Annex A > Chapter 13 - Pre-operative Care > Pre-operative management of care > The management of pre-operative care at the BRHSC
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The management of pre-operative care at the BRHSC
13 In relation to the pre-operative care of children at the BRHSC, Dr Jordan explained that sick infants would be nursed in the paediatric ICU established in 1985:
`The unit was managed medically by a group consisting of the paediatric cardiologists, anaesthetists and Dr [Professor] Fleming from St Michael's Hospital, acting as a paediatric intensivist. The paediatric senior registrars ("SRs") and SHOs also contributed. Latterly specific parts of paediatric SHO posts were devoted to the ITU but prior to that one or more SHOs at any one time combined work there with other duties. For the last few years, I believe that Dr Hughes, one of the anaesthetists, was in administrative charge.
`The main amount of regular attendance was at two fixed rounds each day, 8:30 and 17:30 (including Saturdays, Sundays and Bank Holidays) at which we made every effort to see that at least one cardiologist was present. There was usually a consultant and SR anaesthetists and the paediatric SR on call for that day. Dr Fleming also came regularly. In addition there were the SHOs with responsibility on the unit. The paediatric consultants did not usually come on these rounds but attended later, fitting in with their other duties, as did the paediatric surgeons. Obviously, if there was a cardiological problem at other times the cardiologist would be called and we were able almost always to ensure that the duty cardiologist was in the hospital or available from home.
`Although they operated at the BRHSC on a regular basis (every Monday morning and some Wednesdays, all day) and saw their patients on return to the ITU from theatre, the cardiac surgeons were less often available than the cardiologists. Initially some decisions such as when to remove chest drains were left to the surgeons, but increasingly were taken by cardiologists or other staff (there were no cardiac surgical junior staff at BRHSC) ... We also, from an early stage, had echo-cardiography available and this was useful not only for diagnostic purposes but also to guide treatment for example by assessing left ventricular performance or pulmonary hypertension. This of course also applied to non-cardiac patients nursed on the unit to whose management the cardiologists also made a contribution.' [15]
14 Dr Jordan told the Inquiry about the equipment and staff available to the cardiologists to enable them to care for patients, including the management of pre-operative care:
`From 1987 onwards we had proper diagnostic equipment for angiography and echo-cardiography.' [16]
`In the early 1980s, children were catheterised in the BRI which, apart from having to transfer a child from BCH and back, was inappropriate for children. The angiography equipment was uniplane which meant that twice the number of contrast injections was required to obtain all the necessary views. The cardiac catheterisation suite which opened in the BCH in 1987 was "state of the art" at that stage, and functioned well until 1995.
`We struggled to acquire suitable echo-cardiography equipment during the early 1980s and it was only through the financial support of charitable organisations that we were able to purchase a 2D echo-cardiography machine in about 1984, and a second in about 1989. The situation improved after Trust status, when we acquired our third machine, in lieu of the outmoded first apparatus. We were always short of cardiac technological staff and, throughout 1984 to 1995, we shared technicians with the adult cardiac catheterisation service at the BRI. It was only in this way that we could ensure that, for emergency catheterisation after hours, there would be someone on call who was familiar with the BCH equipment.
`The paediatric cardiologists performed all echo-cardiography procedures themselves until the late 1980s, when we were able to appoint our first echo-cardiographic technician with financial help from the paediatric oncology department for whom we provided a regular service. In the early 1980s, the paediatric cardiologists reported on all angiograms as part of the cardiac catheterisation reports. This was taken over by Dr Wilde, consultant cardiac radiologist in the mid-1980s and his overall advice and assistance was most welcome. By the early 1990s he became overwhelmed by the demands of adult cardiology and was no longer able to participate in the angiographic procedures himself, but still reported on the angiograms.' [17]
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Footnotes
[15] WIT 0099 0040 Dr Jordan
[16] WIT 0099 0043 Dr Jordan
[17] WIT 0097 0306 - 0307 Dr Joffe