10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 1 The organisation and future of paediatric surgical services Kathy Wilkinson.

Slides:

Advertisements

Similar presentations

Welcome to the new acute and community County Durham and Darlington NHS Foundation Trust Clinical strategy FT member events April 2011.

Advertisements

Understanding Diabetes Dr Gill Hood North Thames Clinical Research Network Barts Health NHS Trust

Effectiveness of health checks to improve the physical health of patients with severe mental illness: a single blind cluster randomised controlled trial.

10 Year Review of Paediatric Tracheostomies The Leeds Teaching Hospitals NHS Trust.

Northern England Strategic Clinical Network Conference 15 th May 2015 The Northern Children’s Surgical Network Gareth Hosie.

National and Local Clinical Audit 30/04/2015 Kate Godfrey Director of Operations QI and Development.

Evidence into Practice Nigel Beasley co-Chair East Midlands Clinical Senate.

Breast Cancer Surgery Challenging Preconceptions Hamish Brown Consultant Breast and General Surgeon Sandwell and West Birmingham Hospitals NHS Trust

Health Visiting and the Healthy Child Programme 0-5

A Competent Workforce: The ACAD Experience

The (ex) Policy Maker’s View Chris Ham 31 March 2005.

An Introduction to Innovation ©2Bio Ltd About this Presentation This presentation template is part of the Innovation Toolkit, that was developed.

The Royal College of Surgeons of England Regional Representatives Meeting Simulator Training – in practice Implementation of a Surgical Skills Strategy.

- 1 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire PROPOSED MONITORING ARRANGEMENTS 20th June 2005.

SCCCSS September 13 General Surgery in Childhood across Scotland Service delivery and sustainability remains an unresolved problem Roderick Duncan FRSCEdOrth.

CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP Unscheduled Care Helen Maitland National Lead.

Grantham Children’s Services A Problem or an Opportunity?

English Experience of Setting up Acute and Crisis Services Iain Tulley Chief Executive Devon Partnership NHS Trust.

Expanding the Foundation Programme in Psychiatry Michael Maier Head of London Specialty School of Psychiatry.

Care Quality Commission (CQC) Registration. Background The Care Quality Commission (CQC) is the health and social care regulator for England. From 1 April.

Berkshire Weight Loss Surgery Royal Berkshire Hospital, Reading James Ramus, Consultant UGI & Bariatric Suregon.

Why Has it got to be Multi Professional ? The extent to which different healthcare professionals work well together can affect the quality of the health.

Neonatal Cerebral Function Monitoring (CFM): A survey of its provision and usage in practice throughout the East of England Neonatal Network D Marikar.

England Update January 2018

Children’s Surgical Forum (CSF)

Box plot of subarachnoid space measurements at each gestational week of age. Box plot of subarachnoid space measurements at each gestational week of age.

Normal ranges by corrected gestational age at scan for bFFE assessment of left ventricular output (A), end-diastolic volume (B), end-systolic volume (C)

Box plot of head circumference measurements at each gestational week of age. Box plot of head circumference measurements at each gestational week of age.

Pulse field gel electrophoresis: Lane 1 Lamda marker; lanes 2 to 5 K pneumoniae isolates from cases 3 to 6; lane 6 isolate from case 7; lane 7 ESBL negative.

Scatter graph showing the total number of specialist palliative care beds commissioned compared with the estimated number of people with palliative care.

Schematic representation of the two types of gastric volvulus: organoaxial volvulus occurs around the line A–A and mesenteroaxial volvulus occurs around.

Children and Young People’s Health Support Group National Steering Group for Specialist Children’s Services in Scotland General Surgery for Children.

Effect of confidence interval reduction to demonstrate a true difference in means. Effect of confidence interval reduction to demonstrate a true difference.

Annual review of checklist for children with TSC

Percentage of total eye injection procedures in Hospital Episode Statistics admitted patients care for different primary diagnoses, England, 2008/2009–2014/2015. AMD, age-related.

Organisms that were detected from a 1-year retrospective audit of 463 culture-positive eye swabs in children at Alder Hey Children's National Health Service.

Child poverty and infant mortality in the Organisation for Economic Co-operation and Development (OECD) countries. Child poverty and infant mortality in.

1-year and 5-year survival rates by cancer type, stage and group, England, up to 2011– year and 5-year survival rates by cancer type, stage and.

The parameters in the Reference Group model fit by EPP

UK paediatric cardiac surgery mortality rate by year for all cases and total number of procedures performed between 2000 and 2009/2010. UK paediatric cardiac.

A nomogram to assess for a given height SDS the normal range of SH/H SDS, indicating the ellipse, the regression line, and two lines at 2 SDS units away.

Box plots of urinary creatinine:osmolality ratios in two urine samples of healthy neonates (2 to 4 days apart) (A) and four additional groups of older.

Flow diagram of sample selection and reduction of subject numbers by application of exclusion criteria. ‡Data from Medical Record; ‡‡Records missing gender.

Statistical process control chart for adverse drug events (ADEs) per 1000 doses of medication dispensed during the entire period of audit from January.

Regions of the body (shaded area) where bruises were significantly more likely to occur in a child with confirmed physical abuse than in one where physical.

Knowledge gaps in key risk factor numbers

Presidential address: Time to lead!

Fourth ventricle length (4thVL) by gestational age (GA) with fitted line plot (bold line) and 95% confidence intervals (thin lines). 4thVL (mm) = 4.24 + 0.017 × GA.

Difference in cumulative revision of knee constructs compared with a contemporary benchmark at 7 years in men aged between 55 years and 75 years, using.

Percentage of individuals aged 16 and over taking cardiovascular-related prescriptions, by sex, England 2012–2013. Percentage of individuals aged 16 and.

Cost-effectiveness acceptability frontier for three risk-assessment strategies related to pressure-injury prevention best practices from a US societal.

Excess mortality risk associated with weekend admission per diagnosis related group may exhibit different temporal patterns depending on whether the cause.

Child poverty and percentage of children seriously injured or killed in a road accident; obese at reception age; admitted to hospital with a mental health.

Simulation report card for patient safety.

The comprehensive process for responding to patient safety incidents at the University of Illinois Medical Center at Chicago. The comprehensive process.

Thirty-day crude mortality (%) and adjusted weekend admission ORs (±95% CI): effect of non-availability of NEWS, increasing NEWS band and ICU transfer.

The presence of (A) thyroid peroxidase autoantibodies (TPO-ab) and (B) thyroglobulin autoantibodies (Tg-ab) among 53 individuals with Down’s syndrome in.

Percentage change since 1999, expressed as cumulative change from 1999, in rate of admissions of children for the acute infections normally managed in.

Relationship between percent of high ratings on Yelp and Hospital Consumer Assessment of Healthcare Providers and Systems. Relationship between percent.

Coloured dotplot of mortality rate per population in Scotland by age for those aged 30 to 89 years, from 1974 to 2015, stratified by sex for IHD.

Odds ratio (95% confidence intervals) of reporting respiratory symptoms in patients with treated hypothyroidism or inflammatory bowel disease (IBD) compared.

Odds ratios and 95% CI for all cases of leukaemia in children under 15 given intramuscular vitamin K compared with those given no treatment in all six.

Kaplan–Meier plots of survival by gestational week for babies born at 23–26 weeks of gestation in level 3 and level 2 centres in England in Kaplan–Meier.

Mean difference (95% CI) in teacher ratings of academic attainment for 145 extremely preterm children (

Population of births reported to the EPICure 2 study by place of birth and transfer status, indicating the population of babies included in antenatal transfer,

Proportion of children admitted to hospital with chronic conditions (papers used for the UK21 24–26 and USA ) groups: (1) children with emergency.

Comparison of heart failure admissions rates per annum (recorded hospital admissions/ population at risk) in western developed countries 1978 to.

Allergy Action Plan from the British Society for Allergy and Clinical Immunology/Royal College of Paediatrics and Child Health (available at

Tanner and Whitehouse and UK90 head circumference 50th centiles (male data only shown) compared to survey data from Newcastle (221 boys, 20% systematic.

Cumulative sum control (CUSUM) charts of cumulative monthly difference between expected and seasonally adjusted observed deaths (E-O) in three specialties.

Presentation transcript:

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 1 The organisation and future of paediatric surgical services Kathy Wilkinson

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 2 Change in location of surgery for children

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 3 Why have these changes occurred ? Changes in the surgical population Changes in practice have resulted in a reduction in some common operations e.g. tonsillectomy, grommets, circumcision Training, competencies and confidence Our attitude to risk and our ability to treat children requiring surgery may have changed

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 4 Copyright ©2008 BMJ Publishing Group Ltd. Field, D. J et al. BMJ 2008;336: The changing paediatric surgical population

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 5 Fewer routine ENT procedures Increased laparoscopic surgery Increased endoscopies Increased number of radiology cases Changes in medical and surgical practice

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 6 Paediatric surgical practice in England

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 7 Where do children have surgery? NCEPOD 2011

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 8 Workload

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 9 Do we have the complete picture?

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 10 Assessment of care

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 11 Deaths-Age and gender

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 12 Deaths-Diagnostic group

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 13 UK has a relatively high child mortality

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 14 How long does transfer take?

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 15

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 16 Assessment of care

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 17 Obstacles to safe paediatric practice?

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 18 Networks

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 19 SWACA WACA SEPAP PAGW Oxford PAN WM NW PAG East Anglia Network NE SPAN THAMESP AG

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 20 The new NHS in England…

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 21 CYPHOF

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 22 Other drivers See Back to the Future 2 (RCPCH April 2013) Audit of 10 key paediatric standards Results of this and further workforce planning may result in further closure IP paediatric beds

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 23 Why can’t we have this sort of detail in rest of UK?

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust CSF standards

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 25

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 26 Some snippets

10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 27 Specialist services…