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Fears for children's safety at Lyell McEwin

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Doctors say deep concerns about the safety of paediatric services at the Lyell McEwin Hospital have been realised after a child went into serious decline on a ward after routine elective surgery.

InDaily has learned the young child* had to be resuscitated by an emergency team in January before being transferred urgently to the Women’s and Children’s Hospital for further treatment and observation.

Doctors have told InDaily they are concerned about the events leading to the life-threatening decline in the child’s condition following elective ear, nose and throat surgery (ENT) – a situation they believe is related to systemic pressures at Lyell McEwin following the closure of the paediatric ward at Modbury Hospital last December.

Among the doctors’ concerns are post-surgical supervision at Lyell McEwin, the design of the wards and the wisdom of the decision to close the Modbury pediatric ward, which they say will push an extra 250-300 paediatric ENT patients to the Lyell McEwin over 12 months.

Doctors say there is a lack of appropriately qualified and experienced post-surgical monitoring at Lyell McEwin.

It has become apparent that, as recently as February, Health bureaucrats were still considering the best way to manage surgical care for children at Lyell McEwin – two months after the closure of the paediatric ward at Modbury.

ENT surgeons are particularly concerned that the Lyell McEwin doesn’t have any qualified ENT cover to follow-up and monitor patients after operations. Consultant ENT surgeons are technically on call, but they could be anywhere in the metropolitan area should an emergency arise. There is no ENT registrar available in the case of an emergency, doctors say.

One surgeon, who spoke to InDaily on the condition of anonymity, pointed out that a full-blown ENT department involves a mix of consultant surgeons, registrars, interns and administrative staff. Modbury has a department of this sort; Lyell McEwin only has consultant ENT surgeons.

InDaily has been told by other surgeons – who also refused to be named – that these concerns about the set-up at Lyell McEwin have been raised at a series of consultations with the Northern Adelaide Local Healthcare Network (NALHN).

It is understood that an internal inquiry has been called to investigate the life-threatening incident.

College of Surgeons SA chair Peter Subramaniam said surgeons had warned the Government about closing the Modbury paediatric ward before the shape of services at Lyell McEwin was settled.

“The RACS had told the Government about our concerns about the paediatric ward being closed at Modbury, and about ENT surgery being performed at the Lyell McEwin before a unit had been formally set up,” he told InDaily.

The LAHN is still considering the structure of ENT surgery in the Lyell McEwin, and RACS made a submission highlighting its specific safety concerns.

“The RACS has significant concerns about safety issues in the current situation of ENT surgical services to children and adolescents at the Lyell McEwin and urges the NALHN to address this as a priority,” the submission, dated February 2014, said.

The Chief Executive Officer of the NALHN, Margot Mains, said Lyell McEwin Hospital had “systems in place to ensure all paediatric patients receive safe, quality post-operative care”.

“We continue to monitor these systems as these services transition into new facilities as a result of consolidation of services from a different site,” Mains told InDaily in a statement.

However, she confirmed the hospital was still consulting with doctors and others on service delivery under the new arrangements.

“NALHN is progressing consultation with partner organisations, unions, colleges, key clinicians and staff on building more comprehensive paediatric services, ensuring the community has access to services closer to home.

“With the transition of Modbury Hospital’s paediatric inpatient ward, the number of paediatric registrars at Lyell McEwin Hospital increased, with staff available on site 24 hours a day, seven days a week, providing comprehensive clinical care.”

She said paediatric surgical services had been available at Lyell McEwin for a number of years before the “consolidation” of NALHN’s paediatric inpatient services.

“In 2012-13, more than 100 paediatric ENT surgeries were performed at Lyell McEwin,” she said.

She did not comment on the particular child’s case.

* InDaily has chosen not to publish the child’s age, gender or exact procedure because of doctors’ concerns about the patient’s privacy

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