Restructuring services to reduce waiting times and prevent complications: Neonatal inguinal hernias at Bristol Children's Hospital

Inguinal hernias are a common problem amongst neonates, and a potential source of significant morbidity through incarceration of the hernia. Expedited surgical repair can prevent incarceration and reduce complications. The department at Bristol Children's Hospital aimed to minimise waiting times for surgery thereby reducing incarceration and complication rates. This paper aims to examine how this was done.

Bristol Children's Hospital provides local and regional (tertiary referral) services. Retrospective audit of waiting times from referral to surgery was performed against the departmental standard of four weeks. Data were collected on frequency of incarceration and any complications. Following service restructure, second cycle audit was performed to assess the impact of change.

First cycle audit (n=74) found median waiting time 20 days, (Mean 28.4 days, Range 0‐138 days). A total of 28 per cent of patients waited longer than the target four weeks from referral. Incarceration occurred in 13 per cent of patients awaiting surgery. Two patients (2.7 per cent) experienced complications. Following service restructuring second cycle audit (n=28) found waiting times were significantly reduced (median two days, mean 7.0, p<0.0001). Only 7 per cent of patients waited over four weeks for surgery. There were no incarcerations or complications.

This study demonstrates a successful model of service for management of neonatal inguinal hernias which could be adopted at children's hospitals throughout the UK.

This study highlights a successful audit process, in which the extent of a problem is quantified and analysed, strategies for improvement are identified and implemented, and second cycle audit confirms the impact of change and an improved service.