Changes in Surgery over 46 years A personal perspective Robin Souter Milton Keynes.
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Transcript of Changes in Surgery over 46 years A personal perspective Robin Souter Milton Keynes.
Interventional/diagnostic radiologyVascularNeuroBreastGeneral/hepatobiliaryMR scansCT scansDigital imagesImage transfer
Astonishing general changes
Public HealthEpidemiology Doll and HillGenetic understanding - Double helix-
human genomeOrgan transplantation- immunosupressionJoint replacement
General public
Expectation LitigationPolitical interferenceInternet trawlersUnderstanding/misunderstanding
NDS Oxford5 years in a fast developing environmentEmbryonic day surgeryJulian Britton LA day case hernia repairs in
Abingdonfacility availableexpediencyday case nylon darn hernia repairs
Jean Miller in the Churchill hospital “Do not use opiates”
MK HospitalConcept
2/3 patients treated locallyremainder to travel to Northampton and Stoke Mandeville1.6 beds:1000 population2.4:1000 national norm
Concept fatally flawed!
Partial solution – move to day case surgery
Portakabin 1985. Fight for pipes!Mainly paediatrics and scopesCore enthusiasm for day care surgeryOriginal protocols extremely cautious
Milton Keynes HospitalGreen field site opened April 19841.6 beds/1000 populationNational norm 2.4/1000Concept 1/3 of patients continue to travel
to Northampton or Stoke MandevilleConcept doomed to failure
Drivers for change
RCS working partiesAudit commissionPoliticiansVFM BADS directory “aspirational targets”Improved techniques
Surgery/anaesthetic/analgesiaPublic wish
Public issues
Concerns about hospital cleanliness and outcomes
Worries about chaotic in patient wards- mixed sex, mixed elective emergency care
MRSA/ C.diff. (we were warned!!!)
Where am I now?Ramsay NHS ISTCBlakelands, Milton Keynes
ISTC NHS treatment centre Day case surgery onlyTIVAEnhanced recovery / Australian model
hernia repair 4 hours door to door!Careful follow up and auditHigh patient satisfaction