Special Delivery Unit – Connolly and Beaumont Hospitals Summer 2012

REGIONAL HEALTH FORUM – DUBLIN AND NORTH EAST

FÓRAM RÉIGIÚNACH SLÁINTE – BAILE ÁTHA CLIATH AGUS AN TOIRTHUAISCEART

24TH SEPTEMBER, 2012

AGENDA ITEM NO. 3

MOTIONS

Motion

The SDU at the Department of Health has inspected and reported on the
Mater, Beaumont and Connolly hospitals.  This issue was placed on the
July agenda at the Forum but was effectively ignored.  Does this
warrant a motion of censure by the members?

Cllr. Bill Tormey

Response
A team from the Special Delivery Unit and National Medical and
Surgical Clinical Care Programme Teams carried out diagnostic
exercises in 2 hospitals in Dublin North East in June and July of
2012. The visit to Connolly Hospital took place on 15th June and a
synopsis of the final draft report is provided in Appendix 1.   The
visit to Beaumont Hospital took place over 2 days from 12th – 13th
July and a synopsis of the final draft report is available in Appendix
2.  These visits were fully facilitated and supported by Hospital
Management and Clinical Staff, the RDO and the Area Manager.

Recommendations made by the visiting teams following their visits are
being addressed by the Management Teams of the Hospitals in
conjunction with their Clinical Staff and supported by the Regional
Management Team and the SDU.  Progress of key priority actions by the
Hospitals is monitored weekly at SDU meetings and at set Area and
Regional Performance Meetings

Anne Marie Hoey,
Area Manager – Dublin North,
HSE Dublin North East.

Tel:  (01) 8908711
E-mail:  am.nd@hse.ie

Appendix 1

Synopsis of the Final Draft Report for Connolly Hospital

Emergency Department (ED) and Medical Assessment Unit (MAU)
The visiting team found the Emergency Department (ED) of Connolly
Hospital to be a well laid out area with excellent clinical staff.
The team also recognised that the hospital is performing very well in
meeting targets for ambulance turnaround times.  Congestion in the
Emergency Department and patient waiting times were highlighted as key
priority areas to be addressed.   It was also noted the very positive
development that Connolly Hospital has opened its MAU since May of
this year.
Report Recommendations include:

– More responsive rosters (Medical, Surgical and Nursing) and more

responsive diagnostics.

– The MAU is to continue to develop in line with the National Acute

Medicine Programme.

– To develop and refine pathways which stream patients directly to the

appropriate service.

 

Care of the Elderly
The Report recognises that the Care of the Elderly Service has a
strong patient centred ethos with very well developed patient pathways
in particular for Stroke and Community/Nursing Home patients.  ED
management of Nursing Home patients was commended in the report and it
was noted that the Outreach Service by the Specialist Geriatric
Service has resulted in a reduction in ED attendances by 19% and
admissions by 37% in this patient group since the start of the year.

Surgical Service
The surgical service performs well in achieving set performance
targets.  Pre assessment clinics are in place for day cases and for
certain specialities.

Recommendations form the report centred on more responsive rosters as
per point 1 above

Nursing
Nursing at all levels of the organisation was recognised as being
motivated, skilled and with a desire to extend their roles as required
to meet patient needs.

The team recommended that the Productive Ward Pilot which is due for
commencement be rolled out incrementally to all wards.

Diagnostics:
A review of all diagnostic services was carried out.  The team
identified that services were working hard to meet required demands
and acknowledged limitations imposed by staffing shortages.
Recruitment is underway to replace critical staff.

Conclusion:
The team recognised the commitment of the Management team and Clinical
Staff. The Management team in conjunction with their Clinical Staff
and supported by the Regional Management Team and the SDU are
currently working on addressing all recommendations which emerged from
the Diagnostic Visit.

Appendix  2

Beaumont Hospital Diagnostic Visit July 2012

Beaumont Hospital is the National centre for Neurology, renal
transplantation and cochlear implants.  It is also a designated cancer
centre as per the National Cancer Control Programme.

Synopsis of the Final Draft Report

Emergency Department (ED) and Medical Assessment Unit (MAU)
The main issue is that all patients arrive via the ED and there is
scope to improve patient flow to appropriate settings.

Report Recommendations include:

– Active processing and ownership of patient flow in ED and Short Stay.

– Agree and set referral criteria to the MAU and immediately implement

24hr AMU model.  More “Pulling” of patients from ED is required.

– Roster reconfiguration and extension/enhancement of individual roles.

– Improvements in data management to ensure correct recording of

patient data and correct tracking of patients in ED (i.e. to improve
monitoring of wait times).

– Open a Clinical Decision Unit and develop a Surgical Assessment Unit.

– Egress improvements – document Expected Date of Discharge (EDD) and

plan for each patient.

Care of the Older Person
There is an evident need to develop the pathway and ownership of the
flow of Frail Elderly patient presenting to ED and also the need to
address resources such as Long Term Care/Rehab & Step Down beds and
improve access to community services. A Care of the Elderly group has
been set up and a Project Manager has recently been appointed.

Other Recommendations include:

– Labs – All diagnostic services including radiological in Beaumont

should have a target of same day response and reporting following

referral.

– Ambulance Services – As ambulance turnaround time in Beaumont is

worse than other Dublin Hospitals. It is recommended that there is a

regional monthly meeting of Ambulance service and Hospital to further

develop transport management in Beaumont

Conclusion
The Team found a very engaged hard working team who are very anxious
to improve the patient experience in Beaumont and reduce the long
delays for patients to access or egress services.

The Management team in conjunction with their Clinical Staff and
supported by the Regional Management Team and the SDU are currently
working on addressing all recommendations which emerged from the
Diagnostic Visit