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

  • 33% reduction in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count reduction 37% n=1337 Jan-Nov)
  • performance improvement commenced in July 2016 generally maintained during 2018 reporting period
  • an average daily count value of 6 demonstrated for November 2018 (Target 12 surpassed)

Cavan General Hospital

  • 100% increase in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count increase 18% n=89 Jan-Nov)
  • an average daily count of 4 demonstrated for November 2018 (Target 8 surpassed)

Connolly Hospital

  • 33% reduction in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count increase 75% n=1043 Jan-Nov)
  • an average daily count of 4 demonstrated for November 2018 (Target 8 surpassed)

Our Lady of Lourdes Hospital, Drogheda

  • 43% reduction in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count reduction 33% n=1099 Jan-Nov)
  • an average daily count of 8 demonstrated for November 2018 (Target 12 surpassed)

RCSI Hospital Group

  • 27% reduction in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count reduction 15% n=1320 Jan-Nov)
  • an average daily count of 22 demonstrated for November 2018 (Target 40 surpassed)

National Performance Comparator

  • 10% increase in average number of patients awaiting ward bed accommodation in ED 2018 / 2017 for November (total count increase 5% n=4811 Jan-Nov)
  • an average daily count of 289 demonstrated for November 2018 (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 8% from reporting month 2017 (13 hours) to reporting month 2018 (14 hours)
  • the average time spent in ED for non-admitted patients has increased by 17% from reporting month 2017 (6 hours) to reporting month 2018 (7 hours)

 Cavan General Hospital

  • the average time spent in ED for admitted patients has increased by 25% from reporting month 2017 (8 hours) to reporting month 2018 (10 hours)
  • the average time spent in ED for non-admitted patients has increased by 25% from reporting month 2017 (4 hours) to reporting month 2018 (5 hours)

Connolly Hospital

  • the average time spent in ED for admitted patients has reduced by 8% from reporting month 2017 (12 hours) to reporting month 2018 (11 hours)
  • the average time spent in ED for non-admitted patients has remained constant from reporting month 2017 to reporting month 2018 (6 hours)

Our Lady of Lourdes Hospital, Drogheda

  • the average time spent in ED for admitted patients has reduced by 18% from reporting month 2017 (11 hours) to reporting month 2018 (9 hours)
  • the average time spent in ED for non-admitted patients has remained constant from reporting month 2017 to reporting month 2018 (5 hours)

Target

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

Performance

Beaumont Hospital

  • November 2018 76.0% compliance with 9 hour non-admitted PET / 22.7% compliance with admitted PET

Cavan General Hospital

  • November 2018 91.0% compliance with 9 hour non admitted PET / 55.2% compliance with admitted PET

Connolly Hospital

  • November 2018 86.7% compliance with 9 hour non admitted PET / 42.4% compliance with admitted PET

Our Lady of Lourdes Hospital, Drogheda

  • November 2018 86.5% compliance with 9 hour non admitted PET / 57.2% compliance with admitted PET

RCSI Hospital Group

  • November 2018 84.0% compliance with 9 hour non admitted PET / 45.1% compliance with admitted PET

National Performance Comparator

  • November 2018 86.6% compliance with 9 hour non admitted PET / 53.6% 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 – Nov 2018 3.2% >24hours (2.5% Nov 2017) performance deterioration demonstrated
  • Cavan Hospital – Nov 2018 1.2% >24hours (0.0% Nov 2017) performance deterioration demonstrated
  • Connolly Hospital – Nov 2018 1.9% >24hours (3.5% Nov 2017) performance improvement demonstrated
  • OLOL Hospital – Nov 2018 2.3% >24hours (4.2% Nov 2017) performance improvement demonstrated

  • RCSI HG – Nov 2018 2.3% > 24hours (2.8% Nov 2017)
  • National – Nov 2018 3.4% > 24hours (3.1% Nov 2017)

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 82.9% (2018)

Cavan General Hospital

  • % of patients waiting <52 weeks on OPD wait list 77.1% (2018)

Connolly Hospital

  • % of patients waiting <52 weeks on OPD wait list 86.9% (2018)

OLOL Drogheda

  • % of patients waiting <52 weeks on OPD wait list 87.7% (2018)

Louth County Hospital

  • % of patients waiting <52 weeks on OPD wait list 97.3% (2018)

Rotunda Hospital

  • % of patients waiting <52 weeks on OPD wait list 90.6% (2018)

RCSI Hospital Group

  • % of patients waiting <52 weeks on OPD wait list 84.7% (2018) – overall RCSI demonstrating higher performance than national (see Comparator Graph)

National Performance Comparator

  • % of patients waiting <52 weeks on OPD wait list 70.5% (2018)

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 2018 monthly reporting period

Cavan General Hospital

  • Cavan General Hospital exceeded national target for 2018 monthly reporting period

Connolly Hospital

  • Connolly Hospital exceeded national target for 2018 monthly reporting period

Our Lady of Lourdes Drogheda

  • Our Lady of Lourdes exceeded national target for 2018 monthly reporting period

Louth County Hospital

  • Louth County Hospital exceeded national target for 2018 monthly reporting period

RCSI Hospital Group

  • RCSI HG exceeded national target for 2018 monthly reporting period

National Performance by Hospital Group Comparator

  • 4 Hospital Groups achieving national target – RCSI HG highest performer

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 2018 reporting period (100%). National Performance (91.4%) 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 (90.5%) 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 (89.0%) 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 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

  • 100% compliance within the RCSI Hospital Group for 2018 monthly reporting period

National Performance

  • 99.98% compliance nationally for 2018  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 (November 85.4% compliance)

Cavan General Hospital

  • Cavan General Hospital is currently exceeding this target for reporting period (November 97.1% compliance)

Connolly Hospital

  • Connolly Hospital is currently exceeding this target for reporting period (November 82.7% compliance)

Our Lady of Lourdes, Drogheda

  • Our Lady of Lourdes is currently exceeding this target for reporting period (November 93.8% compliance)

Louth County Hospital

  • Louth County Hospital is currently exceeding this target for reporting period (November 89.8% compliance)

RCSI Hospital Group

  • RCSI Hospital Group is currently exceeding this target for reporting period (November 87.6% compliance)

National Performance Comparator

  • Nationally this target is not being met for reporting period (November 58.5% 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%)

  • 99% 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 100% waiting < 3 months – Beaumont achieved target
  • MRI 99.87% waiting < 6 months – Beaumont did not achieve target
  • CT 99.65% waiting < 6 months – Beaumont did not achieve target
  • national performance currently not published

Connolly Hospital

  • US 41.25% waiting < 3 months – Connolly did not achieve target
  • MRI 100% waiting < 6 months – Connolly achieved target
  • CT 63.72% waiting < 6 months – Connolly did not achieve target
  • national performance currently not published

Cavan Hospital

  • US 96.53% waiting < 3 months – Cavan did not achieve target
  • MRI 93.32% waiting < 6 months – Cavan did not achieve target
  • CT 82.10% waiting < 6 months – Cavan did not achieve target
  • national performance currently not published

OLOL Hospital

  • US 61.09% waiting < 3 months – OLOL did not achieve target
  • MRI 81.05% waiting < 6 months – OLOL did not achieve target
  • CT 92.03% waiting < 6 months – OLOL did not achieve target (OLOL CT includes out-patients scanned in LCH under OLOL MRN)
  • national performance currently not published

Louth County Hospital

  • US 70.01% waiting < 3 months – LCH did not achieve target
  • national performance currently not published

RCSI Hospital Group

  • US 65.28% waiting < 3 months – Group did not achieve target
  • MRI 91.65% waiting < 6 months – Group did not achieve target
  • CT 87.00% waiting < 6 months – Group did not achieve target
  • national performance currently not published

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

  • demonstrating
    • US 63.16% 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 2018 reporting period 13.8% of total new bookings (n=20159) did not attend (DNA) scheduled appointments / 2017 13.9% DNA (n=19103) – represents 5.5% increase
    • Beaumont 2018 14.3% DNA (n=6727) / 2017 14.3% DNA (n=6242) 7.8% increase
    • Cavan 2018 9.1% DNA (n=770) / 2017 9.4% DNA (n=782) 1.5% decrease
    • Connolly 2018 16.9% DNA (n=2950) / 2017 17.5% DNA (n=3003) 1.8% decrease
    • OLOL 2018 10.6% DNA (n=2675) / 2017 10.8% DNA (n=2646) 1.1% increase
    • Louth 2018 11.9% DNA (n=692) / 2017 14.4% DNA (n=747) 7.4% decrease
    • Rotunda 2018 15.9% DNA (n=6000) / 2017 15.5% DNA (n=5348) 12.2% increase

National Performance Comparator

  • during November reporting period 13.3% of total new bookings (n = 12,659) 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. GI Endoscopy National QI programme 2017 Annual Data report, Conjoint Board in Ireland of the Royal College of Physicians and Royal College Surgeons

Target

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

Performance

4 = Our Lady of Lourdes Hospital
5 = Connolly Hospital
7 = Beaumont Hospital
15 = Cavan General Hospital
30 = Louth County Hospital
– All hospitals except Cavan General Hospital 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. GI Endoscopy National QI programme 2017 Annual Data report, Conjoint Board in Ireland of the Royal College of Physicians and Royal College Surgeons

Target

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

Performance

4 = Our Lady of Lourdes Hospital
5 = Connolly Hospital
7 = Beaumont Hospital
15 = Cavan General Hospital
30 = Louth County Hospital
– 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

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 recordNote1: overall sample size n=100 patients (20 per hospital)

  • during November overall sample group demonstrated 90% compliance with data entry requirements

  • during November overall sample group demonstrated 93% compliance with data entry requirements
  • Connolly Hospital extract does not reflect the DTA date but rather date entered on system and is not included in Group total

% compliance with advance patient notification ≥ 14 days noticeNote2: overall sample size n=100 patients (20 per hospital)

  • during November overall sample group demonstrated 96% compliance with patient notification requirements (IP.DC)

% compliance of sending acknowledgement letter (Out Patients) Note3: overall sample size n=100 patients (20 per hospital)

  • during November overall sample group demonstrated 96% compliance with requirement to send acknowledgement letter

compliance of patient specific minimum data set completeness on WL Record Note4: sample size n=250 data sets

  • during November overall sample group demonstrated 74% 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=200)

  • during November overall sample group demonstrated 96%/84% 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