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

Abstract

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