Annual Report: Chief Executive Officer

Ian Carter
Chief Executive Officer
Primary executive and operational control for 2016 centered on securement of planned levels of clinical services within specific quality metrics and allocated finances with general advancement of Hospital Group capital development programme.

Performance outcomes for 2016 were generally satisfactory.

Macro Activity

Figure 1, Macro Activity

Note1: includes Minor Injury Clinic attendances


Emergency Department
Figure 2, ED Patient Wait Volume for Admission – RCSI HG

  • 42% reduction in average number of patients in ED awaiting ward bed accommodation @ 08.00 2016 / 2015 (total count reduction 29% n = 5025)
    • significant in year reduction commenced in February and total wait volume target (40), set for the Hospital Group, secured in June and generally maintained for remainder of 2016
      • average time spent in ED (non-admitted patients) has reduced by 17% from 2015 (6 hours) to 2016 (5 hours)
      • average time spent in ED (admitted patients) has reduced by 15% from 2015 (13 hours) to 2016 (11 hours)
Inpatient / Day Care

IP.DC Adult Patients waiting < 8 Months Figure 3, Nationally – Dec 2016

  • by end of 2016 national target of 70% patients waiting < 8 months for treatment / admission was exceeded (RCSI HG was only one of two Hospital Groups to achieve this target)
  • with the exception of January (98.2% n = 9 non-compliant) there was 100% compliance within the RCSI HG for patients triaged as urgent receiving colonoscopy within 28 days
  • 84% of routine GI endoscopy patients waiting < 6 months at year end (n= 2922)
  • 83% of all patients waiting < 12 months (n= 50,169) for new appointment secured by year end
  • during 2016 13.6% of OPD bookings did not attend designated appointment (n = 19,836) – this value is equivalent to 33% of total number of patients currently waiting for appointment within the Hospital Group

Delayed Discharge

  • during 2016 a monthly average of 4677 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 – annually this is the equivalent of necessary acute bed capacity for the treatment of 8017 elective inpatients (ALOS 7 days) – full access to this bed capacity would have enabled treatment of 86% of patients currently waiting for admission within the Hospital Group
  • establishment of RCSI HG Quality and Patient Safety Forum
  • establishment of RCSI HG Women & Children Serious Incident Management Forum
  • establishment of a suite of performance indicators / metrics to actively use in regard to measuring, tracking and generally guiding performance (published on RCSI HG web site
  • introduction of a specialist frail elderly assessment service in Beaumont Hospital’s Emergency Department
  • Beaumont Hospital’s Imaging and Interventional Directorate mechanical and thrombectomy service for large vessel ischaemic stroke treated 172 patients
  • Beaumont Hospital Transplant, Urology and Nephrology Directorate performed 50 direct living kidney donor transplants
  • significant enhancement of endoscopy capacity and capability on the Connolly Hospital campus enabling transfer of patients requiring routine GI endoscopy from Beaumont Hospital – in total 1,190 additional patients were treated within this initiative
  • commencement of utilisation of existing theatre and endoscopy capacity and capability on the Cavan Hospital campus enabling transfer and treatment of patients requiring routine GI endoscopy and short stay surgery from Beaumont Hospital – in total 1,003 additional patients were treated within this initiative in 2016
  • Rotunda Hospital was awarded title of Maternity Hospital of the year at the Irish Healthcare Awards
  • development of an innovative ‘see-and-treat’ service for patients with benign gynaecologic complaints including consultant evaluation, ultrasound assessment and hysteroscopic diagnostic and therapeutic intervention on the Connolly Hospital campus

RCSI HG achieved target of breakeven versus Gross Expenditure Budget and a surplus on Income Budget (excluding national accelerated income target)

A number of important capital developments were progressed / commenced within the group during 2016

  • ongoing development of Phase 2 Capital Expansion on the Our Lady of Lourdes campus incorporating additional beds (82) theatre and emergency department expansion scheduled for completion in 2018
  • completion of the design brief to develop the Rotunda Hospital as a co-located hospital on the Connolly Hospital campus
  • opening of the upgraded and redevelopment of National Kidney Dialysis Service on the Beaumont Hospital campus
  • commencement of the redevelopment of the Rockfield facility on the Beaumont Hospital campus

Whilst overall clinical treatment volume and access performance values, with the exception of OPD access, are improving, there still remain certain external / internal factors presenting significant challenges negatively impacting on hospital services / specific patient cohorts

  • 8% increase in new ED presentation volume
  • 7% increase in number of patients requiring emergency admission, reflecting volume, complexity, acuity and age value increases
  • whilst congestion within ED, resulting from delay in ward accommodation for patients requiring emergency admission, has been significantly reduced, wait times remain suboptimal. In parallel there also remains insufficient bed capacity to ensure timely access for patients requiring elective treatment / surgery
  • critical care capacity remains significantly insufficient to appropriately match clinical demand volume on a daily basis across all sites
  • provision of necessary home care packages and community accommodation remains inconsistent and less than optimal in terms of timeliness and volume, further rendering diminution of acute bed availability
  • 4% increase in OPD referrals with insufficient clinical capacity to match demand in a timely manner within current hospital-centric delivery model
  • despite in year introduction of ‘First-Strike’, a significant numbers of patients continue not to attend booked appointments and consequent inefficient usage of available OPD capacity
  • 6% increase in diagnostic referrals and insufficient clinical capacity and capability to match all service demands in a timely manner
Infrastructure and Equipment
  • remains insufficient to ensure appropriate maintenance, general upkeep and necessary replacement when required
  • ongoing lack of investment has resulted in continued over reliance on paper records, non-integrated information systems and inability to actualize clinical opportunities presented by EPR / EP
  • increase ED capability in terms of medical and nursing staff
  • increase general acute bed capacity
  • increase critical care bed capacity including the development of High Dependency Facilities for accommodation of patients post complex surgery
  • increase ED capacity and capability
  • increase Diagnostic capacity and capability
  • reorientate current, hospital-centric delivery model, particularly in relationship to chronic disease management > local community based delivery model
  • increase general capacity and capability of community services to manage and generally accommodate patients in a timely manner for whom acute care episode has been completed

Overall the RCSI HG has fully delivered on all agreements with the HSE in service levels, development and financial terms for 2016.

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 2017.

Ian Carter
Rcsi Hospital Group

Chief Executive Officer

8th March, 2018