Background Most paediatric surgical centres are located in major regional hospitals and are refusing at least 10–20% of neonatal referrals because of lack of surgical cots,1 necessitating the transporting of sick neonates considerable distances from home for surgery and imposing added anguish and hardship on their families. Where the surgical centre is not co-located with maternity services, as is the case with some Children's Hospitals, surgical neonates are cared for by neonatal staff with varying degrees of surgical experience.

Aims

• ▶ An increase in surgical cot capacity.

• ▶ Quality of care and outcomes for surgical neonates on a neonatal unit (NNU) are commensurate with those in a surgical centre.2

Issues and solutions Before establishing the outreach service, clinical leads, nurse managers and parents on NNU's were asked for their views on the shape of an effective and inclusive surgical service. Reducing length of stay in a surgical cot requires delaying transfer pre-operatively in some cases, and transferring back to the NNU sooner post-operatively than would previously have happened. This change in practice requires the support of the Surgical Outreach Nurse for staff and parents on the NNU.

Achievements

• ▶ A reduction in out of region transfers: April 2009–March 2010 24 patients.

• ▶ April 10–August10 – 6 patients.

• ▶ September 10–December 10 – 0 patients.

• ▶ Production of surgical care guidelines and an education programme for NNU and Transport Staff.

• ▶ Improved communication between surgeons, neonatologists and parents.

• ▶ Data collection for audit.