years. The age at which surgery is carried out is dependent on the anaesthetic provision. Subspecialisation within each hospital has taken place with a limited number of surgeons providing the elective surgery. ‘Huband-spoke’ provision of GPS to a district general hospital (DGH) from a tertiary centre is embryonic with only 11 surgeons currently in post. An estimate of the annual elective case load of GPS based on the average number of cases done on an operation list works out at 23,000 cases done outwith the tertiary centres. DISCUSSION Almost 10 years ago, a change in the training of young surgeons took place. An increase in training posts in Tertiary centres was made available following advice from the British Association of Paediatric Surgeons (BAPS) but these posts were often not taken up. Many DGH surgeons became uncertain whether they should continue GPS training. A subtle change in the wording of the general guidance by the Royal College of Anaesthetists altered the emphasis on the age at which it was appropriate to anaesthetise children. Change in clinical practice, reducing need, and a drift towards tertiary centres has reduced DGH operations by 30% over a decade. Young surgeons are now seldom exposed to this surgery, and are not being trained in it. The large volume of these low-risk operations in well children cannot be absorbed into the current tertiary centres due to pressure on beds. The future provision of this surgery is at risk unless action is taken now. This survey was carried out to inform the debate, and to make recommendations for the future. The principal recommendations are that: (i) GPS should continue to be provided as at present in those DGHs equipped to do so; (ii) GPS training should be carried out in the DGHs where a high volume of cases is carried out; (iii) management of these cases should use a network approach in each region; (iv) hospital trusts should actively advertise for an interest in GPS as a second subspecialty; and (v) the SAC in general surgery develop a strategy to make GPS relevant to trainee surgeons.

EP.TH.919Developing A Fast Track Paediatric Herniotomy Service In A District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tsitsi Chituku ◽  
Pradip Gupta ◽  
Karen Bartholomew ◽  
Michael Moncrieff
Keyword(s):  
Critical Care ◽  
Inguinal Hernia ◽  
Fast Track ◽  
Elective Surgery ◽  
District General Hospital ◽  
Out Of Hours ◽  
Clinic Patient ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
Paediatric Critical Care

Abstract Introduction Previously to 2011, babies presented as emergency to our Trust with irreducible inguinal hernia at a rate of 1 baby/year. They were referred to our regional tertiary centre for surgery because there is no out of hours Paediatric Surgeon or Anaesthetist. Usually, patients were either, awaiting an appointment to see surgeon or on an 18-week waiting list. The aims of this SIP were to: expedite elective surgery for paediatric inguinal hernias, and prevent emergency paediatric inguinal hernia referrals to our tertiary centre. Method Referrals to paediatric surgical clinics were triaged by the clinic sister. Hernia referrals were expedited to the next available clinic. A provisional date for surgery was arranged ASAP with an identified surgeon and anaesthetist whilst in clinic. Patient demographics and data collected retrospectively. Results A 73% reduction in waiting time for surgery, 1 baby (1.4%) presented as emergency and was referred to our tertiary centre for surgery, the post-op complication rate fell from 6.5% to 0%. Conclusion The success of the fast-track paediatric herniotomy service at our DGH shows that it is possible to provide timely and safe surgery in a DGH in line with the recommendations of the Paediatric Critical Care and Surgery in Children Review (November 2019).

scholarly journals Can laparoscopy be part of a paediatric surgery outreach service?

2017 ◽  
Vol 99 (5) ◽  
pp. 355-357
Author(s):  
R Peeraully ◽  
R Hill ◽  
D Colliver ◽  
A Williams ◽  
S Motiwale ◽  
...  
Keyword(s):  
District General Hospital ◽  
Day Surgery ◽  
Urethral Injury ◽  
Paediatric Surgery ◽  
Undescended Testes ◽  
Postoperative Urinary Retention ◽  
Outreach Service ◽  
Laparoscopic Procedures ◽  
Tertiary Centre ◽  
High Quality Service

INTRODUCTION The aim of this study was to assess the outreach laparoscopic service delivered by four paediatric surgeons to a district general hospital (DGH). METHODS A retrospective review was carried out of all laparoscopic procedures performed in a single DGH between January 2004 and November 2014 by the four paediatric surgeons providing the outreach service. All operations were identified from the electronic theatre system and archived correspondence. Demographic and clinical details were obtained from contemporaneous records. RESULTS Over the 11-year study period, 1,339 operations were performed as part of the outreach paediatric surgery service, with 128 patients (9.6%) undergoing laparoscopy. The indications for laparoscopic surgery were impalpable unilateral or bilateral undescended testes (UDT) (n=79, 62%) or request for insertion of a feeding gastrostomy (n=49, 38%). All but six UDT cases (96%) were performed as day surgery and the median length of stay for gastrostomy patients was 3 days (interquartile range: 2–3 days). There were three UDT cases with surgical complications and one had complications related to the anaesthesia. One gastrostomy case required transfer to our tertiary centre for management of postoperative urinary retention and urethral injury. CONCLUSIONS Elective laparoscopic procedures in young children can be provided safely as components of an outreach paediatric surgery service in a DGH setting as part of an increasing volume of operations performed by specialist paediatric surgeons. This enables children to have a high quality service as close to their home as possible.

scholarly journals Segmentation of specialised and non-specialised work as a model for dealing with rising demand for paediatric surgical services

2021 ◽  
Vol 103 (4) ◽  
pp. 182-185
Author(s):  
JR Davidson ◽  
IE Yardley
Keyword(s):  
Elective Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
National Standards ◽  
Waiting List ◽  
Paediatric Surgery ◽  
Time Data ◽  
Specialist Service ◽  
Umbilical Hernia Repair ◽  
Reoperation Rates

Introduction Shifts in the landscape of surgical care provision have resulted in a rise in demand for specialist paediatric surgery services. Here we describe a model of a single paediatric surgery service delivering elective surgery across two sites, a specialist children’s hospital and an inner-city district general hospital. This model has allowed for a management of increased demand while maintaining key quality indicators within national standards. Materials and methods In a single specialist paediatric surgical service working at two sites (specialist and non-specialist), service demand was evaluated by number of referrals and waiting list additions and removals over an eight-year period (2011–2018). Daycase rate, 30-day readmission, and 12-month reoperation for three commonly performed general surgery of childhood procedures (umbilical hernia repair, Inguinal herniotomy, orchidopexy) are reported. NHS Getting it Right First Time data are used to allow comparison with national standards. Results Referrals to the service increased 2.5-fold (955 in 2011/12 compared with 2,419 in 2017/18) and waiting list additions increased 1.4-fold (585 compared with 840), net additions to the waiting list indicate that demand was met. Readmission and reoperation rates met or exceeded national standards. Discussion This model allows for a high quality of care to be provided with acceptable daycase rates and low readmission and reoperation rates. We commend this model to other specialist paediatric surgical centres experiencing increasing demand on their services

scholarly journals Operating Rooms efficiency: leveraging data to improve management of elective surgery

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Historical Data ◽  
Elective Surgery ◽  
District General Hospital ◽  
Operating Rooms ◽  
Accurate Estimation ◽  
Surgical Time ◽  
Accurate Analysis ◽  
Management Efficiency ◽  
Scheduling Model ◽  
The Mean

Abstract Background Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime. Methods We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)>200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization. Results The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p < 0.001). Mean raw OR utilization increase from 62% to 66% (p < 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p < 0.001). Conclusions This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs. Key messages An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.

Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14050-e14050
Author(s):  
Olusola Michael Adeleke ◽  
Rubyyat A Hakim ◽  
Laurence Dean ◽  
Huma Zahid ◽  
Rongyu Lin ◽  
...  
Keyword(s):  
Goodness Of Fit ◽  
Single Point ◽  
District General Hospital ◽  
Cord Compression ◽  
Radiology Reporting ◽  
Goodness Of Fit Test ◽  
Tertiary Centre ◽  
Chi Squared ◽  
Early Case ◽  
The Uk

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

178 Suspected Cauda Equina Syndrome in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Ellerton ◽  
H Benjamin-Laing ◽  
W J Harrison
Keyword(s):  
General Hospital ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Bladder Function ◽  
Mri Scan ◽  
Eligibility Criteria ◽  
Joint Project ◽  
Tertiary Centre ◽  
Patient Morbidity

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

Sign in / Sign up

Export Citation Format

Share Document