Paediatric Heart Surgery waiting time at Lady Ridgeway children's Hospital in Sri Lanka- The National Center for Paediatric referral: A case study.2019

Abstract

Background: Paediatrics Cardiology is one of the most rapidly advancing fields in Sri Lanka. This advancement is not only in depth where it has advanced from simple to more complex lesions but also in breadth where it has advanced in the percentage of patients it could treat from a minority to a majority. However, we still have waiting lists and patients dying of cardiac conditions while awaiting surgery. Material and Method: A Case study to identify the causes for long waiting list at the main cardiology referral center in Sri Lanka, The Lady Ridgeway Hospital (LRH) performed using available medical record data at the hospital and key informant interviews. Root Cause analysis done to identified the main problems which give rise to long waiting list. Results: On the average, we see 10,000-12,000 new referrals every year. In addition, they have follow up patients which amounts to another 20 000 per year. As they do an echocardiographic assessment in almost all patients, LRH perform approximately 25,000 echocardiograms each year. There is no waiting list for assessment as we do not give appointments for first visits. There are 45 beds in cardiothoracic wards and 14 beds in cardiothoracic ICUs. Annual admission for the cardiothoracic surgeries are around 1500 during 2018.They have performed 1500 cath lab interventions and 952 open and closed heart surgeries during year 2018. Currently there are 4 cardiothoracic surgeons and 4 cardiothoracic anesthetics perform duties. Lack of human recourses facility and infrastructure facility give rise to long waiting list. Current waiting time varies with 6 months to 18 moths periods. Conclusion: Waiting time for cardiac surgery for children in LRH is long and should be viewed as a problem in public health policy. Depending on the type and severity of the disease seen attempt should be made to solve this problem at the national level by increasing human resources and develop the infrastructure facility.