To be nervous about my child having an operation in a private hospital

[elliejjtiny]

Tbh I'm nervous about this operation in general and we've known since he was born that he would have to have this operation and he is now 10 so that's a lot of nerves.

Ds is 10 and has had lots of operations already (20+, I lost count in the end). This one is quite major and he will be in theatre for 3 hours. Ds's normal surgeon is off sick for the foreseeable future so they've brought in another surgeon. We have met him and he seems nice but he does his operations in the private hospital, including the nhs patients, rather than in the children's hospital where ds's usual surgeon works.

For his first operation, which is similar to this one and the same length, ds needed to be in hdu for a few hours afterwards as he took longer to wake up than expected. The private hospital doesn't have a hdu for children, just 3 adult icu beds so he would have to be transferred to the children's hospital about 15 minutes drive away if he needed hdu. The surgeon said if he'd needed hdu in his last operation then this one would be done at the children's hospital just in case but as he has had other operations in between them it wasn't necessary. I asked if he could have the operation at the children's hospital anyway for my peace of mind and was told no. At his last operation (which was also 3 hours) he was really sick multiple times despite having the max dose of ordansetron. He was in the day surgery unit of our local hospital and they sent him home after an hour on the ward, still vomiting and so sleepy that he had to be brought out to the car in a wheelchair. I told the surgeon this and he said the private hospital can cope with that.

Ds is actually quite excited about the operation, mainly about having time off school, being fussed over and getting ice cream afterwards. Obviously I'm not letting him see I'm worried. My in-laws keep saying that it's great that we're in a private hospital and I should be grateful etc and I am but tbh I quite liked being on a ward last time with other children having the same operation. Also I would feel safer at the children's hospital. Ds also has learning disabilities which makes me nervous and he usually has a play therapist go down to theatre with him. We also always know the staff at our local hospital and the children's hospital which I always find reassuring. He has had a few operations where they have had to put him under kicking and screaming and I'm scared of potentially having to do that without help from the play therapist. I know they have peadiatric nurses at the private hospital but not sure about play therapists etc.

No experience of children in private hospitals, but I was sent to a private for an op last year. It was nothing like NHS, the standard of care was so much higher. Because it was all planned operations and no emergency care everything was smooth and very well organised. There seemed more staff than patients - they really looked after me. They looked after my partner while I was in theatre and the food was great. I hope everything goes well for your son and for you.

The surgeon said if he'd needed hdu in his last operation then this one would be done at the children's hospital just in case but as he has had other operations in between them it wasn't necessary

Wasn't necessary or wasn't possible?
Can they not reschedule your son's op for a time that means it can be done in the children's hospital?

I don't know about the other things, but as a hyper vomiter after surgery I have to say that when I had surgery in a private hospital they really listened and when the written up drugs weren't enough they were able to get someone to write up alternatives within minutes. And though I was booked for day surgery, they kept me in to control pain and vomiting

My treatments have always been much better in private hospitals. More staff, better care, better food etc.🙂

Unfortunately they can't as it would have to wait until his usual surgeon was back which could be a long time. The operation needs to be done in a certain time frame really, preferably between the ages of 7 and 10. They are still working through the delays of covid and ds has been on the waiting list for 2 years already.

I really understand your stress and worry.

I think you need to ask them more about the HDU aspect, explain you are afraid and ask them specifically how they will protect your child - will they have what is needed to make a safe transfer to the children's hospital?

But sometimes we don't have the perfect option available, and it sounds like you are in one of those situations now. Always tough, but presumably waiting has risks too?

Private hospitals have a heavily invested interest in not taking cases with any significant risk of complications. If they injure a child through inadequate precautions this could be devastating to their reputation and have a direct effect on the all-important bottom line.

There is no chance your surgeon would be considering his approach if it placed your son at risk. On this occasion I think you need to trust the dedicated medical staff who will be monitoring his condition like a hawk.

Private hospitals don't often have HDU/ICU wards (though some do) but they do have the essential parts of it - namely anaesthetists, nurses and other HCPs - so can still provide level two care until a transfer can be arranged.

YANBU

I would be wary of having an op (even a minor one) carried out in a hospital that didn't have hdu facilities.

If he needs HDU level care when he wakes up, they will have no qualms about transporting him to the other hospital and he will go with a full transport team. They won’t move him out of recovery if that’s the case as anaesthetics is like a little mobile ITU anyway.

It sounds scary but it sounds like the operation needs to happen and you can talk to the anaesthetist on the day and they will be Uber cautious

I totally understand your worries. You’re right they won’t have the same paediatric infrastructure as the children’s hospital. No paeds pharmacist. No paeds HDU/specialist intensivist and doctors if anything were to go wrong. Ask what paediatrician will be on site with responsibility for your son while he has his operation and recovery. They need to have a consultant paediatrician available at all times. Ask about the nursing staff, often they just bring in paeds nurses as agency in private health. Unless they have a dedicated paeds ward and then you should be fine. The anaesthetist will need to be a paediatric anaes but check. Private healthcare is great for adults but less so for children because the specialist staff and equipment are rarely on site. The child doesn’t get best care if anything were to go wrong. It’s very unlikely they will have play staff.

OK, so definitely ask them how they will keep him safe.

As PP says it will not be in their interest to take risks.

If there is a hdu bed available, does the NHS hospital do private paediatric work?

It’s all very well everyone saying how great the level of care is in a private hospital, but the point is that if you need HDU care unexpectedly, then that is far more important than nice food and relaxed nurses, and it simply doesn’t exist in many (most?) private hospitals.

I would share your concern OP, having a child who has had multiple surgeries in NHS care. But as I understand it a planned surgery is less likely to develop into a crisis than an emergency condition, and they do have a plan for an emergency transfer should it be needed. In our huge hospital it could take 15 mins to get to HDU anyway.

Also I’m not sure a longer anaesthetic is too much of a concern if he has tolerated anaesthetic previously. My Dc had a couple of 5 hour surgeries and recovery from the anaesthetic was about the same as from the quick ones. Lots of big deep breaths helps get the gases out of the system.

Anyway, good luck with whatever you decide. It’s good your Ds isn’t anxious. My Dc never was, particularly, but it never gets easier for us parents!

The level of care/attention in a private hospital is likely to match an NHS HDU.
would he have a private room? Otherwise I would worry about his additional need/being in ward with adults.

I do understand your worries, and although I've not been in your position, I personally have had quite major surgery in a private hospital. It was a waiting list initiative, and I was sent to a specialist private hospital, and had a 4.5 hour surgery. I was anxious beforehand, and the anesthetist was the loveliest man in the world, ad really spent time to put me at ease. I was in HDU overnight, after the surgery, and was very well looked after. I was in for 6 days, and I would say the main difference was that there were enough staff. The care was more attentive. (Also, the food was better, and having a private room meant I actually got rest/sleep.) I know private hospitals have arrangements in place, in case they need to do an emergency transfer to another hospital.
I do hope that they can put your mind at rest, and your son can get the surgery he needs - and that it is successful!

If he’s likely to need HDU and pass HDU is not available then the anaesthetist will most likely be the one with the deciding vote. Might be worth seeing if you can speak to them pre-op or find out what the set-up is for preassessment at the private hospital. Private hospitals are generally very risk averse so if they all agree it’s feasible to do it there then it probably is. HTH.

My mum used to work at a private surgical hospital and said as good as it was, she would never send her family there as there was no intensive care so anything that went wrong had to be blue-lighted to the nearest NHS hospital anyway. And sometimes, every second counts.

Awww I get you OP. In the kindest possible way to the adults comparing their private surgery, it's not the same for paediatrics. Just having a play therapist, familiar nurses, safety of a childrens hospital, HDU means a lot. Hugs from another medical Mum xx

Thank you everyone. I have to admit the menu looks so much nicer than the nhs. Although ds will be on a very soft food diet for a few weeks post op so he won't be able to appreciate it much unfortunately. If he had to be transferred to hdu at the other hospital would the private hospital have its own ambulance or would they have to phone 999 and wait goodness knows how long? Ds has had his pre op already (actually he has had 2, one with his usual surgeon 2 years ago and one this week with the new one) and we didn't get to see the anaesthetist, just the surgeon and then ds had his x rays done again because the old ones were now out of date.

I don't think so. The surgeon said that he doesn't do operations in the children's hospital, only the private hospital because there is a risk of the operation being cancelled at the children's hospital. So if he can't have it done at the private hospital he will have to wait until his original surgeon comes back to have it done at the children's hospital. It's quite a specialised operation so there aren't many surgeons who do it. We have to travel about 1 hour 30 minutes which is a pain, especially if you are on the morning list but there are lots of people who have to travel a lot further.

It will be fine. I used to work in adults ICU and several times the lead consultant would get a phone call from the private hospital to say that they thought their patient needed HDU and could they admit? Planned transfer via non-urgent ambulance, all very organised and everything ready for arrival.

There are paediatric recovery teams and all anaesthetic rooms are essentially equipped in the same way as ICU. Adult ICUs can hold paediatric patients for a few hours until paediatric ICU is ready, anyway.

Ultimately, the anaesthetist wouldn't agree to give your DS an anaesthetic if they thought there would be a problem. They would just refuse.

Thank you. Feeling a bit more reassured. He will have his own room and bathroom so not sharing with adults. Just need to ignore in-laws who have now stopped telling me how lucky we are to be going to a private hospital and are now marvelling about how little time we have to wait now. Surgeon says hopefully by end of March. Which I agree isn't far away. But ds has been on the waiting list since November 2021. I know some people have it worse but we are hopefully in the home stretch of a very long wait. And we've also been told that it should only be a couple more months to wait 3 times so far so I'm not holding my breath that it really will be a couple of months. I really hope it won't clash with starting secondary school as that's not the best time to have 6 weeks off school.

Is the anaesthetist even aware of his history, or is the surgeon just bring blithely reassuring? I'd be a lot happier if you had met the anaesthetist at the preop.

I’d follow up and ask all the questions that you want and if you really want, ask for a second opinion. It’s really good that you are taking such care to check that your child is going to be receiving good treatment and aftercare. I have a child needing surgery soon and it will also probably be private, no real option not to unfortunately. I will be looking up the surgeon and asking a million questions also!

Paediatric nurse in a children's hospital here. I would not be happy with that. Particularly as he has needed HDU post op in the past. Private hospitals are fine for minor stuff for children. But I wouldn't want anything more complicated done in one. One of our spinal surgeons did some surgery in our local one, to try and cut waiting lists. Their staff didn't had any experience in it and they were offering shifts to our staff. The arrangement didn't last long. Could you ask for a referral to another consultant? Or ask that he's operated on on a different list?