Table of Comparisons James & Coombe v Connolly

Non-Medical Hospital Development comparators between St James’ and Connolly Sites

Non-Medical Hospital Development comparators between Coombe and Connolly Sites

 

Clinical Comparisons
	St James’	Coombe	Connolly
1. Co-location with Adult	Yes – St. James’	No	Yes – Connolly
2. Co-location with Maternity (see notes)	Site identified	In need of upgrade	Site identified
3. Tri-location with Adult & Maternity possible?	Yes	No – suggested link corridor across town	Yes
4. Appropriate Clinical Environment for Children	No, tight city centre site	No, tight city centre site	Yes, natural parkland site. Allows building and expansion consistent with healthy architecture
5. Academic Activity on site	Yes	Yes	Yes
6. Academic Support	None stated	None stated	RCSI, DCU and NUI Maynooth
7. All Ireland Clinical Capacity	Unclear	Unclear	Clear site capacity and location to encourage cross border service provision
8. All Ireland Academic Capacity	No, insufficient space for on site representation of all Universities and Institutes	No, insufficient space for on site representation of all Universities and Institutes	Ample space to allow onsite presence of all relevant academic bodies
9. Clinical Expansion Space	None	None	Extensive
10. McKinsey Specialties (see notes)	Will be provided by paediatricians moving to site	Will be provided by paediatricians moving to site	Will be provided by paediatricians moving to site
11. Neurosurgery	Provided in paediatric hospital	Provided in paediatric hospital	Provided in paediatric hospital
12. Cardiac Surgery	Provided in paediatric hospital	Provided in paediatric hospital	Provided in paediatric hospital

Notes
1. McKinsey Specialties: refers to the 27 specialties that should be available in a National Children’s Hospital. The clear intent was to describe Paediatric Specialties, delivered by Paediatricians. The following references, taken directly McKinsey highlight the fact that the Children’s Hospital should NOT be dependent upon adult specialists. Indeed outcomes clearly improve with specialist Paediatricians

a. Cardiac: Hannan et al, Paediatrics 1998, demonstrate significant improvement in outcomes in centres with >100 cases per year compared to those with <100 cases per year (5.95% vs 8.26%); Lundstrom et al, Paediatric Cardiology 2000, mortality fell from 9.5 % to 1.9% despite increase in case mix complexity following consolidation of volumes between two centres
b. Oncology: Pritchard, Stiller and Lennox, BMJ 1989 note improved outcomes for patients with Wilms’s tumour when treated in a paediatric oncology centres; Stiller, Arch Dis Child 1988, states the importance of comprehensive, multi-disciplinary treatments as provided by tertiary paediatric centres in certain tumours; and Corrigan, Feig et al, Paediatrics 2004, describe the range of medical and surgical sub- specialties required for tertiary paediatric cancer care
c. Gastroenterology: Brian and Roberts, J Paediatric Surgery, 1996, significant reduction in morbidity for pyloric stenosis when treated by a paediatric surgeon compared to a general surgeon; Ein, Palder, Alton, Daneman, J Paediatric Surgery, 1994, Intussception – improved outcomes through concentrating interventional radiology expertise
d. Anaesthesia: McNicol, Anaesthesia 1997, only specialist centres should do paediatric anaesthesia; Auroy et al, Anesth Analg 1997, case for lower limit on paediatric anaesthesiology at >100 per year and ideally >200 cases per year
e. ICU: Murdoch, Lancet 1993 (letter) PICU to run well needs full range of onsite paediatric specialties…cardiology, renal, neurology and surgery; Rosenberg, Moss, Paediatrics 2004, expand on Murdoch, to give the American Association of Pediatrics guidelines for sub specialist support for PICU
f. General: Arul, Spicer, Arch Dis Child, 1998, meta analysis that notes improved outcomes in oncology, radiology, pathology and intensive care with higher volumes

2. Expansion capacity: it is accepted that paediatric hospitals grow at a rate of approximately 50% every decade. Crumlin has grown by 75% over the past decade. The new Glasgow children’s hospital lists expansion as one reason for moving to a larger site. Further, future emphasis on ambulatory (day care and outpatients) is more space intensive than inpatient care due to large volumes of patient traffic.

3. Maternity Report by KPMG 2008: states clearly that maternity infrastructure needs upgrading and current state presents clinical risks.
“The poor infrastructure in the three hospitals poses risks to both the health and safety of women and infants, within that we include risk of Hospital Acquired Infections (HAI), privacy and dignity. The issues are dealt with in each of the speciality chapters which follow; however, we believe that it is fortunate that there has not been a serious untoward incident due to the mixed quality of facilities. The need to modernise facilities in all three hospitals provides the GDA with a unique opportunity to both improve the environment in which services are delivered and create a new model of care.”

“Poor infrastructure at the three hospitals means that maintaining the status quo is not an option. The facilities at the three hospitals pose risks to health, safety, privacy and dignity. Short-term measures need to be identified to reduce pressure on the current infrastructure as highlighted in each of the following chapters, but it is our view that service reconfiguration and relocation are the means by which the risks that the services currently face can be most robustly mitigated.”