Urgent safety action needed at intensive care unit of Yorkhill Sick Childrens Hospital experts war

URGENT action is required to prevent the intensive care unit at one of Scotlands main childrens hospitals from becoming unsafe a report has warned
Experts who examined heart surgery services at Glasgows Royal Hospital for Sick Children raised significant concerns about some important areas including poor staffing levels in the paediatric intensive care unit PICU
The hospital which has the only specialist childrens cardiac surgery unit in Scotland was examined against standards for England which has larger units
Health Secretary Nicola Sturgeon said the PICU provided a quothighquality servicequot and would be maintained
Scotlands top doctor Chief Medical Officer Sir Harry Burns also praised the quotexcellent childrens cardiac servicequot and said the outcomes for patients there were quotas good if not better than anywhere across the UKquot
But the experts who carried out the review said quotOf concern was a sense that the provision of paediatric intensive care may be unsafe if critical staffing problems are not addressedquot
Thirty one areas of the heart surgery services were ranked in the report of which 19 were classed as poor and one as inadequate
Dr Jennifer Armstrong medical director of NHS Greater Glasgow and Clyde said the review quotconfirmed many areas of good practice as well as highlighted areas where we need to improvequot
She insisted quotI am satisfied that the service we provide is both safe and sustainablequot
At the time of the experts visit in November 2011 staffing problems in the PICU had been worsened by the departure of two consultants
The report said quotThe panel was of the view that urgent remedial action is required in PICU to prevent care from becoming unsafequot
Two consultants must be recruited although hospital staff acknowledged that quotthis may still leave the PICU stretched to a degree that maybe unsafequot the report said
Childrens cardiac surgery units in England are required to have four fulltime consultant surgeons who each perform at least 100 operations a year and ideally 125
The Glasgow hospital only has three surgeons which the report said quotimpeded an ability to deliver a safe surgical rota around the clockquot
The workload was not evenly distributed between them with one surgeon performing about 140 procedures while the other two did about 70 each a year
The experts were quotleft with an impression that the senior leadership team were not operating as a cohesive team and that there was a lack of clear strategic leadershipquot
While there was a high degree of trust between patients and staff patients and parents quotdid not appear to be actively involved in decision makingquot
There was a quotpoor working relationship between members of the cardiology and surgical teamsquot the report also pointed out
Dr Armstrong said quotThe Scottish Congenital Cardiac Service at the Royal Hospital for Sick Children at Yorkhill has been the subject of a rigorous external review and this has confirmed many areas of good practice as well as highlighted areas where we need to improve
quotThe Yorkhill team have put in place an action plan to address these issues and we will ensure that this service continues to deliver excellent carequot
A recent audit showed that the outcomes for children at the unit were quotamong the very best in the UKquot she said
quotThis is due to the highly skilled clinical teams who work in this service and the close partnership with children and their familiesquot
On the number of operations performed by each surgeon a spokeswoman for the NHS board explained that while two surgeons would sometimes be involved in complex operations only one surgeon would be recorded as having done the procedure
She said quotSurgeons will dualoperate during complex cases as part of good clinical practice However the case will only be attributed to one of the two surgeonsquot
Dr Jim Beattie associate medical director of womens and childrens services at the health board said a plan to address areas for improvement had been developed with action already taken in a number of areas
He said quotSignificant progress has been already made in addressing some shortterm staffing issues that were being experienced in the PICU at the time of the review At the time of the review there were two consultant vacancies within the PICU One of these posts has already been filled and we are working hard to recruit to the remaining postquot
A nursing workforce plan for paediatric and neonatal intensive care services had been agreed Dr Beattie said
quotWe have also successfully recruited an additional consultant in paediatric cardiology and a further post is out to advert which when filled will bring the total number of consultant paediatric cardiologists at the RHSC Royal Hospital for Sick Children to seven
quotThe service also requires an additional two wholetimeequivalent cardiac liaison nurses Funding for both posts has now been agreed and the process of recruitment will begin shortlyquot
Ms Sturgeon acknowledged that NHS Greater Glasgow and Clyde was doing work to address the staffing problems
She said quotThe staff of the RHSC provide excellent care to the children and parents who rely on them and this report shows just how much the service is valued by those who need it
quotOur service treats around 300 children each year working with three surgeons who will each undertake 100 operations each year
quotThe fact that this unit provides a highquality service is backed up by UK published data that show the Yorkhill results and outcomes are just as good as other centres in the UK This is why I believe that the current provision at Yorkhill should be maintainedquot
Dr Burns said quotWe know we have an excellent childrens cardiac service in Scotland with clinical outcomes as good if not better than anywhere across the UK
quotWhile we welcome the findings of the review and the recommendations that NHS Greater Glasgow and Clyde are already taking forward it is important to stress that we have a safe and sustainable service here in Scotland
quotThis lifesaving service is a vital part of our NHS in Scotland providing care dayin and dayout for children who need it and we are determined to keep it that wayquot

Date : 19 May, 2012
Reference : http://www.dailyrecord.co.uk/2012/05/18/urgent-safety-action-needed-at-intensive-care-unit-of-yorkhi

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