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

Provision of paediatric surgery under threat

2007 ◽  
Vol 89 (1) ◽  
pp. 25-25
Author(s):  
Elaine Towell
Keyword(s):  
At Risk ◽  
General Hospital ◽  
Gold Standard ◽  
Young Patients ◽  
Surgical Care ◽  
District General Hospital ◽  
British Association ◽  
Paediatric Surgery

The British Association of Paediatric Surgeons (BAPS) exists to ensure that young patients receive the best surgical care possible by setting and maintaining a 'gold standard' for paediatric surgery. Currently the association is concerned that the safety of young patients is at risk due to an increasing lack of general paediatric surgery provision in the district general hospital (DGH) setting.

Cancellation of elective surgery – any improvement after ten years?

2006 ◽  
Vol 88 (1) ◽  
pp. 28-30 ◽  
Author(s):  
XL Griffin ◽  
DR Griffin ◽  
AR Berry ◽  
DC Hunter
Keyword(s):  
Resource Management ◽  
General Hospital ◽  
Elective Surgery ◽  
District General Hospital ◽  
Waiting List ◽  
Admission Process

Cancellation of elective operations represents a waste of resources and a poor standard of service to patients who may already have spent several months on a waiting list. The purpose of this study was to determine the extent of the problem in a typical district general hospital, how it has changed over a period of ten years and whether alterations in resource management in the admission process have led to improvements in service.

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.

scholarly journals Increasing efficiency for reducing elective surgery waiting times: a multi-interventions approach

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Waiting Time ◽  
General Surgery ◽  
Time Allocation ◽  
Optimal Allocation ◽  
Elective Surgery ◽  
Waiting Times ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Mean Waiting Time

Abstract Background Elective surgery long waiting times are a common problem in publicly funded health systems. They have been tackled allocating additional resources or using existing resources more efficiently but results are patchy. We studied the effectiveness of a multi-interventions project based on the reorganization of existing capacity. Methods In a district general hospital (Siena's Province, Italy) with 150 beds, 4 elective surgery operating rooms (ORs) opened 6 hours/day 5 days/week (surgery specialties: general surgery, orthopedics, gynecology and urology) in October 2018 a project for reducing surgery waiting times was implemented based on 3 key points: i) separation of the Day Surgery (DS) flow from that of the ordinary activity; ii) increase of available operating time through reorganization of personnel: 30 additional hours/week were made available; iii) allocation of operating sessions flexibly in proportion to the waiting list: the made-available hours were redistributed through an algorithm able to estimate the optimal allocation of surgical time blocks to minimize the length of waiting lists, taking account of the interventions priority class. The waiting time of the out from 1/10/2019 to 31/12/2019 (N = 635) was compared with that of the interventions carried out from 1/10/2018 to 31/12/2018 (N = 634) using t-test. Results Waiting times for non-urgent cases (that can be operated beyond 30 days) were significantly reduced for all specialties (p < 0.01) except urology. For general surgery, orthopedics and gynecology, DS interventions' mean waiting time decreases from 198 to 100 days (-50%) that one of ordinary interventions from 213 to 134 days (-37%). Waiting time for urgent cases (to be operated within 30 days) was also reduced. Conclusions A multi-interventions project based on using existing capacity (personnel and structures) more efficiently and improving planning methodologies resulted to be strongly effective in reducing waiting times for elective surgery. Key messages To effectively reduce surgical waiting times, a strategy is needed that involve the entire process: from surgical planning, to staff and structures organization. The flexible OR time allocation on the base of the waiting list is a key point to improve surgery planning and reduce waiting list.

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.

scholarly journals Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Ryan C. Pickens ◽  
Angela M. Kao ◽  
Mark A. Williams ◽  
Andrew C. Herman ◽  
Jeffrey S. Kneisl
Keyword(s):  
Pediatric Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Children's Hospital ◽  
Protocol Development ◽  
Balanced Approach ◽  
Projective Curves ◽  
Children’S Hospital ◽  
The Impact ◽  
Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

2002 ◽  
Vol 18 (3) ◽  
pp. 611-618
Author(s):  
Markus Torkki ◽  
Miika Linna ◽  
Seppo Seitsalo ◽  
Pekka Paavolainen
Keyword(s):  
Hallux Valgus ◽  
Waiting Time ◽  
Varicose Vein ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting List ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Potential Problems ◽  
Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

scholarly journals 892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Hashmi ◽  
S Khalid ◽  
K Raja ◽  
A Zaka ◽  
J Easterbrook
Keyword(s):  
Informed Consent ◽  
Royal College ◽  
Mortality Risk ◽  
General Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Surgical Practice ◽  
Full Compliance ◽  
Type Of Surgery

Abstract Introduction COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic. Method Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined. Results Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02). Conclusions RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

scholarly journals Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nolan J. Brown ◽  
Bayard Wilson ◽  
Stephen Szabadi ◽  
Cameron Quon ◽  
Vera Ong ◽  
...  
Keyword(s):  
Medical Ethics ◽  
Health Care Access ◽  
Elective Surgery ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Health Crisis ◽  
Surgical Safety ◽  
Care Access ◽  
Urgent Surgery ◽  
Starting Point

AbstractAt the time of writing of this article, there have been over 110 million cases and 2.4 million deaths worldwide since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, postponing millions of non-urgent surgeries. Existing literature explores the complexities of rationing medical care. However, implications of non-urgent surgery postponement during the COVID-19 pandemic have not yet been analyzed within the context of the four pillars of medical ethics. The objective of this review is to discuss the ethics of elective surgery cancellation during the COVID-19 pandemic in relation to beneficence, non-maleficence, justice, and autonomy. This review hypothesizes that a more equitable decision-making algorithm can be formulated by analyzing the ethical dilemmas of elective surgical care during the pandemic through the lens of these four pillars. This paper’s analysis shows that non-urgent surgeries treat conditions that can become urgent if left untreated. Postponement of these surgeries can cause cumulative harm downstream. An improved algorithm can address these issues of beneficence by weighing local pandemic stressors within predictive algorithms to appropriately increase surgeries. Additionally, the potential harms of performing non-urgent surgeries extend beyond the patient. Non-maleficence is maintained through using enhanced screening protocols and modifying surgical techniques to reduce risks to patients and clinicians. This model proposes a system to transfer patients from areas of high to low burden, addressing the challenge of justice by considering facility burden rather than value judgments concerning the nature of a particular surgery, such as cosmetic surgeries. Autonomy can be respected by giving patients the option to cancel or postpone non-urgent surgeries. However, in the context of limited resources in a global pandemic, autonomy is not absolute. Non-urgent surgeries can ethically be postponed in opposition to the patient’s preference. The proposed algorithm attempts to uphold the four principles of medical ethics in rationing non-urgent surgical care by building upon existing decision models, using additional measures of resource burden and surgical safety to increase health care access and decrease long-term harm as much as possible. The next global health crisis will undoubtedly present its own unique challenges. This model may serve as a comprehensive starting point in determining future guidelines for non-urgent surgical care.

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