1 / 22

Surgery in Children

Surgery in Children. David G. Mason Consultant Paediatric Anaesthetist, Oxford NCEPOD Clinical Co-ordinator . What is NCEPOD Background to surgery in children Aims of study Methods Impact. Aims.

akando
Download Presentation

Surgery in Children

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Surgery in Children David G. Mason Consultant Paediatric Anaesthetist, Oxford NCEPOD Clinical Co-ordinator

  2. What is NCEPOD • Background to surgery in children • Aims of study • Methods • Impact

  3. Aims • Undertake research into the way patients are treated, to identify ways of improving the quality of care • NCEOD publishes reports summarising key findings and recommendations arising from the information they gather • Aim to identify changes in clinical practice that will improve quality of care and ultimately improve patients' outcomes

  4. Status of NCEPOD • Company limited by guarantee and a registered charity • Operates as an independent entity under the “umbrella” of the NPSA • Funded by NPSA/HSSE (NI)/Guernsey/Isle of Man/ Independents

  5. Structure of NCEPOD • Steering Group • Trustees • Clinical Co-ordinators • Non-clinical Staff • Expert Groups • Advisors

  6. Why does it work? • Medicine is a complex system which cannot be described by quantitative analysis alone • NCEPOD unashamedly uses qualitative analysis • Cases reviewed by those that understand problems at coalface • Interpretation of collected data by practising clinicians who understand pressures of clinical practice • Comment by those sympathetic to but not uncritical of current working practices

  7. Confidentiality • Key part of the Enquiry protocol • Anonymised cases • Confidentiality agreement • Section 251 exemption

  8. Background Children’s surgical services in UK • Many changes in the last 20 years • Clinical • Organisational • Specialisation and centralisation of children’s services • Modification of staff training • Not all beneficial to children’s surgical services in DGHs • Events following congenital cardiac surgery at the Bristol Royal Infirmary

  9. Factors for changes • NCEPOD 1989 &1999 • Atwell JD, Spargo PM. The provision of safe surgery for children. Arch Dis Child 1992: 67: 345-349 • The Audit Commission report: Children first: a study of hospital services. 1993 • Kennedy Inquiry 2001 • Monro Report 2003 • Department of Health, National Service Framework for Children. 2004 • Healthcare Commission, Improving Services for Children in Hospital. 2007

  10. NCEPOD reports • Surgeons and anaesthetists should not undertake occasional paediatric practice • Consultants who have responsibility for children need to maintain their competence in the management of children • Concentration of expertise with a Regional approach to the organisation of paediatric surgical services • Review of manpower planning for surgical & anaesthetic services of children • Better audit & review of mortality

  11. Audit Commission / NSF / HCC • Provide access to care and treatment of the highest quality that is evidence based, effective and safe • Ensure care is provided within an environment suited to the needs of children and young people, with appropriate facilities to support families in caring for their child • Ensure care and treatment is provided by staff that are suitably trained and experienced in caring for children and families and that these staff are appropriately supported and developed • Establish clinical networks and improve ‘outreach’ from regional centres, particularly in surgical specialities, to maintain local expertise

  12. Safe surgery for children • Audit of surgical practice • Centralisation of paediatric surgery • Transfer of children < 5 years of age, particularly for acute surgical conditions • Change in paediatric population • Longer survivors • Changes in surgical practice • Changes in society e.g. obesity

  13. Congenital cardiac surgery • Standards were proposed (Monro) • Development of regional team working • Systematic clinical accountability • National audit • Child centred care • Clinical assessment • Consent • Medical and surgical care. • National Specialised Commissioning Group (2009) • Safe and Sustainable Paediatric Cardiac Surgery Services

  14. Interpretation / misinterpretation • Arbitrary number of paediatric surgical / anaesthetic cases per year • Arbitrary age limits • Changes in surgical & anaesthetic training • Incomplete networks of care

  15. Consequences of changes • Decline in the number of children who have surgery performed in DGHs • Change in paediatric surgical practice • Increase in referrals to tertiary centres • Deskilling of surgeons and anaesthetists in DGHs • Is a tipping point approaching in the care of the surgical child in DGHs? • Is the current organisation of CCD surgical care providing the best care? Cochrane H & Tanner S Trends in Children’s Surgery 1994-2005 statistical report 2007 DH Pye JK Survey of general paediatric surgery provision Ann R Coll Surg Engl 2008 90: 193-197

  16. Aims of Study • Primary aim: • Determine the remediable factors in process of care of children 17 years and younger who die within 30 days of surgery • Secondary aim: • What impact have the changes in practice over the last 10 years had on the quality of care of children who require surgery?

  17. Aims of Study • The primary aim would be met by addressing the following factors: • Preoperative care and admission • Intra-hospital transfer • Networks of care • The seniority of clinicians • Multidisciplinary team working (involvement of paediatric medicine) • Delays in surgery • Anaesthetic and surgical techniques • Acute Pain Management • Critical Care • Co-morbidities • Consent

  18. Aims of Study • Secondary aims would be met by addressing the following issues: • To what extent has specialisation / centralisation of paediatric surgical services occurred? • How has staff training developed in last 10 years? • How do hospital facilities (infrastructure) affect care?

  19. How? • Organisational Questionnaire • Clinical Questionnaires • Surgical • Anaesthetic • Peer review • Survey of practice

  20. Examples of reasons for not returning data

  21. Impact • Add to the body of information on surgical and anaesthetic services for children thus guiding future service development and • Maybe answer the question: • What is the best organisational model for delivering surgical care for children in the UK?

  22. Questions? http://www.ncepod.org.uk

More Related