Annual Report: Clinical Services

Prof Patrick Broe
Clinical Director
The RCSI Hospital Group established a clinical directorate structure on becoming operational in January 2015. This year the structure has been re-shaped by abolishing the Group Clinical Directors for Medicine, Peri-operative Care and Diagnostics (FIGURE 4). The remaining Group Directorate is Quality and Patient Safety, led by Dr Siobhan Gormally. This new slimmed down structure has resulted in closer working relationships with each of the sites.
Figure 4

The geographical make-up and general composition of RCSI Hospital Group is more cohesive than many of the other Groups. Beaumont, (Level 4 Hospital) has many pressures from National Specialty and Cancer Services demands such that delivery of its routine local catchment workload is a challenge. Our Lady of Lourdes Hospital, Drogheda is an extremely busy Emergency and Trauma Hospital such that delivery of routine surgery is a challenge.

Early experience whereby long waiters for routine surgery were given the option of travelling to Cavan Hospital to be treated has now been consolidated and treatments available within this initiative now includes gastroscopy, colonoscopy, varicose vein surgery, laparoscopic cholecystectomy and hernia repair.

Connolly Hospital has recently opened a state of the art Endoscopy Unit. An additional room which had been idle was commissioned and staffed and patients on lengthy endoscopy waiting lists from Beaumont have been chronologically treated. Additional capacity in Cavan General and Louth County Hospitals has also been used to reduce waiting lists in Our Lady of Lourdes Hospital and Beaumont Hospital.

This initiative would not have developed to its current level without the Hospital Group Structure. Acceptance of this type movement of patients and clinicians within the Group Hospitals, thereby maximising all available capacity and capability to provide effective, safe and timely care, is an important group-centric initiative which will significantly develop in future years.

As previously noted, Our Lady of Lourdes Hospital is the second busiest trauma hospital in the country (second only to Cork University Hospital). There is no orthopaedic trauma service in Cavan General Hospital and patients with fractures who present to Cavan ED are referred to Our Lady of Lourdes Hospital. This is a prequel to diversion of all trauma from the Cavan & Monaghan area directly to Connolly Hospital, along the M3 corridor, which will be advanced in 2017. This policy is in line with that of the Irish Institute of Orthopaedics that hospitals with no resident orthopaedic surgeon should not receive patients with trauma.

Quality and patient safety are major issues for the Hospital Group. The establishment of the Senior Maternity Incident Management Forum is a very important initiative. This specialty-specific Forum has developed a set of metrics to allow monitoring of trends and outcomes for these services in our Group. Surgeons in Beaumont discussing clinical outcomes with colleagues from Cavan, Our Lady of Lourdes Hospital and Connolly would not have occurred without the Hospital Group structure.

The Hospital Group is fortunate to have the RCSI as academic partner and the recently established Health Outcomes Research Centre (HORC) will strongly support Hospital Group initiatives. RCSI also have considerable expertise in ‘Lean Technology’ and generously support many projects in our hospitals. These projects will ultimately translate into improved and cohesive pathways for all patients in the Group.

The pressure areas for outpatient waiting lists are in Dermatology, Rheumatology, Neurology and ENT. Accordingly pooling of waiting lists between hospitals is being undertaken. An additional initiative in ENT is the establishment of a Consultant appointed between The Royal Victoria Eye and Ear Hospital and Our Lady of Lourdes Hospital, undertaking outpatient work in Our Lady of Lourdes Hospital and the operative sessions in RVEEH.

There are already several posts in Urology and General Surgery with shared sessions between Connolly and Beaumont. In future there will be similar posts in other departments such as Anaesthesia and Pathology as well as an orthogeriatrician for Our Lady of Lourdes Hospital which is high on priority lists for appointment in 2017.

Mechanical thrombectomy for ischaemic stroke has significantly increased volume in the past year treating 172 patients. Beaumont Hospital is now, with Cork University Hospital, the designated national centre for this procedure.

The Head and Neck / Otolaryngology Unit has trebled its referral numbers for head and neck, skull base and immunosuppression induced skin cancers in the past year. The management of these patients is truly multidisciplinary with 41 doctors participating in this MDT.

50 living related kidney transplants were performed and the target for 2017 is 75. Related clinical outcomes have been excellent.

The Upper GI Unit at Beaumont has doubled its referral numbers. Minimally invasive oesophagectomy is routine and outcomes are to date excellent.

Transanal approach to Rectal Cancer management has been introduced in the Beaumont Hospital Colorectal Unit.