Centralisation of paediatric services: assessing impact in suspected testicular torsion
BAUS ePoster online library. Zimmermann E. Jun 26, 2018; 211358
Ms. Eleanor Zimmermann
Ms. Eleanor Zimmermann
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Abstract
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Introduction: In our Trust, paediatric services were recently centralised to a single unit within our multi-site configuration - 17 miles from the Urology Centre. We analysed the impact of this change on the management of patients with suspected testicular torsion. We examined referral numbers, time to specialist assessment, 'knife-to-skin' time, surgical findings and need for orchidectomy.

Methods: Using a comprehensive electronic database we conducted a closed loop audit on suspected testicular torsion outcomes over two 12-month periods, pre and post paediatric centralisation (2015 and 2017).

Results: We observed that the 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). There was no significant difference in time from presentation to 'knife-to-skin' overall: 195 mins vs 227 mins, p=0.20, or in the paediatric population: 211 vs 210 mins, p=0.95. Overall, five patients exceeded a 6-hour target of 'knife-to-skin' time during 2015 compared to one in 2017. There were in total 6 vs 4 confirmed torsions on exploration - all testes were viable. No orchidectomy was required in either period of analysis.

Conclusion: Since paediatric services have been centralised away from our Urology Centre there has been a reduction in patients breaching the 6-hour target. This may reflect a reduction in patient transfers, with Urological surgeons travelling to the new paediatric site. Total numbers of referrals have fallen which may indicate a shift of some patients to neighbouring units.
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