RCSI Hospitals

Macro Activity

Figure 2, Macro Activity

Note1: includes Minor Injury Clinic attendances

Access

Emergency Department

ED Patient Wait Volume for Admission – RCSI HG (FIGURE 3)

• 13% (n = 1274) total count reduction in the number of patients waiting in ED 2018 / 2017
  • significant in year reduction commenced in June 2016 further improved during 2017 / 2018 with total wait volume target (40) set for the Hospital Group secured throughout
    • average wait time in ED (non-admitted patients) has been sustained: 2018 5 hours / 2017 5 hours
    • average wait time in ED (admitted patients) has increased by 10%: 2018 11 hours / 2017 10 hours

Inpatient / Day Care

IP.DC Adult Patients waiting < 8 Months –Nationally – Dec 2018 (FIGURE 4)

• by year end 85.6% of all patients were waiting < 8 months for treatment compared to 76.5% at 2017 year end – this being achieved by increased internal productivity rather than private outsourcing

Endoscopy

• 100% compliance within the RCSI HG for patients triaged as urgent receiving colonoscopy within 28 days
• 92.2% of routine GI endoscopy patients waiting < 13 weeks months at year end

Outpatient

• 85.6% of all patients waiting < 12 months (n= 48,189) for new appointment secured by year end (national performance 70.4% waiting <12 months)

Discharge

Delayed Discharge

• during 2018 a monthly average of 3,778 bed days were inappropriately used for accommodation of patients whose acute treatment episode had been completed and were delayed waiting for either community home placement or home care package

• expansion of foetal anomaly scanning service in Cavan and OLOL Hospitals. Related Consultant posts are split between these hospitals and the Rotunda Hospital. Thereby effecting timely local complex diagnosis and where necessary direct access to specialist care in the Rotunda Hospital
• performing the 500^th kidney transplant from a living donor
• first robotic radical prostatectomy using the daVinci robot undertaken
• opening of a new High Dependency Unit in Beaumont Hospital

Establishment of 3 key Senior Incident Management Forums:

• Perioperative
• Women’s and Children
• Medicine

RCSI HG delivered strong financial performance, achieving breakeven (0.2% surplus) .v. budget (maximum expenditure limit MEL).

Importantly, the Hospital Group has demonstrated significant success in reducing adhoc agency staff deployment through permanent staff recruitment.

A number of capital developments were progressed / commenced within the Hospital Group during 2018

• ongoing development of Phase II Capital Expansion – Our Lady of Lourdes campus with the second ward (29 beds) opened December
• ongoing refurbishment and redevelopment on the Rotunda campus
• development of design plan for relocation of the Rotunda Hospital onto the Connolly Hospital campus
• submission for planning permission for designated Cystic Fibrosis Unit
• opening of 20 additional beds in Connolly achieved through upgrade and redevelopment
• design location / structure for the Emergency Department on the Beaumont Hospital campus
• development of additional bed capacity design (95) on the Beaumont Hospital Campus within the framework of the Slaintecare Action Plan 2019: Workstream 1 – (1.4) (Slaintecare 14.03.19)
• completion of the Cochlear Implantation Department refurbishment and expansion

Whilst overall clinical treatment values are increasing and access performance is improving,  in terms of a reduction in the number of patients waiting for admission in ED, reduction in the number and length of time patients are waiting for elective treatment and a reduction in the length of  time patients are waiting for OPD appointments. There remains certain external and internal factors mitigating against necessary further performance improvements.

External

ED – 3.6% increase in new patient presentations

OPD – 4% increase in GP referrals

Discharge – practices in relationship to access to timely provision of community care and support placements remain inconsistent and generally limited during 2018 the HSE target set of < 112 patients waiting for required HCP / LTC was generally not achieved – as such “lost” bed value equating to 6,500 elective treatments being undertaken annually

Internal

Bed capacity – hospitals currently operating >99% full occupancy

ED capacity – 2 of the 4 ED’s generally remain unfit for purpose, predominately as a result of size limitations and outdated design

ICT – ongoing lack of investment has resulted in continued inappropriate over reliance on paper records, non-integrated information systems and a general inability to actualize clinical opportunities / risk mitigation as presented by EPR / EPP

• commence development of necessary ED capital redevelopment on both Beaumont and Cavan sites
• continue structural / refurbishment developments on the Rotunda campus
• relocation of the Rotunda Hospital to the Connolly campus
• progress necessary bed expansion on Beaumont campus
• reorientate current hospital-centric delivery model, particularly in relationship to chronic disease management, ensuring very much a local community based delivery model – with ability to fast track complex / exacerbation,  where necessary to  hospital ambulatory clinics

Overall the RCSI HG has fully delivered on all agreements with the HSE in Service Levels, Development and Financial terms for 2018.

These achievements were effected only through the continuing exceptional responsiveness and commitment of all staff. As such I thank them for their innovation, commitment and support to ensuring continuing high standards of patient centered treatment and care.

I look forward to their continuing support in facing the challenges to be confronted in 2019.

Ian Carter
CEO
RCSI Hospital Group