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 child or young person, 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 who can help familiarise your child 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.

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, sleep wear, toothbrush/paste, special/favourite toy, pacifier if required, 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 & 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.

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. During this pandemic we are politely requesting one adult/carer 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 be drowsy after their operation, our requirements are that there are two responsible adults to escort your child home, and keep them safe.

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 children 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 strict information to guide you with this. If you are unsure please phone the ward 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.

Parent/carer involvement:

Research has clearly shown that children 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.

We therefore work in partnership with you and your child and aim to fully involve you and, where appropriate, your child in all aspects of care planning and delivery, negotiating what input and support you wish to have.

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. They will complete some 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. We will endeavour to 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, Books, Colouring, and an assortment of toys. We are happy for you to bring your CYP favourite toy with them, however we cannot accept responsibility for any loss or damage occurred to your property whilst you are with us.

Your child will be required to wear two identification bracelets to wear during their stay.

After admission from our paediatric ward nurses, you and your CYP will be seen by a Doctor, and an Anaesthetist, who will also check your admission details. They may carry out a brief physical examination of your CYP, your privacy and dignity will be maintained.

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.

The team will also talk with you about the proposed treatment and ask you to agree sign consent; 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 where possible encourage CYP to also sign their consent form if they wish.

Should your CYP need any additional tests like x-rays and blood tests, the ward staff will direct you to where these take place or accompany you and your CYP to them.

If your child has to have an operation or painful or frightening procedure performed, our staff are experienced in helping support you and your CYP with this. This is always done tailored to individual need, and we have Health Play Specialists who can also help. Explanations at individual level can be offered, explaining sensitively and truthfully what is going to happen. This can be done with the help of photographs and by showing them pieces of medical equipment that they may encounter. They do not go into gross details about the actual operation or procedure, unless desired. Play is an important part of this process, and we have a variety of play items useful for 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/care will be able to be with your CYP whilst they go to sleep. Diversional play is encouraged to dissuade any anxieties, and we will support you and we are happy for your assistance with this. 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 safely asleep you will be escorted back to the ward area to wait for them.

It is expected your CYP will be asleep for at least 1 hour; this does not take into consideration of your CYP 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.

A complimentary tea/coffee or cold drink will be provided once your CYP is safely asleep. 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.

Recovery room:

Once your CYP surgery is finished, they will be transferred to our 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.

Post operative care:

Your CYP may still be sleepy when you first see them back on the ward, and they may be disorientated, upset and tearful. These reactions are completely normal but do vary from child to child, and are common short lived after effects of the medications they have received.

If your CYP is in pain or discomfort, additional pain relief can be given by your nurse.

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 not compromised. Once the nurse and you are happy then it is important to resume normal diet, although caution must be given not to over feed your CYP as a small percentage of CYP are nauseous and may vomit after their procedure. Keeping to small light diet helps avoid this.

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. Regular clinical observations will be measured

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, or you may decide to purchase over the counter medication yourself.

A copy of your discharge letter will be electronically sent to your registered GP. 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 and either leave on your bedside, or pop into the collection box on the ward desk. We are always happy to listen to suggestions and ideas from parents and children.