About the project
The MSN developed a national audit programme for paediatric neurosurgery comprising multidisciplinary peer review of each of the four Scottish units that manage children. The Safe and Sustainable model of service delivery in England that centralised paediatric neurosurgical services was not appropriate for Scotland’s geography and dispersed population. We mapped the paediatric neurosurgical standards to a peer review audit visit, a patient and family experience survey and quality performance indicators. This is the first national review of the paediatric service; this report focuses on the outcome of the peer review visits.
Aims
To ensure children and their families have access to a national paediatric neurosurgical service that provides an ‘emergency-safe’ service in all four centres with the timely and safe transfer of children with more complex conditions to the two larger specialist centres in Glasgow and Edinburgh.
How did we achieve this?
The MSN established multidisciplinary peer review panels that reviewed detailed descriptive reports about the service in each centre prior to conducting an on-site visit to follow the patient journey and meet the multidisciplinary, multispecialty teams responsible for the delivery of care. In addition, a detailed review was undertaken of the management of 104 randomly selected children who presented to the service.
To address the differences in service provision in each of the four centres (e.g. access to paediatric intensive care), we developed system of categorising neurosurgery according to complexity and associated support needs. Three categories of surgery (from the most simple to the most complex) support decision making about the most appropriate location for the delivery of care; these categories were applied to each of the 513 procedures undertaken that year.
Outcome
The peer review panels concluded that the model of service delivery was safe and that the categories of surgery were a useful tool to support decision making and clinical audit.
Areas for improvement were identified in each unit and action plans were put in place. Subsequent visits to each of the four units demonstrated that appropriate action had been taken in response to the Report’s recommendations.
In 2015 we published a national report of our findings: