Utilization of operating theatre time is an important issue in neurosurgery, in a National Health Service Hospital. NHS Trusts are under ever increasing pressure to meet specified 'targets' in relation to admissions and operations. We performed a retrospective audit on the utilization of neurosurgical operating theatres at Royal Preston Hospital, analysed the times required for various common neurosurgical operations, and broke them down into clinical (operating and anaesthetic) and non-clinical times. We have also looked at the adequacy of available theatre sessions, and the under or over-running of available theatre sessions. A detailed time-based evaluation of 810 procedures over a 16-month period is presented. The mean and 80th centile of the time taken for anaesthesia, surgery and other non-clinical activities are described along with the total time spent in theatre for common neurosurgical procedures. The mean times for transit, preparation for anaesthesia, preparation for surgery, recovery in theatre and time between cases were 16, 13, 14, 15 and 8 minutes, respectively. The mean time duration between the end of one surgical procedure and the beginning of the next was 101 minutes. It was found that actual operating time was surprisingly only 56% of the time available. These data could be used to schedule operating theatre sessions for neurosurgery in the UK, as we believe our practice to be representative of a majority of units in the country.

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Acute ischaemic stroke (AIS) is an important cause of disability and death in children. It affects 1.2-8 children per 100 000 per year, and almost 70% of survivors have significant ongoing disability, resulting in reduced quality of life, increased care requirements for families, and cost. 1 Reperfusion therapies, which include intravenous thrombolysis and endovascular clot retrieval (ECR), are established as effective to improve long-term outcomes of adults with AIS. Paediatric stroke consensus guidelines allow for reperfusion therapies in children, but access is currently limited due to diagnostic delays. 2

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Aim The risk of serious illness in febrile infants (<60 days old) is high, and so fever often warrants aggressive management. Infrared thermometers are unreliable in young infants despite their ubiquity. We aim to describe the: (i) frequency of infrared thermometer usage; (ii) progression to documented fever in the emergency department (ED) and (iii) rate of serious illness (meningitis, urinary tract infection and bacteremia). Methods In this single‐centre retrospective chart review at The Royal Children's Hospital, Melbourne, we audited medical records of infants (<60 days old) presenting to the ED with pre‐hospital fever on history over a 12‐month period. We described the type of thermometer used at home (tympanic or forehead, ‘infrared’ vs. axillary or rectal, ‘direct’) correlated to peak temperature in ED, investigations, treatment and diagnosis. The primary outcome was subsequent fever in ED. Results Of 159 infants, two of three had infrared temperature measurement at home. Fifty‐one (32.1%) developed fever in ED (direct 28/54, 52% vs. infrared 23/105, 22% RR 2.36 (95% CI 1.52–3.69)). Investigations (75%) and admission (60%) were common. Pre‐hospital fever alone was less likely to be associated with serious illness, with fever in ED a much stronger predictor. Conclusions In young infants, infrared thermometer use is common and less likely to predict subsequent fever. Twenty‐two percent of infants with fever via infrared measurement had fever in ED. History of fever without confirmation is less likely to signal serious illness. Education to public and health‐care providers is required to avoid usage of infrared devices in this population.