Posts Tagged ‘NHS’

Reducing the number of surgical centers

April 28, 2010

A recent report by the NHS (Britain’s National Health Service) recommends that several facilities that currently offer pediatric heart surgery to be consolidated into larger centers. Of the eleven children’s heart surgical programs currently operating, it has been recommended that at least four be closed. As you could expect, not everyone is thrilled with this idea. The Patient’s Association is concerned about travel distance and the stress on families that such a consolidation will bring.

I can understand their worry – I’ve done that myself. Going to Birmingham Alabama for heart surgery is scary, when you live in South Carolina. My Adult Congenital Heart checkups require an overnight trip to Atlanta. But overall the consolidation would be a good thing.

As I have often said, The doctors I need do not practice in small towns. I have a complex Congenital Heart Defect, and not just anybody can understand my healthcare needs. If I were to go to my local community hospital (130 beds) for heart surgery, I would come out in a box. It’s that simple. And not because the staff didn’t care, or didn’t do their best, but because they would be overwhelmed.They don’t have the experience needed to handle me.

So the idea of having just a few locations where they specialize in cardiac surgery makes a lot of sense. After all, it isn’t just the surgeon who needs experience – Everyone from Pre-Op through the surgical procedure and on to Recovery is an important piece of the puzzle. What good is having the world’s best surgeon if the nurses working in the Recovery Room can’t even get an IV started?

Repetition builds confidence and skill. Learn how to do a procedure, and keep doing it… and do it correctly, each and every time. Constantly review procedures to learn how to improve them, what to do if things go wrong (and they will go wrong, sooner or later!) Studies have proven that surgical experience can lead to even more positive outcomes. And a 2004 study proved that one of the best ways to learn how to detect heart murmurs is through repetition. The study suggests 500 repetitions of learning 4 basic heart murmurs.

The key to doing any task well is 1) Do it often; and 2) do it right. Consolidating surgical centers will allow that to happen.

Hospital Suspends Heart Surgery Program

March 5, 2010

An alarming story is coming out of Great Britain today, where all pediatric heart surgery at the John Radcliffe Hospital in Oxford has been suspended after the deaths of four children in three months.

All four of the children had Congenital Heart Defects and had been receiving care for some time before their operations. With the unusually high number of deaths, officials at Radcliffe decided to stop everything and review their procedures. The shutdown has affected twenty-six children awaiting surgery, but all are being transferred.

When something like this happens, it is a good idea to review procedures and try to learn if the problem is arising locally. The Health Secretary is obviously concerned, but also notes that heart surgery is “high-risk”. Heart surgery is an exacting science; there is little (if any) room for error…. which is why the President of the Society of Cardiothoracic Surgery has been concerned about the number of specialized surgical units.

“There are 25 to 30 surgeons involved in the whole country. We feel they are spread too thinly across those units. Everyone is working hard to provide a good quality of care but we don’t think it is sustainable.”

While it is quite possible to just have “a run of bad luck” (try explaining that to grieving parents) could overworked surgeons be the root cause of the problem? Or is it a local issue? Radcliffe Hospital has had problems before – an investigation in 2005 found that the death rate after a coronary artery bypass graft was “higher than expected” and there have been previous concerns.

Hopefully this time the investigators will be able to remedy the problem.

A/H1N1 Flu Notes

July 16, 2009

This isn’t an “official” Swine Flu update, just some news links I’ve found over the last few days. The US State Department has issued a Travel Warning for China – The Chinese have instituted a quarantine for travelers who show fever or flu-like symptoms. The warning was issued because there have been reports that unaccompanied minors traveling in China have been quarantined, also. There have been more than 1300 cases of H1N1 reported in China, and the Los Angeles Times recently ran a first person account of Chinese quarantine procedures.

PalMD at White Coat Underground gives us an example of how a summer camp handled a H1N1 outbreak. Marc Siegel, writing in Slate, gives us a look at another camp… and you won’t believe how this outbreak got started.

In Great Britain, the P word doesn’t stand for Pandemic, but rather Panic… triggered by a government report and spurred on by the media.  This article’s headline implies that H1N1 is spreading at a phenomenal rate, but the third paragraph states that it’s not necessarily H1N1 – what’s spreading is Influenza-Like Illness (ILI). One may not be the other, but just reading the headline would make you think the world was ending.  Add a few dire predictions and suddenly you have people running in the streets. It’s to the point that prominent doctors are telling the Health Minister to shut up – ‘It’s almost like he’s been preparing for this pandemic flu for so long he wants it to be fulfilled.’

My crystal ball is cracked, so I can’t make any prediction on what H1N1 will do. But a full scale panic won’t help. This is a situation in which cooler heads need to prevail.