The Rotunda Hospital Ambulatory Hysteroscopy Service at Connolly Hospital

The Rotunda Hospital Ambulatory Hysteroscopy Service at Connolly Hospital Gynaecology Service Development Phase 1 FFiiinnaalll VVeerrrssiiioonn Date: 11th February 2016 1 CONTRIBUTORS Ms Pauline Treanor Secretary General Manager Rotunda Hospital Ms Margaret Philbin DOM/N Rotunda Hospital Ms Marie Keane ADOM/N Rotunda Hospital Dr. Eve Gaughan Consultant Obstetrician/Gynaecologist, Rotunda Hospital Ms Judy McEntee DON Connolly Hospital Ms Patricia Meade ADON Connolly Hospital Ms. Louise Collins Director of Clinical Services, Connolly Hospital Mr. Jim Hussey Director of Finance, Rotunda Hospital Mr. Sean Williamson Materials Manager, Rotunda Hospital 2 CONTENTS Page 1. Introduction 5 2. Background 5 3. Proposal 6 4. Current Gynaecological Service Overview 6 4.1 RCSI Hospital Group 6 4.2 Rotunda Hospital Gynaecological Activity 2014 7 5. Ambulatory Hysteroscopy Service Phase 1 Proposal 8 5.1 Ambulatory Outpatient Service – Resource 8 Requirement 6. Patient Pathway 9 7. Cherry Ward Ambulatory Procedure Room 9 8. Decontamination 9 9. ICT Support 10 10. Medical Emergency Management 10 11. Waste Management 10 12. Technical Services 10 13. Portering Services 10 14. Security Services 10 15. Laboratory 11 16. Cherry Ward Facility Requirements 11 17.Discharge Protocol 11 18.GP Communication 11 19. Breakdown of Total Costs both once off and recurring 12 3 APPENDICES Appendix 1 Rotunda Ambulatory Hysteroscopy Service – Patient Flow Pathway 14 Appendix 2 Standard Operating Procedure Medication Management 15 Appendix 3 Standard Operating Procedure Checking and Labelling of Specimens/Samples 16 Appendix 4 Transport of Laboratory Specimens from the Hysteroscopy Day Service at 17 Connolly Hospital to the Rotunda Hospital Appendix 5 Standard Operating Procedure for an Emergency Situation 18 Appendix 6 Standard Operating Procedure Surgical Vasovagal Episode 19 Appendix 7 Preparation of Local Equipment prior to transfer to RH 20 Appendix 8 Procedure Room Decontamination Pathway 21 Appendix 9 Equipment and Consumables 22 Appendix 10 Health Care Assistant Job Description 27 Appendix 11 Staff Nurse Job Description 31 4 1. INTRODUCTION The Rotunda Hospital is a Voluntary Hospital operating under a Charter from 1756 with a Board of Governors and a Mastership system. It is a member of the RCSI Hospitals Group. The hospital is a 198 bed stand alone maternity teaching hospital providing outpatient and inpatient services with public funding augmented by private patient income under a Service Level Agreement with the HSE. The hospital is struggling with a large increase in obstetric activity leading to capacity pressure and to the constriction of benign gynaecology work and an increased volume of gynaecology referrals due to changing practices in other hospitals. In June 2015 the Rotunda welcomed the announcement by the Minister for Health, Dr. Varadkar to relocate the Rotunda Hospital to a site on the Blanchardstown Campus. This will result in the Rotunda meeting its strategic objective to co-locate with an appropriate adult hospital. 2. BACKGROUND In 2012, the Mater Hospital significantly reduced Benign Gynaecology to concentrate on Gynaecology Oncology. This increased the number of benign gynaecology referrals to the Rotunda by up to 40% that same year. By the end of 2013, it was clear that the hospital was exposed to a risk of failing to identify significant pathology within this cohort of waiting patients and the Board of Governors approved a pilot Waiting List Initiative. Under this initiative, patients with a defined set of indications were identified from the waiting list and seen in ‘urgent Gynaecology clinics’ with any associated surgical procedures carried out in the Mater Private Hospital Theatre. (See Table 1). In October 2014, this pilot project was extended with the objective of reducing the Gynaecology Out Patient Waiting List in keeping with the national agreed timeframes. This initiative was again funded by the Rotunda Board of Governors. The provision of a service provided on this basis was not sustainable in the long term and an alternative solution was required. This current proposal offers such an alternative which will alleviate the benign gynaecology services problem and also initiate a working relationship between the Rotunda and Connolly hospitals. Table 1: Summary of the Mater Private Initiative from October 2014 to June 2015 Referrals sent to the MPH 1076 Patients seen 715 Surgical procedures performed 366 5 3. PROPOSAL It is proposed to establish a new Rotunda Gynaecology Service at the Connolly Hospital site. The objectives for this service are to: Assist in the management of the Out Patient Waiting List in the Rotunda Hospital Provide a more responsive service to women in the future Bring the Rotunda services in line with international best practice Initiate closer links with both hospitals It is proposed to develop Rotunda Gynaecology services at the Connolly Hospital site in 2 phases. Phase one will establish a “one stop” ambulatory hysteroscopy service that should support approximately 25% of all referrals to the Rotunda. Phase 2 will aim to establish an additional Day Surgery session in Connolly to assist in the management of up to 70% of women referred to Rotunda. It is acknowledged that the additional Out Patient and Theatre sessions will not replace current Rotunda Hospital services but will enhance and supplement them. 4. CURRENT GYNAECOLOGY SERVICE OVERVIEW 4.1 RCSI Hospitals Group The RCSI Hospitals Group has a high level of demand for Benign Gynaecology. There are also many residents of the Group that go “out of Group Hospitals for care” (Table 2). Analysis by Dr. Declan Bedford and colleagues in the RCSI Hospitals Group show that the Rotunda Hospital performed 52% of benign gynaecology activity within the Group in 2013. Table 2: Out of Group Discharges by Patient Type, Residents of RCSI Hospitals Catchment Area, 2013 RCSI Hospitals Out of Group Total N % N % Day-Patient 3,144 69.4 1,385 30.6 4,529 Elective In- 887 63.1 518 36.9 1,405 Patient Emergency 244 74.4 84 25.6 328 In-Patient Total 4,275 68.3 1,987 31.7 6,262 6 There was a Group fall of 3% in benign gynaecology services in 2013, however in the same period the Rotunda showed a 2% increase in the same category as referenced in Table 3 below. Residents of Meath and North County Dublin were the most likely to go out of group, followed by residents of North County Dublin. Residents of Cavan and Monaghan were least likely to attend a hospital outside of the RCSI Hospitals Group. However the potential to capture all Group residents would give an overall increase of 31% activity per annum. This potential increase should be factored into this proposal. Table 3: Total benign Gynaecology discharges in the RCSI Hospital Group for the years 2012 and 2013: 2012 2013 N N Change Rotunda 3,018 3,081 63 Beaumont 353 354 1 St. Joseph's Raheny 87 82 -5 Connolly 108 89 -19 Cavan General 564 469 -95 Monaghan General 52 65 13 Our Lady of Lourdes, Drogheda 378 316 -62 Louth County, Dundalk 476 425 -51 Total 5,036 4,881 -155 4.2 Rotunda Hospital Gynaecological Activity 2014 There were 1593 gynaecology elective procedures in the Rotunda Hospital theatre in 2014. These have been analysed to determine how they ideally could be conducted. 7 Table 4|: Rotunda analysis of possible alternative management pathway of 2014 discharges 2014 Gynaecology Activity – Possible Public Private Split for New Model Out Patient Office without Anaesthesia 169 235 Day Case with Anaesthesia 434 536 Inpatient 90 130 An analysis of Rotunda Theatre procedures for 2014 indicates that 25% of all elective procedures could be accommodated in a designated and purpose equipped Out Patient Facility (235 public and 169 private). Assuming that 25% of the patients accommodated through the Mater Private Treatment initiative could be Ambulatory this would be an additional 175 public patients. Therefore a predicted 410 Rotunda public patients and some private patients (not all Consultants will be working at Connolly) could be seen in an Ambulatory Hysteroscopy Care facility. It is likely these numbers will be greater if referrals from Connolly and Beaumont Hospitals are included and it is also likely that the service will attract additional referrals from other hospitals over time. 5. AMBULATORY HYSTEROSCOPY SERVICE – PHASE 1 PROPOSAL Phase 1 of this proposal is to establish a Rotunda led outpatient service in Cherry ward, Connolly Hospital commencing with a 4 day out patient Hysteroscopy service. The service will be managed within the core working week. This initiative requires joint input from both the Rotunda Hospital and Connolly Hospital. The Rotunda Hospital will provide staffing, governance and management in relation to patient pathways of care, Connolly Hospital will provide the physical environmental facilities, storage and day to day Bioengineering Support in addition to limited patient administration and portering supports. 5.1 Ambulatory Outpatient Service – Resource Requirement Consultant Gynaecologists Three Rotunda Consultants will operate 4 clinics per week on the Connolly site. 8 Nursing / Support Staff To support a service that consists of 4 days Hysteroscopy/Gynaecological procedures the following Nursing/Support Staff are required 1 x Procedure Room “Scrub” Nurse (See Appendix 7 JD) employed by the Rotunda Hospital 1 x Procedure Room HCA (See Appendix 8 JD) as Patient Chaperone & Support employed by the Rotunda Hospital 1 x HCA to cover Procedure Room and Surgical Day Cases employed by the Rotunda

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