Paediatric Day Surgery
The Paediatric Day surgery area, in The Arthur Levin Day Surgery Unit, is a 7 bedded bay used for day case surgical procedures for children and young people/person [CYP] between the ages of 1 – 16 years.
In the event of any CYP requiring an overnight stay they will be admitted to Rudham Ward our paediatric inpatient ward in the main body of the hospital, where an adult will be permitted to stay with them.
Admission criteria for the paediatric day surgery is based on a variety of data including age, weight, residential geographical distance from unit, the requirement of two adults who can drive, and a responsible adult able to stay with the child at all times for 48 hours after surgery. Eligibility is also at the discretion and agreement of the operating consultant/speciality, and is based on such risk assessment including staffing, capability, equipment, and need.
What happens first?
Once a planned surgical intervention has been agreed, a referral to our services is made. Next you will receive a pre-assessment clinic appointment, where our pre-assessment nurse will go through the pre-assessment check list process with you. Occasionally this may happen during your appointment with a doctor. This enables us to safeguard your CYP, consider any special requirements, and advise you on what happens next. An opportunity for your CYP to have a look around the facilities can help to reduce any anxieties you or your CYP may have. We have a small team of Health Play Specialists and paediatric staff who can help familiarise your CYP with what happens next and have a variety of useful resources such as theatre prep books and a video, age appropriate information leaflets, and fun activities. We have added 'Little Journey' a free digital application that you will be able to access at home on a smartphone or similar device to help support you and your CYP with a virtual tour of our facilities and access other functions such as useful information, and push notifications reminders. You can access the application via this link https://www.littlejourney.health/qr-scan
Once the pre-assessment has been completed, you will receive an appointment to come into day surgery for either a morning or afternoon list. There will be strict instructions on fasting to help keep your CYP safe and comfortable prior to surgery.
What to bring – packing for your CYP:
Although you have been selected for a surgical day case, it is important to bring a basic overnight bag just in case there are any complications or adjustments that necessitate an overnight stay.
Useful items include, comfortable lounge wear/sleep wear, a toothbrush/paste, and a special/favourite toy (please note although we are happy for you to bring your CYP favourite toy with them, we cannot accept responsibility for any loss or damage occurred to your property whilst you are with us.) We are unable to plug in any home items that require electricity/charging. Please bring in any pacifiers if required and any current medications *please check these in with your nurse on admission. We politely request sleep wear to be loosely fitting so it is comfortable and can be easily removed.
If your CYP is under the age of 5 years, please bring with you your ‘Child Development Book’ previously referred to as your ‘Red Book’.
Please note that this Trust operates a pay and display car parking system, it is your responsibility to purchase a ticket as cars without a ticket will be fined. It is predicted that your stay should be around 6 hours; however it is always worth discussing this with your nurse.
When you get to the Arthur Levin Day Surgery Unit:
If you have it, please bring your referral/appointment letter with you, and hand any personal information amendments to the receptionist who will happily check you in and update your details for you.
Parent/carer involvement:
Research has clearly shown that CYP not only cope far better with hospital admission, but also recover more quickly and have less long-term worries if care is delivered in partnership with the family/carers.
We therefore work in partnership with you and your CYP and aim to fully involve you and, where appropriate, your CYP in all aspects of care planning and delivery, negotiating what input and support you wish to have.
Security/Safety:
The safety of CYP is of paramount importance to all of us so we politely ask that accompanying parents/ carers are kept to a minimum. We politely requesting that due to space constraints one accompanying parent/carer is preferable per child, and that you have alternative arrangements for your other children whilst your CYP is having a surgical procedure with us.
Because your CYP will may be drowsy after their operation, our requirements are that there are two responsible adults to escort your child home and keep them safe. We politely request that all parents and visitors should use hand gel/liquid on entering and leaving the ward to prevent the spread of infection.
Food and drink:
Most CYP who attend paediatric day surgery require an anaesthetic and will be asked to fast (avoid any food or drink) prior to their operation to keep them safe and reduce any risks or complications. You will have been given information to guide you with any preoperative requirements. If you are unsure, please see our pre-assessment tab or telephone the ward - number and speak to a member of staff who will happily clarify this for you.
We provide light snacks for your child after their procedure. However if your child has any specialist dietary requirements we will do our best to help, however it is often easier and desirable to bring a small selection of your CYP favourite/specialist foods with you, for them to enjoy after their procedure when your nurse informs you that it is safe to do so.
Admission:
After checking in, you will be called or shown through from the waiting area to the ward area. A nurse will show you to your allocated space in Bay 4. A nurse will complete the admission paperwork with you and once you have settled in, a nurse will check your CYP height and weight, and check basic observations such as temperature, pulse, and blood pressure. A brief orientation and opportunity to ask questions will help us to help make your stay with us as comfortable as possible.
We have a designated play area suitable for all ages, with many items to help keep your CYP entertained such as DVDs, Tablets, Games console, Colouring, and an assortment of toys for all ages and abilities.
Your child will be required to wear two identification bracelets during their stay.
Admission will be conducted by a paediatric nurse and once completed you and your CYP will be seen by a doctor, and an anaesthetist, where you will have a further opportunity to ask any questions you may still have, they will also re-check your admission details, discuss the procedure and talk about how we may best help your CYP get to sleep. A brief physical examination of your CYP may be required, where attention will be given to maintain privacy and dignity.
If your CYP has a fever or if there is any evidence of infection or cough, the operation may have to be postponed; this is because the risk of postoperative complications increases if infections are present. If your CYP has any of these please telephone the ward at the earliest opportunity for advice regarding your surgery.
The team will also talk to you about the proposed treatment and ask you to agree and sign a consent form; the team will answer any questions you may have. If your CYP is old enough to understand, we will also ask their views and permission as part of the consent, and if appropriate encourage your CYP to also sign their consent form if they wish.
Should your CYP need any additional tests such as x-rays or blood tests, the ward staff will direct you to where these take place or accompany you and your CYP to them. You may not be able to be present during procedures that require radiology, but you will be able to remain close by.
If your CYP requires an operation or what may be perceived as a painful or frightening procedure, our staff are very experienced in helping support you and your CYP with this. Here at Team QEH, we always practice patient focussed care, and we have nursing staff and health play specialists who are always happy to help and support. Sensitive, truthful explanations with the help of photographs and examples of medical equipment that may be encountered can be utilised to help facilitate this and help ease any anxieties your CYP or yourself may have. Play is an important part of this process, and we have a variety of play items useful for both educational, and diversional play and distraction.
Going to sleep:
Once admitted, and the team is ready for your operation. You and your CYP will be escorted to the anaesthetic room. One parent/carer will be able to be with your CYP whilst they go to sleep. Diversional play is encouraged to reduce anxieties, and we encourage you to be involved. Our experienced team are trained to help make this as smooth as possible and will expertly look after your CYP and keep them safe.
Once your CYP is asleep you will be escorted back to the ward area to wait for them, where complimentary refreshments will be offered to you. We politely ask that you refrain from eating and drinking in the ward area before your CYP has gone to surgery, as there will be other CYP who are fasting at this time, and your co-operation will make this easier for all, and is greatly appreciated.
We politely ask that you refrain from eating and drinking in the ward area before your CYP has gone to surgery, as there will be other CYP who are fasting at this time, and your co-operation will make this easier for all, and is greatly appreciated.
The time your CYP will be away from the ward area is dependent on the procedure. You can ask your nurse or doctor on the day if they can give you an individual estimate of length of procedural time, and whilst you wait on the ward we will endeavour to keep you updated at all times.
Recovery room:
Once your CYP’s surgery is finished, they will be transferred to our first stage recovery area, for close monitoring and observations from our dedicated expert team, and when they are assessed as safe and ready to return to you, they will be brought back to you on the ward. If your CYP is unsettled or we feel they will benefit by your presence we will always call you in, otherwise your CYP will return to the ward area to be with you and will be encouraged to continue to sleep off the effects of their anaesthetic.
Post operative care:
As your CYP may still be sleepy when you first see them back on the ward, they may also be disorientated, upset or tearful. These reactions are completely normal and vary from child to child, however they are often very short lived, and we will do everything to reassure and support you with this.
If your CYP is in pain or discomfort, additional pain relief can be given by your nurse, however, please do consult the nursing staff if you have any concerns.
Once your CYP is fully awake and your nurse and/or anaesthetist are happy you will be able to offer your CYP sips of drink. It is important your CYP has a drink first to ensure their airway and swallowing is safe. Once the nurse is happy that swallowing is safe it is important to resume eating and drinking.
Your CYP may be drowsy for the rest of the day, and some CYP will have another short nap to sleep of any ill effects. They may also want to carry on with day to day activities, however it is important to encourage quiet gentle activities and promote rest. Your nurse will advise you further on this.
Your nurse will make regular clinical observations and help you monitor your CYP until they are safe to be discharged home.
Discharge and follow up:
When your CYP is ready to be discharged home a nurse will go through all your post-operative instructions and follow up care. If they need any prescription medicines we will try to provide them from the hospital. It may be that we give you a prescription to take to a chemist.
A copy of your discharge letter will be sent to your registered GP,electronically, if this is not the case because you live out of area we will provide an additional copy and ask you to drop this in with your GP at your earliest convenience. Any appropriate supporting information leaflets will also be given to you.
A follow up appointment may be made for your child to return to see your consultant or registrar; this appointment will be given to you or sent to you by post.
How you can help us:
Please contact us if your CYP is unwell or you are unable to make your appointment.
If you or your CYP has any questions or concerns whilst you are here please speak to your nurse in the first instance or alternatively please ask to speak to the Nurse in Charge, who will be happy to help.
This Trust routinely surveys parents and CYP views to improve services. We kindly ask you to please fill in your ‘Friends & Family’ Feedback forms at the end of your stay and either leave this on your bedside, or pop this into the collection box on the ward desk. We are always happy to listen to suggestions and ideas from parents and children that may help us to improve our service.