22 Tackling Centralisation of Paediatric Services: Understanding the Impact in Suspected Testicular Torsion
Eleanor Zimmermann, Rachel Cichosz, Paul Rajjayabun
Alexandra Hospital, NHS Worcestershire Acute HospitalsNHS Worcestershire Acute Hospitals, Redditch, United Kingdom

Abstract

Aim of Study

Paediatric services were recently centralised to a single unit within our multi-site configuration - 17 miles from the Urology Centre. We analysed the subsequent impact on assessment and outcomes for all patients presenting with suspected testicular torsion.

Methods

Using a comprehensive electronic database we conducted a comparative service evaluation on suspected testicular torsion outcomes over two 12-month periods, pre- and post-paediatric centralisation (2015 and 2017). 

Main Results

Total number of scrotal explorations reduced from 41 to 21 - of which 28 and 12 respectively were within the paediatric population. Median age of patients was 15 (range 4-51) vs 16 (range 4-46).  

Where applicable, median time from admission to assessment by the Emergency Department (ED) was 32mins (range 7 – 131) vs 37mins in 2017 (range 9-198).

Time to specialist assessment for the paediatric population was lower in 2017 at median 50mins (range 0-120) vs 55mins (range 0-345), however this was not significant, p=0.87. Where applicable, time for patient transfer in 2015 (n=7) was median 103mins (range 72- 363) vs 139mins (range 129-213) in 2017 (n=4). There was no significant difference in time from presentation to ‘knife-to-skin’ overall: 195mins vs 227mins, p=0.20, or in the paediatric population: 211mins vs 210mins, p=0.95.

Five patients exceeded a 6-hour target of ‘knife-to-skin’ time during 2015 compared to one in 2017. There were 6 vs 4 confirmed torsions on exploration - all testes were viable. Orchidectomy was not required in either period.

Conclusion

Although paediatric services have been centralised distant to our Urology Centre, there has not been an increase in time taken for specialist assessment. The number of patients breaching the 6-hour target has reduced. Interestingly, total numbers of referrals have fallen which may indicate a shift of patients to neighbouring units as an unintended consequence of centralisation.


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