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Paediatric surgery in a general hospital

Paediatric surgery in a general hospital. The view of the general surgeon. Elective operations. 1981 2007 Hernias Hernias Orchidopexy Orchidopexy Circumcisions Circumcision Cutaneous lesions Cutaneous Insertion of V-P shunts. Emergency operations. 1981 2007

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Paediatric surgery in a general hospital

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  1. Paediatric surgery in a general hospital The view of the general surgeon

  2. Elective operations • 1981 2007 • Hernias Hernias • Orchidopexy Orchidopexy • Circumcisions Circumcision • Cutaneous lesions Cutaneous • Insertion of V-P shunts

  3. Emergency operations • 1981 2007 • Spina bifida • Appendix Appendix • Hernia Hernia • Intussussception • Scrotal operations Scrotal operations • Pyloric stenosis Pyloric stenosis

  4. Consultant staff • Raigmore Belford Caithness • Anaes 14 3 3 • Surgeon 8 4 3

  5. Hernia/Groin operations • Year Raigmore Belford Caithness • 1991 46 3 • 1993 55 3 • 1995 46 3 • 2003/5 56(28) 5(3) 4(2) • Number <=5 44(22)/1(1)/4(2)

  6. Circumcision • Year Raigmore Belford Caithness • 1991 31 5 • 1993 40 8 • 1995 25 4 • 2003/5 40(20) 0 5 Number <=5 13/0/3

  7. Orchidopexy • Year Raigmore Belford Caithness • 1991 38 10 • 1993 40 1 • 1995 26 4 • 2003/5 86(43) 4(2) 5(3) Number <=5 49

  8. Appendicitis Raigmore Belford Caithness • 2003/5 109(55) 8(4) 16(8) • Number <=5 1 at Raigmore

  9. Pyloric Stenosis • Year Raigmore Belford • 1991 8 0 • 1993 5 0 • 1995 6 0 • 2003 2 0 • 2004 1 0 • 2005 0 0 • 2006 1 0

  10. Two recent cases • 4 week old (gestational age 43 weeks) • Weight 3.0Kgs • Pyloric stenosis • 9 week old (gestational age 43 weeks) • Weight 3.6 kgs • Incarcarated inguinal hernia

  11. Total number of operations 2003/5 All ages <=5 • Raigmore 414(207) 219(105) • Belford 63(32) 10(5) • Caithness 50(25) 12(6) • Excludes ENT/Opth/ortho/dentists

  12. Classical problem(1) • Low number of admissions • Low number of operations • Increasing numbers of surgeons and anaesthetists • Increasing public expectations re outcome

  13. Classical problems(2) • Will travel for elective procedures • Expect emergency care locally • Guidelines re “children friendly areas” increasing • Political pressure

  14. Requirements for paediatric surgical care (1) • Designated ward (beds) • Designated lists • Paediatrician active involvement • Theatre reception child friendly • OP clinic child friendly • A&E child friendly area

  15. Requirements for paediatric surgical care (2) • Paediatric trained nurses • Paediatric trained surgeons • Paediatric trained anaesthetists

  16. Types of Hospital • Teaching hospitals • DGH • Remote & Rural hospitals

  17. Teaching hospitals • Aberdeen, Edinburgh and Glasgow • They have all the above • Can therefore provide a comprehensive paediatric surgical service

  18. Requirements for paediatric surgical care (1) • Designated ward (beds) • Designated lists • Paediatrician active involvement • Theatre reception child friendly • OP clinic child friendly • A&E child friendly area

  19. Requirements for paediatric surgical care (2) • Paediatric trained nurses • Paediatric trained surgeons • Paediatric trained anaesthetists

  20. Dundee • Visiting service from Edinburgh 2 days per week. Clinics and op lists • Joint appointment • 2 local surgeons do 1 in 4 o/c for 3 &<3 • Edinburgh cover the other nights. • GS look after 4 and >4 • Active involvement of paediatricians.

  21. District General Hospital • Can and should provide all of the above requirements. • No neonates • Elective service by nominated GS/Anaesthetists • Emergency service - ?all GS/Anaesthetists ? separate rota • Visiting service ?clinics ?op lists

  22. Requirements for paediatric surgical care (1) • Designated ward (beds) • Designated lists • Paediatrician active involvement • Theatre reception child friendly • OP clinic child friendly • A&E child friendly area

  23. Requirements for paediatric surgical care (2) • Paediatric trained nurses • Paediatric trained surgeons • Paediatric trained anaesthetists

  24. Raigmore hospital • 8 GS • 2 do elective work • 8 do emergency work • 1 fully trained paediatric surgeon • Elective theatre/clinic work in Inverness • 1 week O/C in Aberdeen

  25. Remote and rural hospitals • They have very few of the above • Could provide a visiting service for elective cases • What about the emergencies? • Should they transfer all emergency paediatric cases? • Island versus mainline hospitals

  26. Requirements for paediatric surgical care (1) • Designated ward (beds) • Designated lists • Paediatrician active involvement • Theatre reception child friendly • OP clinic child friendly • A&E child friendly area

  27. Requirements for paediatric surgical care (2) • Paediatric trained nurses • Paediatric trained surgeons • Paediatric trained anaesthetists

  28. The future • More visiting services to DGH and R&R • Elective work by those who undergo training as trainees • Emergency work by these surgeons when O/C. • When not O/C ?transfer ?”babysit”?phone around. GS o/c treat 5 and >5 • ? Dual appointments by 2 hospitals close to each other. • Active paediatrician involvement.

  29. Surgical training • N&N/E scheme do 6/12 in first year or two • This will continue with MMC • ? Where else will training be available • Needed to provide future DGH surgeons • Proleptic appointment or top up training

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