Dimension: Access and Patient Flow (A+PF)

Rationale for measurement

Overcrowding within ED negatively impacts on both dignity and privacy for patients and the ability of staff to deliver fully effective care / treatment. Related international studies have also demonstrated extended length of stay within overcrowded EDs leads to poorer clinical outcomes for concerned patients.

Measurement methodology and data sources

  • data refers to the daily number of patients on trolleys in ED, at 8.00am daily, as recorded by the hospital (TrolleyGAR)
  • data set is provided by BIU – HSE

Target

The following daily targets were set by the HSE Acute Hospital Division:

  • Beaumont Hospital: 12
  • Cavan General Hospital: 8
  • Connolly Hospital: 8
  • Our Lady of Lourdes Hospital: 12
  • RCSI Hospital Group: 40
  • National: 228

Performance

Beaumont Hospital

  • 200% increase in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (total count increase 23% n=221 Jan-Apr)
  • performance improvement commenced in July 2016 generally maintained during 2018 reporting period
  • an average daily count value of 12 demonstrated for April 2019 (Target 12 equalled)

Cavan General Hospital

  • performance maintenance in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (performance maintenance n=1 Jan-Apr)
  • an average daily count of 3 demonstrated for April 2019 (Target 8 surpassed)

Connolly Hospital

  • 44% reduction in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (total count reduction 41% n=507 Jan-Apr)
  • an average daily count of 5 demonstrated for April 2019 (Target 8 surpassed)

Our Lady of Lourdes Hospital, Drogheda

  • 17% reduction in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (total count reduction 35% n=463 Jan-Apr)
  • an average daily count of 5 demonstrated for April 2019 (Target 12 surpassed)

RCSI Hospital Group

  • 9% increase in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (total count reduction 20% n=750 Jan-Apr)
  • an average daily count of 24 demonstrated for April 2019 (Target 40 surpassed)

National Performance Comparator

  • 7% increase in average number of patients awaiting ward bed accommodation in ED 2019 / 2018 for April (total count reduction 7% n=3011 Jan-Apr)
  • an average daily count of 319 demonstrated for April 2019 (Target 228 not achieved)

Rationale for measurement

International studies have demonstrated extended length of stay within overcrowded EDs leads to poorer clinical outcomes for patients.

Measurement methodology and data sources

  • Data extract from hospital site patient administration system (PAS), extrapolated by HSE Business Intelligence Unit, measuring for all ED attendances the length of time spent in the Emergency Department.

Average time spent in ED – non admitted / admitted

Target

  • 100% of patients admitted / discharged from ED within 24 hours

Performance

Beaumont Hospital

  • the average time spent in ED for admitted patients has increased by 33% from reporting month 2018 (12 hours) to reporting month 2019 (16 hours)
  • the average time spent in ED for non-admitted patients has increased by 17% from reporting month 2018 (6 hours) to reporting month 2019 (7 hours)

 Cavan General Hospital

  • the average time spent in ED for admitted patients has reduced by 20% from reporting month 2018 (10 hours) to reporting month 2019 (8 hours)
  • the average time spent in ED for non-admitted patients has remained constant from reporting month 2018 to reporting month 2019 (4 hours)

Connolly Hospital

  • the average time spent in ED for admitted patients has reduced by 20% from reporting month 2018 (15 hours) to reporting month 2019 (12 hours)
  • the average time spent in ED for non-admitted patients has remained constant from reporting month 2018 to reporting month 2019 (5 hours)

Our Lady of Lourdes Hospital, Drogheda

  • the average time spent in ED for admitted patients has remained constant from reporting month 2018 to reporting month 2019 (9 hours)
  • the average time spent in ED for non-admitted patients has remained constant from reporting month 2018 to reporting month 2019 (5 hours)

Target

  • 100% patients admitted or discharged or non-admitted from ED within 9 hours

Performance

Beaumont Hospital

  • April 2019 74.2% compliance with 9 hour non-admitted PET / 19.9% compliance with admitted PET

Cavan General Hospital

  • April 2019 93.7% compliance with 9 hour non admitted PET / 62.0% compliance with admitted PET

Connolly Hospital

  • April 2019 90.4% compliance with 9 hour non admitted PET / 38.8% compliance with admitted PET

Our Lady of Lourdes Hospital, Drogheda

  • April 2019 86.2% compliance with 9 hour non admitted PET / 61.7% compliance with admitted PET

RCSI Hospital Group

  • April 2019 84.7% compliance with 9 hour non admitted PET / 45.5% compliance with admitted PET

National Performance Comparator

  • April 2019 85.7% compliance with 9 hour non admitted PET / 54.3% compliance with admitted PET

Target:    

  • 100% of patients wait less than 24 hours in Emergency Department for ward bed accommodation

Performance

RCSI Hospital Group

  • Beaumont Hospital – Apr 2019 5.7% >24hours (1.2% Apr 2018) performance deterioration demonstrated
  • Cavan Hospital – Apr 2019 0.4% >24hours (0.2% Apr 2018) performance deterioration demonstrated
  • Connolly Hospital – Apr 2019 1.5% >24hours (6.4% Apr 2018) performance improvement demonstrated
  • OLOL Hospital – Apr 2019 0.9% >24hours (1.9% Apr 2018) performance improvement demonstrated

  • RCSI HG – Apr 2019 2.4% > 24hours (2.3% Apr 2018)
  • National – Apr 2019 3.6% > 24hours (3.9% Apr 2018)

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome for patients.

Measurement methodology and data source

  • Compliance % with <52 weeks waiting time. Periodic local data extracts submitted to NTPF extrapolated for analysis and publication.

Target

  • 100% patients waiting <52 weeks for new outpatient appointment

Beaumont Hospital

  • % of patients waiting <52 weeks on OPD wait list 86.6% (2019)

Cavan General Hospital

  • % of patients waiting <52 weeks on OPD wait list 78.7% (2019)

Connolly Hospital

  • % of patients waiting <52 weeks on OPD wait list 89.1% (2019)

OLOL Drogheda

  • % of patients waiting <52 weeks on OPD wait list 87.3% (2019)

Louth County Hospital

  • % of patients waiting <52 weeks on OPD wait list 96.7% (2019)

Rotunda Hospital

  • % of patients waiting <52 weeks on OPD wait list 91.5% (2019)

RCSI Hospital Group

  • % of patients waiting <52 weeks on OPD wait list 86.9% (2019) – overall RCSI demonstrating higher performance than national (see Comparator Graph)

National Performance Comparator

  • % of patients waiting <52 weeks on OPD wait list 69.3% (2019)

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data source

Number of adult patients waiting < 8 months for admission / attendance. Periodic local data submission to NTFP extrapolated for analysis and publications excluding patients with ‘to come in date‘ (tci) (NTPF – definition).

Target

  • 70% patients waiting <8 months for admission / attendance

Performance

Beaumont Hospital

  • Beaumont Hospital exceeded national target for 2019 monthly reporting period

Cavan General Hospital

  • Cavan General Hospital exceeded national target for 2019 monthly reporting period

Connolly Hospital

  • Connolly Hospital exceeded national target for 2019 monthly reporting period

Our Lady of Lourdes Drogheda

  • Our Lady of Lourdes exceeded national target for 2019 monthly reporting period

Louth County Hospital

  • Louth County Hospital exceeded national target for 2019 monthly reporting period

RCSI Hospital Group

  • RCSI HG exceeded national target for 2019 monthly reporting period

National Performance by Hospital Group Comparator

  • 4 Hospital Groups achieving national target. RCSI Hospital Group highest performing for Apr 19

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data source

  • periodic local data extracts submitted to the National Cancer Control Programme (NCCP), extrapolated for analysis and publication

Target

  • 95% of attendances whose referral was triaged as urgent by the cancer centre and attended or were offered an appointment within 2 weeks

Performance

Beaumont Hospital

  • Beaumont Hospital exceeded National Target set for 2019 reporting period (100%). National Performance (55.2%) did not achieve target.

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data source

  • % of patients attending the rapid access clinic who attended or were offered an appointment within 10 working days of receipt of referral in the cancer centre
  • Periodic local data extracts submitted to NCCP, extrapolated for analysis and publication

Target:

  • National Target Compliance is 95%

Performance

Beaumont Hospital

  • Beaumont Hospital exceeded National Target set for 2018 reporting period (100%). National Performance (91.0%) did not achieve target

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data source

  • % of patients attending the rapid access clinic who attended or were offered an appointment within 20 working days of receipt of referral in the cancer centre
  • Periodic local data extracts submitted to NCCP, extrapolated for analysis and publication

Target:

  • 90% compliance

Performance

Beaumont Hospital

  • Beaumont Hospital exceeded National Target set for 2018 reporting period (100%). National Performance (52.2%) did not achieve target.

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome for patients.

Measurement methodology and data source

  • Periodic local data extracts submitted to NTPF, extrapolated for analysis and publication

Target

  • 100% of patients identified a requiring urgent colonoscopy undertaken / offered appointment within 28 days

Performance

RCSI Hospital Group

  • 99.19% compliance within the RCSI Hospital Group for 2019 monthly reporting period.

National Performance

  • 99.73% compliance nationally for 2019 monthly reporting period

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data sources

  • Periodic local data extracts submitted to NTPF, extrapolated for analysis and publication

Target

  • 70% of patients identified as requiring routine GI endoscopy undertaken or offered appointment within 13 weeks

Performance

Beaumont Hospital

  • Beaumont Hospital is currently exceeding this target for reporting period (April 76.6% compliance)

Cavan General Hospital

  • Cavan General Hospital is currently exceeding this target for reporting period (April 99.8% compliance)

Connolly Hospital

  • Connolly Hospital is currently exceeding this target for reporting period (April 87.9% compliance)

Our Lady of Lourdes, Drogheda

  • Our Lady of Lourdes is currently exceeding this target for reporting period (April 89.3% compliance)

Louth County Hospital

  • Louth County Hospital is currently exceeding this target for reporting period (April 79.0% compliance)

RCSI Hospital Group

  • RCSI Hospital Group is currently exceeding this target for reporting period (April 85.0% compliance)

National Performance Comparator

  • Nationally this target is not being met for reporting period (April 52.3% compliance)

Rationale for measurement

Significant delay in accessing hospital services delays diagnosis and any necessary treatment commencement with potential for less than optimal outcome.

Measurement methodology and data sources

  • Monthly data provided by BowelScreen programme

Target

  • Minimum standard target is ≥90% of clients offered a colonoscopy appointment that occurs within 20 working days from when a client was deemed clinically suitable following pre-assessment / notification of positive FIT

Performance

RCSI Hospital Group – Per Month

Rationale for measurement

Beaumont Hospital is the National Referral Centre for Neurosurgery in Ireland. Neurosurgery concerns the operative and non-operative management of patients with disorders of the central and peripheral nervous systems. The specialty developed initially through the treatment of cranial trauma and intracranial mass lesions. Subsequent advances in microsurgical techniques, non-invasive imaging, neuro-anaesthesia, intensive care, image-guided surgery, and the introduction of sophisticated radio-oncological and interventional treatments have substantially enhanced and widened the scope of effective neurosurgical treatment. Delay in access to Unit can result in delay in treatment commencing with potential for less than optimal outcome for patients.

Measurement methodology and data sources

  • Beaumont is the National Neurosurgical Unit. Therefore data for Beaumont hospital only is represented.
  • Periodic local data extracts submitted quarterly and retrospectively extrapolated for analysis and publication.

 Targets

  1. 100% of patients triaged as Traumatic Brain Injury (TBI) admitted to Unit within 12 hours of acceptance.
  2. 90% of patients triaged as Grade I / II Sub-arachnoid Haemorrhage (SAH) admitted to Unit within 24 hours of acceptance.
  3. 90% of patients triaged as having a brain tumour are transferred to Unit within 5 working days / 7 calendar days of acceptance

 Performance

RCSI Hospital Group

  • 100% compliance with target achieved (National target of 100%)

  • 100% compliance with target achieved (National target of 90%)

  • 97% compliance with target achieved (National target of 90%)

Rationale for measurement

Significant delay in securing necessary diagnostic image report can delay primary diagnosis, treatment commencement or treatment review with potential for less than optimal outcome for patients.

Measurement methodology and data sources

  • waiting time from diagnostic order identification and diagnostic being undertaken (either GP or Consultant)
  • local site data sets extrapolated for analysis and publication, by definition excluding time staged diagnostic order requirements
  • national data sets not available at time of report publication

Target

  • Ultrasound < 3 months
  • MRI < 6 months
  • CT < 6 months

Performance

Beaumont Hospital

  • US 99.76% waiting < 3 months – Beaumont did not achieve target
  • MRI 98.01% waiting < 6 months – Beaumont did not achieve target
  • CT 100% waiting < 6 months – Beaumont achieved target
  • national performance currently not published

Connolly Hospital

  • US 100% waiting < 3 months – Connolly achieved target
  • MRI 100% waiting < 6 months – Connolly achieved target
  • CT 59.12% waiting < 6 months – Connolly did not achieve target
  • national performance currently not published

Cavan Hospital

  • US 100% waiting < 3 months – Cavan achieved target
  • MRI 97.93% waiting < 6 months – Cavan did not achieve target
  • CT 64.79% waiting < 6 months – Cavan did not achieve target
  • national performance currently not published

OLOL Hospital

  • US 63.48% waiting < 3 months – OLOL/LCH did not achieve target
  • MRI 84.38% waiting < 6 months – OLOL did not achieve target
  • CT 92.02% waiting < 6 months – OLOL did not achieve target (OLOL CT includes out-patients scanned in LCH under OLOL MRN)
  • national performance currently not published

RCSI Hospital Group

  • US 80.15% waiting < 3 months – Group did not achieve target
  • MRI 93.60% waiting < 6 months – Group did not achieve target
  • CT 85.95% waiting < 6 months – Group did not achieve target
  • national performance currently not published

Rotunda Hospital (not included in Group total – only Gynae scans)

  • US 72.40% waiting < 3 months – Rotunda did not achieve target

Rationale for measurement

Non-attendance of new patients for OPD appointment negates the ability to diagnose and treat and generally wastes clinical time. This wasted clinical time significantly adds to wait times for other patients.

Measurement methodology and data sources

  • periodic local data extracted and extrapolated for analysis and publication by HSE BIU
  • source for national data provided by BIU OPD MDR

Target

  • Less than 5% of new OPD bookings do not attend appointment

Performance

RCSI Hospital Group

  • cumulative for 2019 reporting period 13.2% of total new bookings (n=6,608) did not attend (DNA) scheduled appointments / 2018 14.0% DNA (n=7,013) – represents 5.8% decrease
  • Beaumont 2019 14.8% DNA / 2018 14.3% DNA
  • Cavan 2019 9.1% DNA / 2018 10.0% DNA
  • Connolly 2019 14.2% DNA / 2018 17.4% DNA
  • Louth 2019 11.7% DNA / 2018 11.6% DNA
  • Monaghan 2019 9.7% DNA / 2018 5.6% DNA
  • OLOL 2019 9.7% DNA / 2018 10.6% DNA
  • Rotunda 2019 14.3% DNA / 2018 16.2% DNA

National Performance Comparator

  • during April reporting period 13.0% of total new bookings (n = 11,107) did not attend scheduled appointment

Rationale for measurement

Internationally accepted guidelines on performance indicators for colonoscopy recommend monitoring of detection rates of suspicious lesions including polyps and adenomas.

Measurement methodology and data sources

The data is recorded at local hospital Endoscopy Units. It is subsequently reported into Conjoint Board in Ireland of the Royal College of Physicians and Royal College National Quality Improvement Programme in GI Endoscopy (EQI Programme) in collaboration with the National Cancer Control Programme.

Results are reported as colonoscopies with polyp detected expressed as a % of total colonoscopies per endoscopist.

Data Sources:

  1. https://www.rcpi.ie/quality-improvement-programmes/gastrointestinal-endoscopy
  2. National GI Endoscopy Quality Improvement Programme 2017-2018 Data Report, Conjoint Board in Ireland of the Royal College of Physicians and Royal College of Surgeons

Target

  • 20% of all colonoscopies have a polyp(s) detected.

Performance

4 = Our Lady of Lourdes Hospital (23%)
5 = Connolly Hospital (37%)
7 = Beaumont Hospital (32%)
15 = Cavan General Hospital (23%)
30 = Louth County Hospital (31%)
– All hospitals in RCSI Hospital Group achieved target

Rationale for measurement

Caecal intubation is defined as the passage of the tip of the colonoscope to a point proximal to the ileocecal valve so that the entire cecum is visualised. Caecal intubation rates (CIR) is a key quality indicator of colonoscopy. Caecal intubation can be expected to be difficult in 5%–15% of colonoscopies, but skilled colonoscopists should be able to apply techniques to overcome the difficulties in most of these instances and reach the cecum in ≥90% of all cases.

Measurement methodology and data sources

The data is recorded at local hospital Endoscopy Units. It is subsequently reported into Conjoint Board in Ireland of the Royal College of Physicians and Royal College National Quality Improvement Programme in GI Endoscopy (EQI Programme) in collaboration with the National Cancer Control Programme.

Results are reported as number of colonoscopies where the terminal ileum / caecum / anastomosis has been reached as a % of total colonoscopies per endoscopist.

Data Sources:

  1. https://www.rcpi.ie/quality-improvement-programmes/gastrointestinal-endoscopy
  2. National GI Endoscopy Quality Improvement Programme 2017-2018 Data Report, Conjoint Board in Ireland of the Royal College of Physicians and Royal College of Surgeons

Target

  • 90% of all colonoscopy cases should reach the terminal ileum/caecum/anastomosis

Performance

4 = Our Lady of Lourdes Hospital (90%)
5 = Connolly Hospital (94%)
7 = Beaumont Hospital (92%)
15 = Cavan General Hospital (97%)
30 = Louth County Hospital (92%)
– All hospitals in RCSI Hospital Group achieved target

Introduction

Elective day surgery is the admission of selected patients to hospital for a planned surgical procedure who return home on the same day. Elective day surgery benefits patients as they receive treatment that is suited to their needs and allows them to recover in their own home. In addition the risk of patients contracting a hospital acquired infection is reduced. Elective day case surgery releases inpatient beds for major cases, this improves throughput of patients and reduces waiting lists.

Rationale for measurement

75% of elective admissions on each of the 24 procedures identified can be carried out as day cases (National Elective Surgery Programme, Royal College of Surgeons in Ireland, Irish College of Anaesthetists and Health Service Executive).

(Orchidopexy, Circumcision, Inguinal Hernia Repair, Excision of Breast Lump, Anal Fissure Dilatation or Excision, Haemorrhoidectomy, Laparoscopic Cholecystectomy, Varicose Vein Stripping or Ligation, Transurethral Resection of Bladder Tumour (<2cm), Excision of Dupuytren’s Contracture, Carpal Tunnel Decompression, Excision of Ganglion, Arthroscopy, Bunion Operations, Removal of Metal-ware, Extraction of Cataract with/without Implant, Correction of Squint, Myringotomy, Tonsillectomy, Sub Mucous Resection, Reduction of Nasal Fracture, Operation for Bat Ears, Dilatation and Curettage/Hysteroscopy, Laparoscopy).

Measurement methodology and data sources

Local Hospital HIPE Data extrapolated for analysis and publication and published on a quarterly basis.

Target

75% of elective admissions on each of the 24 procedures identified are carried out as a day case.

Performance

  • 78% of procedure basket undertaken on a daycare basis – overall target achieved

Rationale for measurement

Four key reasons may cause delay in patients receiving timely diagnosis and treatment and can also waste clinical treatment time:

  • tardy recording of patient details onto scheduled care waiting list record (OPD / IP / DC)
  • absence of advance patient notification in regard to intended scheduled care: OPD appointment / Day Care attendance / Inpatient admission date
  • incomplete patient specific minimum data set record
  • non-compliance with Hospital Group policies in regard to patients not being able to attend (CNA) scheduled OPD appointment / Day Care attendance / Inpatient admission date or patients who do not attend (DNA) scheduled OPD appointment / Day Care attendance / Inpatient admission (see 3.12)

Measurement methodology and data sources

  • periodic sampling (taken on a monthly basis) of Hospital Group ‘waiting list’ data sets to ascertain:
    • time period from receipt of GP referral letter / treatment requirement identification and waiting list record entry
    • advance patient notification in regard to intended scheduled care: OPD appointment / Day Care attendance / Inpatient admission date
    • completeness of patient specific minimum data set record: all hospital waiting list cards examined for inclusion of 25 items
    • for those patients identified as ‘could not attend’ (CNA) i.e. sickness, leave, family commitments review of subsequent practises in terms of record keeping including patient waiting time
    • for those patients identified as ‘did not attend’ (DNA) review of subsequent practices in terms of record keeping including patient waiting time

Target:

  • > 95% of New OPD / Day Care / Inpatient record entries. Two measurements of compliance
    • WL record is updated within 3 working days of receipt of WL booking form
    • start date on WL record = Decision to Admit date
  • > 95% of patients are directly notified in regard to intended scheduled care appointment / attendance
  • > 95% compliance with sending acknowledgement letter (outpatients)
  • > 85% compliance with completeness of patient specific minimum data set record
  • > 90% compliance with DNA / CNA RCSI HG policies

Performance

% compliance recording of patient details onto scheduled care waiting list recordNote1a: overall sample size n=250 patients (50 per hospital)

  • during April overall sample group demonstrated 88% compliance with data entry requirements

Note1b overall sample size n=250 patients (50 per hospital)

  • during April overall sample group demonstrated 94% compliance with data entry requirements

% compliance with advance patient notification ≥ 14 days noticeNote2: overall sample size n=250 patients (50 per hospital)

  • during April overall sample group demonstrated 98% compliance with patient notification requirements (IP.DC) 

% compliance of sending acknowledgement letter (Out Patients) Note3: overall sample size n=250 patients (50 per hospital)

  • during April overall sample group demonstrated 100% compliance with requirement to send acknowledgement letter

compliance of patient specific minimum data set completeness on WL Record Note4: sample size n=500 data sets

  • during April overall sample group demonstrated 80% compliance with completion of patient specific minimum data set

compliance of DNA / CNA Policy compliance Note5:  DNA policy: DNA patients are removed from waiting list
Note6:  If patient cannot attend (CNA) their wait time clock restarts
Note7:  Report sample size (n=500)

  • during April overall sample group demonstrated 98%/100% compliance with DNA and CNA policies respectively
    • Beaumont DNA/CNA information unavailable on PTL as ICT project for mapping of codes is currently in process