Beaumont Hospital 06
Positive developments
Annual Report 2006 contents
Chairman's Report 03 Members of the Board 05 Chief Executive's Review 07 Finance Report 17 Medical Executive and Medical Board Report 27 Director of Nursing Report 29
Hospital Divisions Division of Surgery 39 Division of Medicine 43 Department of Anaesthesia and Intensive Care 53 Department of Radiology 55 Neuroscience Division 57 Division of Laboratory Medicine 65 Clinical Services Division 69 Non-Clinical Services Division 87 Functional/Support Departments 93 Human Resources Department 93 Organisational Change & Development 94 Integrated Quality & Safety Department 95 Clinical Governance 98 Projects & Estate Management 98
St Joseph's Hospital, Raheny, Report 101 Royal College of Surgeons in Ireland, Report 105 Beaumont Hospital Organisation Chart 112 Research Report 113 + positive developments
As one of the country’s largest acute hospitals, Beaumont provided close to a quarter- of-a-million bed-days in 2006, 140,000 radiology examinations and approximately 160,000 out-patient attendances and day cases.
02 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chairman’s Report
put new emphasis on local management other academic teaching hospitals, partic- by multidisciplinary teams. The aim is a ularly those in Dublin with which we robust, accountable yet highly flexible share common concerns. One of these is organisation. the provision of appropriate “step down” The extent of the change involved in accommodation for patients no longer this organisational development should needing a bed in an acute hospital but not be underestimated. It does involve not fit enough to go directly home. rethinking how the hospital organises No-one should be under any illusion that and undertakes a range of its activities. provision of additional bed capacity But the approach which has been alone will address the issues of over- Donal O Shea, adopted is, above all, consensual. It is crowding in Beaumont and its Chairman only by harnessing the ideas and talents associated problems. Operating at close which abound within the hospital that to full capacity means all too frequent we can effect meaningful change. delays in admissions, whether that be through the Emergency Department or As one of the country’s largest acute This process was well begun in 2006 as an elective in-patient, and difficulties hospitals, Beaumont continues to and I and my boardroom colleagues are in preventing and containing hospital operate at consistently close to confident that the structures are in acquired infections. maximum capacity and, indeed, often place to facilitate this. above that level. It provided close to a Beaumont Hospital, however, is not an Clearly, the more efficiently Beaumont quarter of a million bed days last year, island which develops independently of can operate as a hospital, the shorter the some 13,000 theatre procedures, the rest of the world. As a regional and length of time patients will need to 140,000 radiology examinations and tertiary referral centre, we have strong spend in hospital and the greater the catered for approximately 160,000 out- relationships with doctors and hospitals number of patients that can be admitted. patient attendances and day cases. throughout Ireland. As a teaching There is an obligation on us, therefore, to constantly review and improve our In addition to meeting the needs of a hospital and research centre we have processes and arrangements so that we large population in North Dublin and its close working links with colleges, can ensure the most efficient use of our environs Beaumont also provides wider universities and many other agencies, resources, in such areas as access to regional specialities and is the tertiary both in Ireland and further afield. diagnostics, for example, and in devel- referral centre for a number of The nurture and development of these oping pre-assessment clinics to expedite important national specialities. is an integral part of the five year strategy because it is essential to the service delivery to patients. Organising this complex matrix of future development of the hospital. We also value greatly the work being services to ensure equity of access, undertaken by the HSE and other parties timeliness of provision and quality of Teaching and research are equally in the programme for Primary Commu- treatment is a challenging task, important activities which are both nity and Continuing Care (PCCC). As part especially when capacity is under intrinsic parts of this Hospital. As the of the PCCC Local Implementation considerable pressure in many areas. principal teaching hospital for the Royal Team in our area we are working with This challenge is successfully met for College of Surgeons in Ireland, these partners to improve care on the the vast majority of patients on a daily Beaumont benefits greatly from the ground, within communities, so that basis and this achievement is testimony enthusiasm and clinical excellence of timely earlier interventions will reduce to both the commitment and the abilities both talented students and talented the subsequent need for treatment in of all staff. I regret that all too frequently educators. Research is an integral part hospitals – of great benefit to the patient this passes without recognition in the of this, too, for both institutions. The as well as hospitals such as ours. midst of the many concerns which exist Hospital strategy recognises the impact about the health service in general. that an active research programme has, Within the hospital, a number of not least on our ability to attract high independent surveys have been Organisation, with a view to achieving calibre clinicians. That is why our undertaken on behalf of the HSE with efficiency and effectiveness from the commitment to both teaching and the aim of identifying areas for potential patient perspective, has been a key to research, as evidenced in our strategy, improvement in processes and to ensure the notable achievements of the is strong. Neither is an adjunct to what the appropriateness of our admissions. hospital. The five year strategic plan we do, both are integral to our current While these have been most helpful and currently in train is designed to provide purpose and vision for the future. recognising that there is always scope a new basis for this continuing quest for for improvement, I am pleased to say quality. At its core is a significant devel- We also have close working relationships that by and large such surveys have opment of the organisation which will with our primary funding agency and
BEAUMONTHOSPITAL ANNUAL REPORT 2006 03 Chairman’s Report
found that Beaumont has a particularly there for considerable periods of time, Hygiene is another factor and I am good record in terms of appropriateness typically ranging from a few months to pleased that considerable work under- of admission and discharge. years. Very few of the beds made avail- taken in this area, to which I referred to Furthermore, it is clear from these able today will become available again in my report last year, has resulted in studies that the overriding constraint to for other patients in the future. significant improvements. Hygiene service provision at Beaumont is indeed I am pleased that progress has been encompasses not just basic cleaning capacity, compounded by the difficulties made in the development of the Hospital and hand washing by visitors and staff. in discharging patients no longer in in a number of areas. These include the It is affected by the very fabric of the need of an acute bed to which I provision of a new Admissions Lounge building, materials used in furnishings referred above. We have clearly seen which provides improved conditions for and even the design of equipment. how well Beaumont can perform on a patients waiting to be transferred from Beaumont has made huge strides in wide range of criteria – from length of the Emergency Department to a ward, this area, not least in terms of devel- waiting times in the Emergency the installation recently of a long-awaited oping a hygiene aware culture amongst Department to improvements in second MRI scanner and approval for staff. I am confident that the systems admission of elective patients – when the bringing into service of an additional are in place to ensure continued rigour “step down” capacity is provided which theatre. These and many other important in this regard. I would caution, however, frees up its overall capacity. We have developments are detailed in the report that the issue of Hospital Acquired equally seen what happens when the of the Chief Executive. Infection is multifaceted and cannot be supply does not meet the hospital's successfully addressed without action Beaumont is also playing its part in needs and delayed discharges rise to being taken on a variety of fronts. developing its areas of specialist totally unacceptable levels. expertise. Additional consultant appoint- During 2006 a new Board was This has been recognised by the Health ments in such areas as neurosurgery appointed. This Board has shown itself Service Executive, which sought to and cancer treatment are the start of to be highly motivated and keen to play provide additional “step down” capacity more ambitious plans needed to meet an active role in guiding the work and in the North Dublin area during 2006. the growing needs of patients in these future direction of the hospital in what This includes an interim solution in areas. In the area of cancer treatment, was a busy year. There was significant Beaumont Convalescent Home, adjacent Beaumont is one of eight hospitals board involvement in many areas, the to the Beaumont campus, pending the identified as having the established deliberations on the proposals for the provision of significant additional expertise and scale to be further devel- co-located hospital being just one capacity at a 100 bed unit at St. Joseph’s oped as a centre of excellence. This example of the work undertaken. Hospital in Raheny in 2008. follows its selection as a future centre I would like to pay warm tribute to my I welcome these initiatives, the results of for radiotherapy and the launch of a fellow directors for their time and which are tangible in terms of the freeing Symptomatic Breast Disease Service effort, particularly on the various up much needed capacity to allow more last year. The further development of subcommittees which play such an patients to be seen and treated. The cancer services at Beaumont can be important role in the overall effective- proposal to develop a colocated private expected to see increased activity in ness of the main board. both research and education. hospital on the Beaumont Campus in Services and Governance Committee partnership with Beaumont Hospital, The various developments referred to Chair: Ms Catherine Duffy which was progressed during 2006, is above are part of a programme of much Members: Dr Paul Brennan designed to ensure a greater availability needed growth and I hope and expect Dr John Casey of beds for public patients in Beaumont. that progress will soon be evident in a Ms Suzanne Dempsey But I believe it is important that we look number of other vitally important areas, Finance Committee further ahead, too. It is a simple fact that including provision of a new dialysis Chair: Mr Patrick Mercer we have a rapidly growing population of unit, a new Intensive Care Unit, and a Members: Mr Alan Eustace elderly people who will require more Medical Assessment Unit. Mr Matt Merrigan services from the acute hospital sector In recent times there has been a grow- Ms Mary Ronan as they grow older. Furthermore, this will ing awareness of and concern about Prof Chris Stevenson give rise to ever greater demands for Hospital Acquired Infection and its Audit Committee “step down” facilities and home care causes. In large acute hospitals such as Chair: Mr Matt Merrigan supports to enable patients to return to Beaumont the difficulties in isolating Members: Ms Mary Cullen their own homes, where possible. and cohorting patients due to capacity Ms Ita Green constraints is compounded by case mix, For Beaumont the problem is simply Donal O Shea which means we have large numbers of stated: patients going into “step down” Chairman accommodation are likely to remain patients more susceptible to infection due to their condition.
04 BEAUMONTHOSPITAL ANNUAL REPORT 2006 MEMBERS OF THE BOARD
Members of the Board
Board Members 2006 - 2009
Mr. Donal O Shea Councillor Maurice Ahern Ms. Catherine Duffy Mr. Patrick Mercer Ms. Mary Ronan Chairman
Mr. Matt Merrigan Ms. Ita Green Ms. Mary Cullen Mr. Michael Horgan Professor Chris Stevenson
Dr. John Casey Dr. Paul Brennan Dr. Liam Grogan Ms. Suzanne Dempsey Mr. Alan Eustace
Name Nominated by/Representing Term of Office Mr. Donal O Shea Chairman, nominee of Minister for Health and Children January 13, 2006 - December 31, 2008 Councillor Maurice Ahern Nominee of Minister for Health and Children May 17, 2006 - May 16, 2009 Ms. Catherine Duffy Nominee of Minister for Health and Children May 17, 2006 - May 16, 2009 Mr. Patrick Mercer Nominee of Minister for Health and Children May 17, 2006 - May 16, 2009 Ms. Mary Ronan Nominee of Minister for Health and Children May 17, 2006 - May 16, 2009 Mr. Matt Merrigan Nominee of Chairman May 17, 2006 - May 16, 2009 Ms. Ita Green Nominee of Chairman May 17, 2006 - May 16, 2009 Ms. Mary Cullen Nominee of Chairman May 17, 2006 - May 16, 2009 Mr. Michael Horgan Royal College of Surgeons in Ireland (Chief Executive) May 17, 2006 - May 16, 2009 Professor Chris Stevenson Dublin City University (Professor of Nursing) May 17, 2006 - May 16, 2009 Dr. John Casey General Practitioner May 17, 2006 - May 16, 2009 Dr. Paul Brennan Chairman, Medical Board, Beaumont Hospital February 17, 2006 - December 31, 2007 Dr. Liam Grogan Vice Chairman, Medical Board, Beaumont Hospital February 17 ,2006 - December 31, 2007 Ms. Suzanne Dempsey Elected by Hospital Staff September 2006 - May 16, 2009 Mr. Alan Eustace Elected by Hospital Staff September 2006 - May 16, 2009
BEAUMONTHOSPITAL ANNUAL REPORT 2006 05 + positive developments
Patients treated In-patients 20,971 Out-patients 125,947 ED admissions 47,291 Day cases 35,690 Theatre procedures 13,166
06 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chief Executive’s Review
2006 was a year in which the Hospital Beaumont Hospital is managing this embarked on the implementation of its facility as an extension of the Hospital. five-year strategic plan which was This unit will ultimately transfer to the launched at the end of 2005. The new facility in St Joseph's when it strategic plan set the framework for the becomes operational. Hospital's development over a five-year The delayed discharge issue presented period. One of the chief elements is the difficulties in meeting the targets set by programme of organisation development the HSE with regard to patients waiting to transform the management of the in the Emergency Department. While we Hospital by 2010. The foundations for did strive to meet the targets, it must be this ambitious programme were laid in Liam Duffy, recognised that we are severely 2006 and will entail the development of a Chief Executive hampered by the unavailability of beds number of business units based around for Emergency Department admissions. groups of specialties. There will be We are continuously reviewing our significant changes in the way services admission processes and patient are organised with improved pathways to ensure that patients are not multidisciplinary team-working, ultimately kept inappropriately in hospital. leading to improved service-delivery to Our waiting lists patients and a more active role for staff We have benchmarked our length-of-stay over the last five in local management. The key to starting against national and international norms. years have shown this work was the appointment of a Head Where there are variations we have addressed them as a matter of urgency steady improvements; of Organisational Development and Ms and focused on reducing these variances, for example the list Anne McNeely was successful in obtaining this post. The Deputy Chief particularly in the area of admission prior has reduced by over Executive post was also filled by the to surgery, with the establishment of pre- 100% between 2001 appointment of Ms Margaret Swords admission clinics. (3005) and 2006 who will also play a pivotal role in the We were pleased to receive funding to (1405). development programme. open an Admissions Lounge adjacent to the Emergency Department. This Activity provides accommodation in dignified In the year under review the Hospital surroundings for ten patients while continued to face challenges to deliver awaiting admission to a hospital ward. efficient and high-quality services to its patients in the face of ever-increasing Plans for the new Acute Medical demands. The tables on pages 10-15 Assessment Unit and the second MRI demonstrate that activity levels were made progress during the year and we maintained at the same levels as recent are hopeful that these two units will years. What the tables do not show, become operational during 2007 or early however, is the fact that our number of 2008. The new AMAU building will also delayed discharges remained at very high accommodate a new HDU unit with eight levels during the year, although it must beds, including four single rooms with be acknowledged that the HSE did negative pressure facilities. We also plan secure an additional number of places to address the shortage of ICU beds by during the year which did help to ease the addition of two new ICU beds. This pressure. At the end of 2006, we were will be achieved by conversion of a staff delighted with the announcement by the room adjacent to the existing ICU. HSE that a new 100-bed unit is to be Our waiting lists over the last five years developed on the grounds of St Joseph's have shown steady improvements; for Hospital, Raheny, as a facility for long- example the list has reduced by over term patients from Beaumont Hospital. 100% between 2001 (3005) and 2006 As an interim measure, the HSE have (1405). This has been achieved through a leased accommodation in the Beaumont combination of improved verification of Convalescent Home, adjacent to waiting lists, more throughput of elective Beaumont Hospital, which will provide an cases by the acquisition of St Joseph's interim facility for thirty-five patients. Hospital, and improved referrals to the
BEAUMONTHOSPITAL ANNUAL REPORT 2006 07 Chief Executive’s Review
National Treatment Purchase Fund. resources for this service which, when was performed by staff at all levels of the The Hospital is committed to further up and running, will perform fifteen organisation towards preparing for this improving referrals to the NTPF in the transplants in the first year. inspection. future. The investment in the symptomatic We continued to concentrate resources Major Developments breast disease service and the diabetes on improving hygiene standards Two developments planned for the service was acknowledged by the official throughout the Hospital, and we were Beaumont Hospital campus over the launch by Ms Mary Harney TD, Minister rewarded by a greatly improved result in coming years will have significant for Health and Children during the year. the second hygiene audit which saw our implications for the delivery of services in score rise by 20 points to 84. A much Out-patients service the hospital, viz. higher level of awareness is evident For some time, we have striven to among staff of the Hospital and we improve the services for our out-patients Colocated private hospital continue to strive to achieve higher levels The Minister for Health and Children to provide an efficient and appointment- of hygiene, particularly in the clinical announced plans for the development of based service. During 2006, after areas. One area of continuing concern, colocated private hospitals on a number completion of a total refurbishment of however, is that of hand hygiene and we of public hospital sites, one of which was our out-patients’ department, we have a need to have a continuous education and Beaumont Hospital. During the latter part bright, modern department with audit programme to increase compliance of the year, there was intensive activity as reconfigured space which has allowed us rates amongst staff. It is gratifying to note the HSE worked up proposals for inviting to introduce three clinics per day for the growth in awareness by members of tenders for this facility. At the time of some services. I am delighted to the public evidenced by the usage of the writing this report, a decision has been announce the success of this initiative alcohol gel dispensers which are made to award the tender to Beacon and plans are in train to extend the abundant throughout the building. appointment system to all our out-patient Medical for the development of a private The challenge posed by MRSA and other hospital on the Beaumont campus. clinics over the coming years. This will require changes in schedules for some healthcare acquired infections remains a critical issue for the Hospital. The North Dublin Supra-Regional consultants and administrative staff. continued high occupancy rates and the Cancer Service While we focus on maximising the use of limited number of single rooms militate The announcement of the development our out-patient space, we will also be against our efforts to control infection of this facility was made in 2005 by the aiming to ensure that patients are treated rates. The new Acute Medical Minister for Health and Children. within as short a timeframe as possible Assessment Unit is being designed to Approval was given in 2006 to the provide an additional 15 single rooms, development interim radiation oncology Accreditation and audit In May 2006, we underwent inspection and this together with two new ICU beds services (two linear accelerators) but it by surveyors from the Irish Health and a new eight-bed HDU unit by 2008 was disappointing that progress was Services Accreditation Board. I would like will be very welcome in our drive to slow during the year and it is difficult to to pay tribute to the extensive work that control infection rates. see the target date of 2009 being met at the time of writing.
Service developments During the year we focused on developing business cases for our national specialities of Neurosurgery and Renal Transplantation. We were very pleased to received approval for additional consultant neurosurgeons, particularly in the area of paediatric neurosurgery, where the existing consultant has for too long provided this service on his own. The HSE also approved funding to allow for the opening of a new theatre (theatre 11) which will provide additional capacity for neurosurgery and for the emerging living donor transplantation service. We very Members of the Kennedy family raised €30,000 to support research into Motor much welcomed the approval of Neurone Disease. They presented the cheque to Orla Hardiman, Consultant Neurologist, in the presence of the Minister for Health & Children, Mary Harney TD.
08 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chief Executive’s Review
Paediatric Hospital Hospital but there is considerable work At the invitation of the HSE, we submitted involved to integrate this into all a proposal for the development of the specialties. The next step is the new tertiary paediatric hospital on the appointment of a Clinical Governance Beaumont Hospital campus. Our proposal Manager and we are hopeful that this was based on the distinct advantages appointment will be made in 2007. which we felt Beaumont Hospital had to offer, including unique paediatric synergies with adult clinical specialties, e.g. national neurosurgery referral centre, national renal/pancreatic transplantation, national cochlear implantation, major cystic fibrosis unit, and site of new supra-regional radiotherapy/cancer centre. A lot of effort and consultation with key stakeholders was involved and we were disappointed that our proposal was not successful. The main reason for our failure to secure this facility was access to the Hospital. We acknowledge that this is a particular problem and we had sought to develop a link with the new Metro East but, regrettably, this was not sanctioned. We will continue our efforts to link in with the development of new transport initiatives that would improve access to our campus. Professor Arnold Hill, Professor of Surgery, RCSI, Mary Harney TD, Minister for Health & New Consultants Children and Mr Donal O Shea, Chairman Beaumont Hospital at the launch of the We welcomed the following new hospital’s new Symptomatic Breast Disease Service. consultants to the staff of the Hospital during 2006: - Mr Peter Lacy, Consultant ENT Surgeon Conclusion - Dr Maria Moran, Consultant 2006 was a very successful year for the Psychiatrist/Psychiatry of Old Age Hospital as we continued to build and - Mr Donncha O'Brien, develop our areas of strength. I would Consultant Neurosurgeon like to thank my colleagues on the management team, the Medical - Dr Ross Morgan, Consultant Executive, the Hospital Board and our Respiratory & General Physician external partners, the HSE, RCSI, DCU, in - Mr Richard Power, Consultant particular for their continued support and Transplant Surgeon & Urologist assistance to me. We also acknowledge - Dr Jacinta Morgan, Consultant in the work of the Beaumont Hospital Rehabilitation Medicine Foundation and their contribution to the - Dr Fidelma Fitzpatrick, facilities of the Hospital. Consultant Microbiologist Liam Duffy - Prof Arnold Hill, Prof of Surgery Chief Executive Clinical Governance Our Clinical Governance structure was strengthened during the year by the appointment of a Chair of Clinical Governance Committee, Professor Austin Leahy. Peer clinical audit is practised by many specialties in the
BEAUMONTHOSPITAL ANNUAL REPORT 2006 09 Chief Executive’s Review
Table 1: Admissions Specialty 2003 2004 2005 2006 Cardiology 1,265 1,178 1,240 1,122 ENT 1,536 1,381 1,618 1,406 Medical 7,257 6,689 7,338 7,705 Nephrology 1,639 1,420 1,605 1,573 Neurology 770 806 775 838 Neurosurgial 2,114 2,093 2,048 1,838 Surgical 4,633 4,668 5,180 5,316 Urology 1,110 1,134 1,206 1,173 Total 20,324 19,369 21,010 20,971
Please note St. Joseph's Hospital activity is included in above information from 2005.
Table 2: In-Patient Admissions by Catchment and Non-Catchment Areas 2006 Medical Surgical ENT N/S Neph/Uro/T’Plant Total Catchment Area 7,902 4,215 775 268 1,137 14,297 Non-Catchment Area 1,763 1,101 631 1,570 1,609 6,674 Totals 9,665 5,316 1,406 1,838 2,746 20,971
Please note St. Joseph's Hospital activity is included in above information. Note: Beaumont Hospital Catchment Area is Dublin 3, 5, 9, 11, 13, 17 and North County Dublin/ Fingal.
Table 3: Bed Days Used Specialty 2002 2003 2004 2005 2006 Surgical 47,538 48,777 48,129 47,688 46,415 Neurosurgical 25,925 26,515 25,740 26,476 25,794 Urology 7,383 7,377 7,931 8,118 7,547 ENT 6,222 6,478 6,012 5,946 6,158 Medical 78,315 81,149 81,032 98,464 99,209 Nephrology 17,739 17,462 16,951 16,393 16,201 Cardiology 12,970 12,577 15,284 13,727 14,271 Neurology 9,494 9,979 10,561 10,805 10,707 Unallocated 3,224 3,711 3,600 3,841 4,797 Total 208,810 214,025 215,240 231,458 231,099
Please note St. Joseph's Hospital activity is included in above information from 2005.
10 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chief Executive’s Review
Table 4: Day Case Procedures Specialty 2002 2003 2004 2005 2006 Cardiology 886 1,086 1,131 1,161 998 Dermatology 1,091 1,192 1,259 1,292 1,516 ENT 1,356 1,299 2,311 2,075 1,831 Gynaecology 197 214 357 558 378 Medical 12,891 13,585 17,004 20,147 20,342 Neurosurgery 43 134 253 295 277 Neurology 64 35 92 172 240 Nephrology 217 323 345 377 359 Orthopaedics 2,079 2,148 459 631 655 Pain Relief 489 680 609 924 754 Surgical 4,426 4,865 4,750 6,115 5,452 Urology 2,927 3,032 3,445 3,511 2,888 Totals 26,666 28,593 32,015 37,258 35,690
Haemodialysis 2002 2003 2004 2005 2006 25,413 25,017 28,096 31,557 34,665
Please note St. Joseph's Hospital activity is included in above information from 2005.
Table 5: In-Patient Admissions by Health Board Health Board Medical Surgical ENT N/S Neph/Uro/ Total % T’Plant Eastern 8,578 4,578 973 871 1,588 16,588 79% North-Eastern 534 403 280 233 480 1,930 9% South-Eastern 132 77 31 175 186 601 3% North-Western 121 98 28 101 169 517 2% Western 71 35 34 228 87 455 2% Midland 92 56 11 118 105 382 2% Mid-Western 41 11 21 62 70 205 1% Southern 29 17 25 32 43 146 1% EEC 48 23 2 15 18 106 1% Unspecified Area Code 19 18 13041 0% Total 9,665 5,316 1,406 1,838 2,746 20,971 100%
Please note St. Joseph's Hospital activity is included in above information from 2005.
Table 6: Out-Patient Activity 2002 2003 2004 2005 2006 New 24,817 24,953 24,703 24,756 25,754 Return 94,565 94,861 99,707 99,036 100,193 Total 119,382 119,814 124,410 123,792 125,947
Table 7: A & E Activity - Attendances 2002 2003 2004 2005 2006 New 44,473 44,087 45,126 44,262 44,931 Return 3,472 3,637 4,173 3,690 2,360 Total 47,945 47,724 49,299 47,952 47,291
BEAUMONTHOSPITAL ANNUAL REPORT 2006 11 Chief Executive’s Review
Table 8: Radiology Activity Specialty 2002 2003 2004 2005 2006 General Examinations 88,276 91,365 95,317 99,031 98,827 Ultrasound 7,464 8,175 8,794 8,346 7,844 CT Brain Scan 5,782 5,884 6,000 6,474 6,290 CT Body Scan 9,048 8,146 9,711 14,941 12,859 Isotope Scans 2,474 2,366 2,331 2,401 2,487 Neurovascular 809 1,092 1,179 1,371 2,891 Neuroangio 2,088 2,216 2,473 3,573 1,047 MRI 7,737 6,370 6,953 6,200 7,953 Total Examinations 123,678 125,614 132,758 142,337 140,198 Total Patients 102,648 103,580 107,631 118,605 112,428
Table 9: Total Lab Activity Requests 2002 2003 2004 2005 2006 1,295,840 1,318,920 1,396,554 1,577,282 1,726,751
Table 10: Beaumont Hospital Theatre Activity Specialty 2002 2003 2004 2005 2006 Surgery 3,551 3,640 3,979 3,857 3,884 Orthopaedic 1,226 1,322 1,428 1,472 1,595 Urology/Transplantation 1,156 1,493 1,516 1,428 1,560 ENT 1,094 1,216 1,296 1,166 1,146 Neurosurgery 1,504 1,547 1,706 1,706 1,582 Gynaecology 296 309 360 338 370 Medical Spec 82 162 234 299 319 Total 8,909 9,689 10,519 10,266 10,456
Table 11: St. Joseph's Theatre Activity Specialty 2006 Endo 949 General 401 Urology 312 Gynae 52 Plastics 67 Ortho 35 Pain 163 ENT 223 Locals 464 Dermatology 41 Totals 2,710
12 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chief Executive’s Review
Table 12:Waiting Lists - In-Patients Waiting > 3 Months December Specialty 2002 2003 2004 2005 2006 Surgery: General 840 791 390 351 356 Orthopaedic 201 94 32 22 43 Neurosurgery 796 602 409 472 400 Urology 191 173 143 125 82 ENT 554 247 107 83 120 Gynaecology 65 29 29 4 11 Dental 31000 Pain 22 29 35 35 30
Medicine: General 163 515 168 216 206 Nephrology 36 21 37 13 4 Neurology 122 112 135 170 105 Cardiology 11 20 30 52 48 Haematology 11221
Totals 3,005 2,635 1,517 1,545 1,406
Above information represents a snapshot of patients waiting > 3 months in Dec of appropriate year. Surgery:"General" includes: General Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Maxillo Facial. Medicine: "General" includes Dermatology, Endocrinology, Gastroenterology, General Medicine, Geriatrics, Oncology, Psychiatry, Respiratory Medicine, Rheumatology.
Table 13: Average Length of Stay - Days 1999 2000 2001 2002 2003 2004 2005 2006 9.7 9.1 10.1 10.2 10.3 11.1 11.3 11.0
Table 14: Cardiac Interventional Suite Procedures 2004 2005 2006 AICD 55 73 73 Alcohol Ablation 100 Angiogram Total 1,902 1,876 1,757 E.P. Studies 26 15 17 E.P. Study With Radio Frequency Ablation 10 14 15 Ivus Total 35 37 31 Loop Recorder 45 58 57 Miscellaneous 57 16 7 Non-Coronary Stenting (Renal Stents) 15 10 4 Pacemaker Total 255 252 241 PFO/ASD Closures 11 19 21 Plaato 0 18 8 Pressure Wire/FFR 21 59 32 PTCA Total 714 655 539 Renal Angiograms 103 147 64 Right & Left Heart 26 43 106 STENTS Used Per Month 1,552 1,447 1,206 Valvuolplasty 020
BEAUMONTHOSPITAL ANNUAL REPORT 2006 13 Chief Executive’s Review
Table 1: Admissions Table 4: Day Case Procedures
21,500 40,000
21,000 35,000
20,500 30,000
20,000 25,000
19,500 20,000
19,000 15,000 10,000 18,500 5,000 18,000 2003 2004 2005 2006 0 2002 2003 2004 2005 2006
Table 2: In-Patient Admissions By Catchment & Non-Catchment Areas Table 5: In-Patient Admissions By Health Board 2006
16,000
14,000 Eastern 16,588 12,000 = Catchment Area North-Eastern 1,930 10,000 South-Eastern 601 = Non-catchment Area 8,000 North-Western 517 Western 455 6,000 Midland 382 4,000 Mid-Western 205 Southern 146 2,000 EEC 106 0 Unspecified Area Code 41
Table 3: Bed Days Used Table 6: OPD Attendances
235,000 129,000 229,500 127,000 125,000 224,000 123,000 218,500 121,000 213,000 119,000 207,500 117,000 202,000 115,000 113,000 196,500 111,000 191,000 109,000 185,500 107,000 180,000 105,000 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006
14 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Chief Executive’s Review
Table 7: A&E Activity - Attendances
49,500 Table 10: Theatre Activity
49,000 12,400 48,500
10,800 48,000
47,500 9,200
47,000 7,600 46,500
0 46,000 6,000 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006
Table 8: Radiology Activity Table 11:Waiting Lists - In-Patients Waiting > 3 Months December 145,000 3,500
3,000 135,000 2,500
2,000 125,000 1,500
1,000 115,000
500
105,000 0 2002 2003 2004 2005 2006 2002 2003 2004 2005 2006
Table 9: Total Lab Activity Requests Table 12: Average Length of Stay - Days
1,800,000 12 1,670,000
1,540,000 11 1,410,000 10 1,280,000 1,150,000 9 1,020,000 890,000 8 760,000 7 630,000
500,000 6 2002 2003 2004 2005 2006 1999 2000 2001 2002 2003 2004 2005 2006
BEAUMONTHOSPITAL ANNUAL REPORT 2006 15 + positive developments
Funding € million Revenue Funding 249.5 Capital Funding 17.4 Other income 39.8
16 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Finance Report
Introduction Revenue Funding The financial outcome for the year ended Revenue funding for 2006 increased by December 31, 2006 shows a cumulative €16.489m (7.0%) over the 2005 total. € surplus of 0.991million (2005 The main components of this increase € cumulative surplus 3.327 million) on a were: non-capital allocation of €249.546 million. The Hospital’s 2006 funding from the Pay increases under national pay Health Service Executive fell short of its agreements and increments € expenditure by €2.336 million, reducing ( 9.513m) € the closing surplus to 0.991 million. The Funding for service and cost pressures Gus Mulligan, closing surplus has been committed to a (€7.798m) Financial Controller number of hygiene and other projects Service developments which will be completed in 2007. (€2.087m) The difficult funding environment Non - Pay and Technical inflation experienced in recent years continued (€3.103m) throughout 2006. Despite this, the Hospital progressed or completed a The Hospital also suffered a number of Substantial number of important clinical funding reductions, principally: investments in A&E development initiatives including: Increases in public hospital charges (€1.617m) and hygiene the symptomatic breast service. Targeted value-for-money savings contributed to expansion of oncology services. € significantly ( 1.936m) expansion of renal dialysis services. improved results in Patient Experience appointment of consultants as part of (€0.500m) both areas. the St. Joseph’s Hospital project Minor Capital (replaced by a capital Substantial investments in A&E and allocation in 2006) hygiene contributed to significantly (€ 3.100m) improved results in both areas. Furthermore, the Hospital continued to Capital Funding improve its capability in the areas of The Capital Funding allocation of quality and risk management and project €17.395m represented the 2006 management through investment in drawdown in respect of the four-year these areas. Capital Equipment Replacement and These projects - while delivering Refurbishment Programme funded under substantial benefits - added to the the National Development Plan. together inflationary pressures on the Hospital’s with a number of specific projects cost base. funded subsequently. The most significant projects were: Funding Allocation Funding from the Department of Health Staff Change Area related to 35-bed Service Executive for 2006 totalled day ward € €265,950m (2004: €244.102m). This ( 2.997m)
comprised revenue funding of Out-patients Department Refurbishment €249.546m and capital funding of (€2.369m) €17.395m (2005: €233.057m and Pipes and Pumps Replacement Project €11.045m respectively). (€2.358m)
Medical Equipment (€1.546m)
Building Refurbishment (€1.265m)
BEAUMONTHOSPITAL ANNUAL REPORT 2006 17 Finance Report
Boiler House Upgrade There were also a number of significant Taxation (€0.894m) increases, mainly: The taxation provision of €792,000 in the
Kitchen Upgrade Laboratory costs increased significantly Balance Sheet arises from the receipt of (€0.702m) due to the costs of the GP Courier income from the Multi Storey Car Park Car Park through the Beaumont Hospital Electrical Infrastructure scheme and outsourcing of tests. Car Park Company Limited in the years (€0.698m) X-Ray costs increased as capacity 1999-2003. (See Annual Report 2004). pressures gave rise to a need to Income & Expenditure outsource MRI tests. The directors consider and are advised Account Expenditure that the rents were held in trust for Food costs increased in line with Gross expenditure (before deduction of Beaumont Hospital Board and were activity following canteen refurbishment. income) for 2006 was €291.660m, an collected by the company as its agent. increase of €20.400m (7.5%) over 2005. The Hygiene programme led to However, the Revenue Commissioners significantly higher cleaning costs. Pay Costs (including superannuation) contested this view and indicated their intention to raise an assessment for increased by €17.116m (9.4%) for the Gas and electricity price rises following main reasons: increased energy costs. taxation on the rents received on the grounds that Beaumont Hospital Car Park Increases under the Sustaining Financial and Administrative costs rose Company Limited is a taxable entity. Progress Agreement and full year by €3.179m (22%) due mainly to: The Revenue Commissioners raised the costs of Benchmarking and Parallel Major increases in expenditure on assessment for the years 1999-2002 and Benchmarking. computer infrastructural hardware and the Hospital’s tax advisers have appealed Increments. software. this decision to the Revenue Appeals Clinical developments in Breast Increased insurance charges as the Commissioners. Surgery, Oncology, Renal Dialysis and 2005 base figure included a once-off St Joseph’s. premium rebate. Liquidity The Hospital had a net cash outflow of Expansion in St. Joseph’s related Income €3.891m due to the shortfall in funding services, including Anaesthetics, Income for 2006 was €39.778m an and a rise in working capital needs. Endocrinology, Plastic Surgery, increase of 9.2% over the prior year level Within the working capital a significant Respiratory and Vascular. (€36.436m). The main contributors to the increase in Creditors (€5.993m) was Investment in Change, Project, Risk increase were: partly offset by increases in Stocks and Quality Management capability. (€0.725m), HSE Debtors (€3.087m) and A 30% increase in recoverable costs. € Non-Pay expenditure, in total, increased non-HSE Debtors ( 0.561m). The rise in A 16.6% increase in Retail, Restaurant by €7.966m (9.7%) over 2005. Creditors was due to increased non- pay and Car Park receipts. and project spending and an exceptional Direct Patient Care costs increased by A 3% increase in private/semi-private accrual for IT expenditure at year end. €0.993m (2.0%) in 2006. This modest income as a 10% increase in charge During 2006 the Hospital significantly level of increase arose from moderate rates was partly offset by a fall in increases in oncology drugs and vaccines. increased its dependence on overdraft private bed utilisation. € These were partly offset by a fall in blood funding which rose by 6.093m to € charges from the exceptional levels of A 12% increase in in-patient 18.647m. This represented almost 2005 and the removal of medical statutory charges. 100% of the maximum overdraft limit set by HSE. equipment purchases from the revenue An 8.7% increase in superannuation allocation to the capital allocation. deductions in line with the increase in The provisions of the Prompt Payments Patient Care as a proportion of non-pay pay costs. Act 1997 apply to the payment practices of the Hospital. Under Section 12 of the spending fell to 52.2% in 2006 from The income from private beds grew by Act the Hospital issues a Prompt 52.7% in 2005. only 3% despite a 10% rate increase as Payments of Account Statement to the € the need to use private beds for patient Support Services costs fell by 1.222m Minister for Enterprise and Employment. (4.4%) from the 2005 level. The main isolation and public patient emergency reason was a fall in spending on admissions grew. During the year up to building refurbishment from the high 50% of private beds were used for level of 2005. these purposes.
18 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Finance Report
Balance Sheet Funding for equipment replacement Support for Clinicians in Management. Total Capital Employed of at the end of and building maintenance continues to The Hospital is actively working on a 2006 was €103.950m (2005: €94.053m). fall well short of what is required. This suitable implementation of CIM. This will This comprised Fixed Assets (at net book situation is forcing replacement cycles place considerable demands on the value) €104.759m, Current Assets which are unrealistically long and Finance function in terms of business €60.986m, Current Liabilities €52.738m ultimately unsustainable. There is an support and information provision. € urgent need for a further Capital and Long Term Liabilities of 9.057m. In the uncertain funding environment Equipment Replacement Programme to Of the cash balances shown in the the operation of focused cash address this problem. Balance Sheet, €4.264m (73.1%) management, financial forecasting, represents the balance on the Multi- These issues introduce considerable budget management, cost analysis and Storey Car Park Sinking Fund. Under the uncertainty in planning and delivering centralised cost containment measures Multi-Storey Car Park Agreement, these services. The Hospital continues to work have received high priority. with the NHO to address these planning funds are not available for use by the Expansion of the services provided to Hospital until 2013 and may then only be and funding issues. managers. The Finance Department used to exercise the Hospital’s option to continues to focus on improving the acquire title to the Multi-Storey Car Park. Developments The most important development quality of financial analysis and project- An increase of €1.550m in other cash priorities for the Finance function are: costing services available to managers as holdings was mainly due to increased a key priority. holdings of research funds which are also The improvement of costing activity, unavailable to the Hospital. diagnosis-related group (DRG) and patient level. DRG level costs were Significant Issues produced in 2006 and will continue to be The baseline funding of the Hospital is refined. Lack of suitably skilled external inadequate to fund the running of the resources continues to be limiting factor. Hospital. In 2006 the Hospital’s allocation Devolved budgeting for which roll-out fell short of its normal day-to-day is planned for 2007. Funding shortfalls spending by €1.700m. As in previous which persist throughout each year years the Hospital’s funding relied on continue to present the most significant 1.Savings on development projects, barrier to the operation of effective which arose from normal devolved budgeting. implementation delays. Upgrading of financial systems. 2.Non-recurring minor-capital The Hospital upgraded its financial ledger allocations. system in 2005 giving significantly As savings on development projects improved levels of visibility, analysis and must be spent in subsequent years and control of financial information. Upgrade as minor capital allocations can vary of the Purchasing and Accounts Payable significantly from year to year, this software modules, scheduled for 2007, creates major uncertainty. will give further benefits in terms of cost control and improved processes. While 2006 was relatively free from cost pressures in the area of new An integrated HR and Salaries system technologies and drugs there are major which would streamline HR and Payroll pressures arising from new drugs and procedures, eliminate duplication and new drug combinations. In general, improve controls. A proposal for a funding for new treatment technologies system has been developed and in the current funding model continues to awaits funding. be totally inadequate.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 19 Finance Report
BALANCE SHEET AT 31ST DECEMBER 2006 Notes 2006 2005 €'000 €'000 €'000 €'000
FIXED ASSETS 4 104,759 94,861 FINANCIAL ASSETS DONATIONS AND BEQUEST FUNDS
CURRENT ASSETS Stocks 47,513 38,353 Debtors 7,647 6,922 Bank/Cash Balance 5,826 3,537
60,986 48,812
CURRENT LIABILITIES Creditors 33,299 27,304 Bank Overdraft / Loan 18,647 12,554 Taxation 792 792
52,738 40,650
NET CURRENT ASSETS / (LIABILITIES) 8,248 8,162
LONG TERM LIABILITIES Financing Obligations 9,057 8,970
NET ASSETS 103,950 94,053
FINANCED BY: Non-Capital Income & Expenditure Account (Deficit) / Surplus 991 3,327 Capital Income & Expenditure Account (Deficit) / Surplus (1,800) (4,135) Capitalisation Account 104,759 94,861
103,950 94,053
20 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Finance Report
REVENUE INCOME & EXPENDITURE ACCOUNT YEAR ENDED 31ST DECEMBER 2006 Notes 2006 2005 €'000 €'000
STAFF COSTS
Salaries 1 190,998 174,181 Superannuation 1 7,678 7,379
NON-PAY EXPENDITURE Direct Patient Care 2 48,521 47,258 Support Services 2 26,778 28,000 Financial and Administrative Costs 2 17,685 14,442
Expenditure for the year 291,660 271,260
Income for year 3 39,778 36,436
Net expenditure for the year 251,882 234,824 Taxation Allocation for the year 249,546 233,057
DEFICIT / (SURPLUS) FOR THE YEAR 2,336 1,767
Cumulative Revenue Deficit / (Surplus) from previous year (3,327) (5,094)
CUMULATIVE REVENUE DEFICIT / (SURPLUS) AT END OF YEAR (991) (3,327)
BEAUMONTHOSPITAL ANNUAL REPORT 2006 21 Finance Report
2006 EXPENDITURE
Financial and Management / Administration Administration Pay % €'000
Support Services Management / Administration Pay 8% 24,712 Medical / Dental Pay Medical / Dental Pay 18% 51,384 Nursing Pay 24% 69,746 Paramedical Pay 9% 25,380 Direct Patient Support Services Pay 5% 15,452 Care Maintenance / Technical Pay 1% 4,324 Superannuation 3% 7,678 Direct Patient Care 17% 48,521 Super- annuation Support Services 9% 26,778 Maintenance / Technical Pay Nursing Pay Financial and Administration 6% 17,685
Support Services Pay Paramedical Pay Totals 100% 291,660
2006 INCOME
Other In-patient Income Statutory Charges % €'000 Out-patient Charges ( including A&E and MRI) Retail / Car Park RTA receipts In-Patient Statutory Charges 6% 2,511 receipts Out-patient Charges (including A&E and MRI) 3% 1,301 RTA receipts 2% 781 Private/semi-private charges 27% 10,693 Canteen receipts Other In-patient charges 1% 331 Superannuation 19% 7,597 Other payroll deductions 2% 895 Recoverable costs 16% 6,549 Recoverable costs Private/ semi-private Canteen receipts 3% 1,078 charges Retail / Car Park receipts 19% 7,547 Other payroll Other deductions In-patient Other Income 1% 495 Superannuation charges Totals 100% 39,778
22 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Finance Report
NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31ST DECEMBER 2006 1 STAFF COSTS 2006 2005 €'000 €'000 Management Administration 24,712 22,620 Medical / dental 51,384 46,750 Nursing 69,746 64,547 Paramedical 25,380 22,887 Support Services 15,452 13,503 Maintenance / Technical 4,324 3,874 Total Pay 190,998 174,181 Superannuation Pensions and refunds 6,511 5,882 Gratuities and lump sums 1,167 1,497 Total Superannuation 7,678 7,379 Total Staff Costs 198,676 181,560
2 NON-PAY EXPENDITURE 2006 2005 €'000 €'000 Direct Patient Care Drugs and medicine 17,922 16,858 Blood and blood products 4,746 4,892 Medical gases 365 388 Medical and surgical supplies 23,198 22,304 Other medical equipment Supplies & contract med. equipment 2,290 2,816 Total 48,521 47,258 Support Services X-ray/imaging 4,245 4,807 Laboratory 6,507 5,719 Catering 2,597 2,203 Heat, power, light 2,385 1,959 Cleaning and washing 5,266 4,644 Furniture, crockery, hardware 228 407 Bedding and clothing 483 381 Maintenance - Buildings 3,659 6,688 Maintenance - Grounds 52 65 Transport and travel 1,356 1,127 Total 26,778 28,000 Financial and Administrative Bank loan repayment 1,066 962 Bank interest and charges 175 140 Insurance & claims 1,196 794 Audit 57 40 Legal 146 71 Bad and doubtful debts 220 15 Office expenses (rent/rates/postage/tel.) 3,370 3,371 Computer 5,386 3,044 Professional services 926 926 Miscellaneous 5,079 5,079 Office equipment Total 17,621 14,442 Total Non-pay Expenditure 92,920 89,700
BEAUMONTHOSPITAL ANNUAL REPORT 2006 23 Finance Report
NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31ST DECEMBER 2006 3 INCOME 2006 2005 €'000 €'000 In-Patient Statutory Charges 2,511 2,237 Out-patient Charges (including A&E and MRI) 1,301 1,179 RTA receipts 781 1,056 Private/semi-private 10,693 10,378 Other patient charges 331 306 Superannuation 7,597 6,941 Other payroll deductions 895 709 Recoverable Costs 6,549 5,010 Canteen receipts 1,078 696 Retail / Car Park Receipts 7,547 6,383 Other income 495 1,541
Total income 39,778 36,436
24 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Finance Report
NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31ST DECEMBER 2006 4 FIXED ASSETS Work in Land Buildings Progress Equipment Vehicles Total €'000 €'000 €'000 €'000 €'000 €'000 Cost Balance at 1 January 2006 215 82,555 24,983 43,819 22 151,727 Additions 13,998 472 2,415 16,885 Revaluations Disposals -186 -186 Transfers 23,735 -23,735 Balance at 31 December 2006 215 120,421 1,720 46,048 22 168,426 Depreciation Accumulated depreciation at 1 January 2005 26,985 29,874 7 56,866 Depreciation Charge 1,929 4,995 3 6,927 Depreciation on Disposals -126 -126 Accumulated depreciation at 31 December 2006 28,914 34,743 10 63,667 Net book amount at 31 December 2006 215 91,507 1,720 11,305 12 104,759 Net book amount at 31 December 2005 215 55,703 24,983 13,945 15 94,861
Notes 1. The Multi-Storey Car Park on which the Hospital holds a call option maturing in 2013 has been included in Buildings at the option value, €8,888,165. No depreciation has been provided on this asset. A corresponding long-term liability has been included in the Balance Sheet. 2 The net book amount of equipment does not include any amounts in respect of leased assets
Work in Buildings Progress Equipment Total 2006 €'000 €'000 €'000 €'000 Funding of Additions Capital Grants 13,505 472 2,149 16,126 Revenue Grants 493 266 759 Other Leased Assets 13,998 472 2,415 16,885
BEAUMONTHOSPITAL ANNUAL REPORT 2006 25 + positive developments
Work on developing a cancer strategy for the Hospital started during 2006, in the context of the HSE’s plan for the fullest possible level of integration between the National Programme for Radiation Oncology (NPRO) and the National Cancer Control Programme (NCCP).
26 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Medical Executive & Medical Board Report
The Medical Executive met on seven • Funding for the development of occasions during 2006 and focussed on a neurosciences and living-donor number of major issues during the year: transplantation was approved during the • We welcomed the announcement by year. Development of these services is the Minister for Health and Children to vital but the excessive lead time from the locate the north Dublin radiation oncology announcement of developments to facility at Beaumont Hospital and look actual approval to proceed is of concern. forward to this much-needed service • It was a disappointment that projects being developed on our campus previously approved, i.e. the Medical • Work on developing a cancer strategy Assessment Unit, psychiatric unit and Paul Brennan, for the Hospital started during 2006, the renal dialysis unit, did not advance Chairman Medical Board in the context of the HSE’s plan for the during 2006 and we hope for significant fullest possible level of integration progress in 2007. between the National Programme for • The Clinical Ethics Forum was Radiation Oncology (NPRO) and the established in 2006 under the National Cancer Control Programme chairmanship of Dr Ciaran Donegan. (NCCP). We have been working to develop We appreciate the work undertaken The primary focus for our cancer services in anticipation of the by Dr Donegan and his colleagues on the Clinical implementation of the NPRO and the the Forum. NCCP, including recruiting key personnel. Governance Manager I would like to thank the members of the It is acknowledged that our cancer strategy will be to support and Medical Executive and the staff in the should set out clearly our priorities in terms Medical Administration Department for facilitate the of service development, staffing and their assistance to me during my first year development of infrastructure. The strategy will also as Chairman of the Medical Executive. clinical governance identify principles which will underpin the Paul Brennan in all clinical services development of Cancer Services at Chairman Beaumont, identify high level needs within Beaumont Medical Executive and Board analysis for Cancer Services at Beaumont Hospital. and establish strategic priorities for Cancer Services, based on the current state of Members of Medical Executive 2006: Cancer Services in Beaumont and future objectives. Dr Paul Brennan, Chairman Dr Liam Grogan, Vice Chairman • The new colocated private hospital to be built on the campus was announced Professor David Foley, by the Minister for Health and Children Honorary Secretary and we spent much time working with Dr Anthony Dorman, Chairman, the HSE on this project. A key principle Laboratory Medicine Division of the colocated policy is that the public Dr Rory Dwyer, Chairman, and private hospitals must work in a Anaesthetic Division totally integrated fashion, with similar Dr Mark Logan, Chairman, case-mix and with consultant staff Radiology Division working across both sites. These will be Dr Joan Moroney, Chairman, key requirements to delivery of a Neurosciences Division successful colocated model. Dr JA O’Dwyer, Medical Administrator • The establishment of a Clinical Mr Henry Osborne, Chairman, Governance framework started in 2006 Surgical Division and we hope to make significant progress on this with the appointment of Dr Stephen Patchett, Chairman, a Clinical Governance Manager in 2007. Medical Division The primary focus for this post will be to support and facilitate the development of clinical governance in all clinical services within Beaumont Hospital.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 27 + positive developments
Nursing complement: 989 full-time equivalents
28 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Director of Nursing Report
As the nursing shortages persist the The Department of Nursing Department of Nursing is indebted to acknowledges her dedication and the commitment of nursing staff who wishes her many happy and healthy made themselves available to ensure years of retirement. continuity of patient care, thus enabling the Department to maintain optimum Departures: staffing levels during the past year. Mr Paul Gallagher - Divisional Nurse Manager: Theatre/X-ray/CSSD Turnover of Nursing Staff Ms Cathy Connolly - CNM3, ICU Nursing turnover continued to be a Marie Keane, challenge throughout 2006: turnover Ms Avril O’Leary - Night Superintendent Director of Nursing increased slightly on 2005 figures to 15.7% by the end of December 2006. Professional Development for This compares with a nursing turnover Clinical Nurse Managers of 14.4% in 2004 and 15.3% in 2005. In order to maintain a high-quality service there has been an active Nursing Staff Complement participation by nursing staff in post Every effort was made to attain the graduate education, professional In the increasingly WTE complement of 989 RGNs development and regular attendance at multidisciplinary during 2006. conferences and workshops held. environment of 149 nurses were appointed (39 non- Management and Development Beaumont Hospital EU). 156.53 RGNs resigned of which 14 Programmes for Clinical Nurse highly skilled and were non-EU nationals. Non-European Managers (18 per programme) were trained nurses nurses comprise 33% of the total successfully completed. Clinical continue to play a nursing complement. projects were undertaken by the participants. These programmes are central role in the The rostered students helped to facilitated by Ms Raphaela Kane, DCU support patient care on the wards and delivery of services and Beaumont Hospital. to our patients. fill some of the vacancies; however, the number of vacancies has reduced and Accreditation was supplemented with Agency Nurses The Nursing Department was actively and nurses working overtime. The skill- involved on all Accreditation mix of nursing staff in the clinical area Committees with many taking the lead. remained an issue. Nurses, as part of the multidisciplinary teams, worked on reviewing the Senior Nursing Appointments standards and identifying areas of During the past year the following strength and opportunities for senior appointments were made: improvement in the organisation. Theatre/CSSD/ICU/X-Ray: Ms Judy These teams continue to meet monthly McEntee, Divisional Nurse Manager to develop the quality programme. The Accreditation survey took place in Medical: Mr Ken Fitzgibbon, Divisional May 2006 and we await the outcome. Nurse Manager Renal: Ms Sharon Dwyer, Divisional St. Joseph's, Raheny Nurse Manager The Department of Nursing embraced the management of nursing services in Nursing Support Services Manager: St. Joseph's Hospital Raheny, in con- Ms Rosemary Derwin, CNM3 junction with Ms.Maura Hazlett. The full Nursing complement was achieved Retirement which enabled services to be expanded. Ms Bridget Hogan retired as Divisional Nurse Manager in the Renal Division. Nursing Recognition Day Ms Hogan was a very valued member A Nursing Recognition Day was held in of the nursing staff and gave many conjunction with the Beaumont Staff years of outstanding service to patients. Day. The theme of this day was Quality
BEAUMONTHOSPITAL ANNUAL REPORT 2006 29 Director of Nursing Report
and Recognition. 55 Nurses graduated The workload of the division continued CENTRE OF NURSE EDUCATION and received their nursing hospital to expand in all areas of activity during Director of Centre: Mary T O'Sullivan badge, 25 received Higher Diploma 2006. Certificates and 30 received Special The focus of the centre is to provide a Practice Certificates. Awards were Emergency Department high standard of continuous education presented for Research Projects for the The department continued to work and professional development for Sheppard Trust, the Charitable Infirmary under extreme pressure with the mixed qualified nursing staff and health-care Charitable Trust, the Buchalter Bursary demands of providing an emergency assistants within Beaumont Hospital (confined to ICU Nursing) and the service to North Dublin and an and St Joseph's Hospital, Raheny. Josephine Bartley Award. in-patient service for ten to thirty Educational and professional patients per day. Development of a 10- development needs are planned and Conclusion bedded Admission Lounge adjacent to delivered in collaboration with the On a personal note I would like to thank the department is progressing and will Nursing Practice Development Unit and my colleagues in the Department of be opened in early 2007. This area will the Learning and Development Unit. Nursing, including the night staff and allow patients dignity and privacy while out-of-hours nursing staff and the awaiting admission to the Hospital. In partnership with the Royal College of clinical nursing staff, for their co- Surgeons in Ireland the following Staff turnover decreased from 12% in operation, commitment and support programmes are being provided for 2005 to 11% in 2006. during the past year. approximately 38 RGNs. This Post Graduate Diploma / MSc (NQAI level 9) I would also like to acknowledge the Out-patients Department is provided in: support of all the Hospital staff. Refurbishment of the department was Their contribution ensured that the completed in 2006 increasing the • Emergency, Intensive Care, Coronary nursing staff were able to continue to capacity in clinic suites A to D by three Care, Peri Operative, Neuroscience, provide a quality service to all patients. rooms each and the addition of a new Gerontological and Oncology Nursing. four-roomed suite, clinic F. In the latter Clinically-based six-month Specialist EMERGENCY part of 2006, Sr. Frances Sullivan was Practice Programmes are run in a DEPARTMENT/OUT-PATIENTS' appointed as Project Manager for the variety of areas such as Neurosciences, DEPARTMENT DIVISION expansion and development of the Out- Coronary Care, Emergency Department, Divisional Nurse Manager – Mary Rose patient Service. Oncology, Nephrology and Gerontology.
The Emergency Department/Out- Education of nursing staff continued to The Centre provides a plethora of Patients' Department Division be a priority: clinical educational programmes ranging comprises the following areas: nurses have successfully from two-hour sessions to two-day Emergency Department completed the BNS programme programmes. Some of these are Annual attendance of circa 45,000 highlighted opposite; 5 nurses have successfully Out-patients Department completed the Higher Diploma in The Health Care Support Certificate Annual attendance of 110,000 Nursing (A/E) in partnership with the (FETAC level 5) is run through the Centre Royal College of Nursing in conjunction with the Mater, Temple Anticoagulation Service Street and the Rotunda Hospitals. Annual attendance circa. 3,000 5 nurse have successfully completed This course runs once a year over nine the Diploma in Management St. Michael's Detoxifcation Unit months and is made up of a five-week 10 beds 2 nurses have successfully trained in theoretical component and clinical advanced trauma life support in practice. The group is made up of Stephen Doyle Endoscopy Unit Northern Ireland approximately 40 Health Care Assistants Annual attendance of circa 7,000 from a variety of Health Care settings of 6 clinical nurse managers have Urodynamics which 12 are from Beaumont. successfully completed the Annual attendance of 3,000 management development The Return to Nursing Practice Coleman K. Byrne (Haematology) Unit programme Programme is also run in conjunction Annual treatments 3,000 with the Mater Hospital. This is a six- 12 staff nurses have completed the week course run twice a year. Hepatology Unit 6-month specialist practice certificate Annual attendance 1,000 in A&E nursing
30 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Director of Nursing Report
Many conferences, both nationally and Clinical educational programmes internationally, were attended by nursing Programme Title No. of times run per year No. of participants Induction for new staff 12 87 staff in oncology to ensure practice is on Orientation for International Nurses 2 39 par with international best practice. Preceptorship Programme 8 117 These included conferences in Belfast, Workshop for International Nurses 3 40 Toronto, Boston and Barcelona. Orientation for newly-qualified staff nurses 2 45 Ms Aine Byrne (CNM2 Oncology Day IV Study Day 12 108 Haemovigliance 12 127 Ward) and Ms Clodagh McHugh Venepuncture for phlebotomy staff 1 11 (Oncology Liason Nurse) were selected CERP Training 1 37 by the Health Research Board Ireland – Venepuncture & cannualation 5 38 Northern – National Cancer Institute Tracheostomy Education Programme 8 67 /Cancer Consortium to participate in a Respiratory Education Programme/ Inhaler five and a half week Clinical Trials /Humidification Update 4 50 Training held in the National Cancer Chest Drain 2 20 Institute in Washington DC in the USA Stoma Care Education Programme 5 59 in Oct / November 2006. Peg Tube management 2 20 Managing Aggressive Behaviour 2 22 Infectious Diseases Pressure Ulcer Study Day 1 19 The Infectious Diseases Out-patient Management of peripheral arterial disease & measurement of ankle brachial index 2 15 Clinic, which is nurse-led, is held once Enhancing Support Skills Study Day 1 26 weekly, since 2004. During 2006 this Presentation Skills for Education Providers 1 18 clinic operated to its full capacity and Major Emergency Workshop 4 99 consideration will have to be given to English Language Workshop expanding the service in the future. Informed Consent 1 115 The main out-patient clinic deals with one to two new HIV diagnoses per week, with many other patients attending for treatment of Hepatitis C. The Infectious Certificate in Healthcare Support MEDICAL I DIVISION Diseases Team participated in World Aids undertaken by health-care assistants Day on June 15 and set up an education General Medicine and Oncology from Mater Miseracorde Hospital, stand outside the staff canteen which Divisional Nurse Manager: Ken Community areas 7 and 8, St. Francis helped to increase awareness of the Fitzgibbon Hospice and Beaumont Hospitals. incidence of HIV AIDS. The Medical 1 Division comprises 195 Oncology beds in the following areas: St Patrick’s, Respiratory Nursing Centre Beaumont Hospital was selected as a St. Mary’s, St. Paul’s, St. Laurence’s, St. 2006 saw the continuation and Supra-Regional site for the proposed new Clare’s, Oncology Day Ward, St. Teresa’s, development of education in relation to Radiation Oncology / Cancer Care Centre and Jervis Ward. non-invasive ventilation, with formal and plans were ongoing in 2006 to sessions being run on a regular basis in The Medical 1 Division also incorporates process- map this venture as well as an the Centre of Nurse Education, as well as Palliative Care and Infectious Diseases. interim solution to initiate this service. teaching continuing at ward level. Congratulations to Mr. Paul Troy on his Palliative Care promotion to CNM3 Oncology services The number of patients with Cystic The Palliative Care Team has a during 2006. A Masters in Oncology Fibrosis attending Beaumont Hospital complement of three nurse specialists, Nursing was developed in partnership with continued to rise in 2006. A submission who provide an invaluable advisory the RCSI. Four staff nurses are at present was made in 2005 to the HSE for service to patients and staff. They also participating in the Higher Diploma in additional staff to support this service, participated in the now annual Palliative Oncology which is year one of the two- and we are awaiting the recruitment of a Care Study Day which was very well year Masters programme. A waiting-room further Clinical Nurse Specialist (CNM2) attended by staff from Beaumont has been developed for our oncology day to enhance this essential service. Plans Hospital as well as staff from hospice unit which has greatly enhanced patient for a non-invasive ventilation high- and community settings. Nurse comfort and our oncology day unit has dependency unit within our respiratory Specialists from Palliative Care continue increased its hours of service from 5pm to service are ongoing. to be actively involved in teaching and 8pm to facilitate the numbers of patients management of the Palliative Care attending this service. Module for the FETAC (Level 5)
BEAUMONTHOSPITAL ANNUAL REPORT 2006 31 Director of Nursing Report
Clinical Practice Support As with every year, many nurses comprises a five-day intensive structured The division welcomed Ms Orla Flynn to undertook further studies. Courses varied education programme. Thus far, 36 the role of Clinical Practice Support Nurse from CNM Management Development patients have become DAFNE graduates. in late 2006. The Clinical Placement Programmes, Bachelor of Nursing Programme for Candidate Nurses and a Studies, Masters in Nursing. Diploma in St. Joseph's Hospital Ms. Maura Hazlett continues to lead the competency-based development Management to specialist courses such nursing team in St. Joseph's Hospital. programme for Staff Nurses, developed as Higher Diploma in Oncology Nursing 2006 saw an increase in activities in in 2005, continue to successfully provide and Diploma in Respiratory Nursing. both theatre and the Hospital in general. support to new members of our nursing I would like to take this opportunity to In June Professor Finucane retired after staff and are currently being evaluated. thank nursing and all staff in the division many years of service. The introduction of ward-based education for their hard work throughout 2006. by the CPSN is being developed to Ms Liz McArdle, Clinical Nurse Manager individual ward needs as well as providing MEDICAL II DIVISION II, and Ms. Elaine Whelan from the ongoing general basic care topics to all Divisional Nurse Manager: Bernie Lynch Rehabilitation Unit presented a paper on areas. Fourteen new graduates from the “Goal Setting” at the Gerontology Study 2006 was another busy and challenging BSc (Hons) began their roles of staff Day held in Beaumont Hospital. Nursing year for the division. Once again the nurses in all areas of the division in staff were actively involved in the dedication and commitment Autumn of 2006. The CPSN continued to accreditation process and attended many demonstrated by all staff must be provide support for overseas nurses for meetings in Beaumont. acknowledged. adaptation and direct registration within The professional development of staff the division. Accreditation within the Hospital continued with many A lot of hard work continued in the early Accreditation staff attending in-service training and part of 2006 in preparation for the specialist seminars. Two nurses from the Beaumont Hospital participated in Accreditation Survey which took place in Rehabilitation Unit commenced the assessment by IHSAB accreditation the week commencing May 8, 2006. Higher Diploma in Gerontology Nursing surveyors in May 2006 where nurses from in September. the Medical 1 Division participated on a Staff Training & Development number of Accreditation Teams including Education of nursing staff continued to Respiratory, Oncology, Gastro-Intestinal Chest Pain Service be a priority. The Chest Pain Service within Beaumont Medicine and General Medicine. Hospital incorporates the Cardiology Seven nurses undertook the Higher Diagnosis Unit and Chest Pain Service Medical Wards Diploma in Coronary Care Nursing and Clinic. This service is co-ordinated by Nursing staff from the medical wards four nurses completed the six-month Paul Stoneman, Cardiac Nurse Specialist, were actively involved in new initiatives Specialist Practice programme. and aims to improve the assessment in relation to discharge-planning. Three nurses commenced the Higher diagnosis and treatment of patients This ranged from facilitating Diploma in Gerontological Nursing and presenting to the Emergency Department Multidisciplinary Team meetings at ward five nurses completed the six-month with undifferentiated chest pain. level to attending Bed Management Specialist Practice programme. Discharge-planning meetings. The Heart Failure Service facilitation of Multidisciplinary Team Participation by Clinical Nurse Managers External funding was secured in 2006 to meetings proved very challenging on in the Management Development initiate a long-awaited Heart Failure wards where as many as 22 different Programme continued in 2006. Service. Ms. Clare Lewis was appointed consultants had patients on some as a Heart Failure Nurse Specialist in medical wards. Nurses in the Medical Diabetes Care Day Centre November. The aim of this role is to help Division also participated in the 2006 was an exciting year for diabetes reduce the risk of progressive introduction of a discharge-planning IT care. The new centre was officially deterioration of heart failure, improve initiative within our Nursing Information opened by the Minister for Health and quality of life for patients and their System as well as the introduction of Children, Ms Mary Harney TD, in October. families, reduce the frequency of hospital electronic nursing discharge letters. The centre offers more space and affords re-admission and promote patient self- some privacy for patients with the Congratulations to Ms Nerissa management. Furthermore, it will assist provision of two examination rooms. Ramittere on her appointment to CNM1 the Hospital in developing best practice St. Patrick's ward and Ms Aine Byrne on A new education initiative was in managing this chronic illness. her appointment to CNM2 Oncology introduced for patients with Type 1 Day Ward. Diabetes, with the commencement of the DAFNE programme in May. This
32 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Director of Nursing Report
Cardiac Rehabilitation Department The Department of Nursing wishes to Budgeted Staff Complement The Cardiac Rehabilitation Department is congratulate the newly-appointed staff Nurse Staffing Grades and Whole-Time developing on an ongoing basis. The links and wish them every success in their Equivalents with Dublin City University are continuing new roles. with phase IV Cardiac Rehabilitation now 2005 2006 restructured to include more of our DIVISION OF RENAL NURSING Clinical Nurse Divisional Nurse Manager – Sharon 11 patients. A very successful golf fund- Manager III Dwyer. raising day took place, organised by past Clinical Nurse Manager II 9.5 10.5 patients. The money raised helped the 2006 saw the retirement of two Clinical Nurse department to upgrade equipment. In May, stalwarts of the Renal Nursing Division, Manager I 12 14 the first CPR programme for family and Ms. Bridget Hogan, Divisional Nurse Renal Nurse friends was attended by 30 family Manager, and Ms. Kathleen Kelly, CNM3 Counsellor CNM II 1.5 1.5 members. Four members of staff, for Haemodialysis Services. Together, Patient Care Katriona Slack, Deirdre Dodd, Alison Ms. Hogan and Ms. Kelly were Co-Ordinator CNM II 33 Cahill and Helen Newton, graduated with instrumental in the development of the Renal Clinical Systems a Masters in Cardiac Rehabilitation from speciality of Renal Nursing and dedicated Nurse CNM II 11 the Royal College of Surgeons in Ireland their working lives to the development of Haemodialysis Nurse in June 2006. services for renal patients. Indeed, as Instructor CNM II 11 Ms. Hogan retired, planning permission Renal Virology Care of the Elderly Service was granted for a new state-of-the-art Co-Ordinator CNM II 11 Planning continued in relation to the 44-station haemodialysis unit Staff Nurses 88 110.5 development of a new Day Hospital. It is incorporating facilities for peritoneal anticipated that building will commence dialysis, counselling, occupational Total Number of in 2007. A very successful Gerontology therapy and physiotherapy for renal Whole-Time Equivalents 118 143.5 Study day, organised by Sean O'Brien, patients. Ms. Hogan and Ms. Kelly were Education Co-ordinator, was held on joined in retirement later in the year by October 12, 2006. There was a country- another very senior member of the renal The following new appointments were wide attendance of over one hundred nursing team, Ms. Marion O’Farrell, also made during 2006:- and seventy people. It had a particular after many years of dedicated and focus on the management in the acute excellent service. We wish each of them • Ms. Veronica Francis, was appointed environment of patients with dementia. well in their retirement. as CNM3 for Haemodialysis Services.
Funding has been secured from the Another major change for the Division of • Ms. Ciara White, was appointed as National Council for the Professional Renal Nursing was the inclusion of St. Education Facilitator/Course Coordinator. Development of Nursing and Midwifery, Damien’s Ward in the Division. St. for ten Dementia Awareness Study Days. Damien’s Ward is a 33-bed in-patient Staff Training and Development ward, with 9 beds allocated to Renal 13 nurses successfully completed the New Appointments Transplantation, 9 beds allocated to Specialist Practice Programme in Renal The following new appointments were Haematology and the remaining 15 beds Nursing. made during 2006. allocated to Urology. The curriculum for a Post Graduate • Ms. Anna Polson was appointed A summary of the major activity of the Diploma in Renal Nursing was developed Clinical Nurse Manager in the Coronary Renal Department is provided in the Renal in conjunction with the RCSI with the Care Unit. Medical Report. However, the general hope of commencing the programme in September 2007. • Ms. Mary Coogan was appointed trend was an increase in workload with as many as 220 patients requiring maint- Clinical Nurse Manager in the Coronary A number of nurses attended Care Unit. enance haemodialysis towards the end of International Nephrology and Transplant the year. To relieve the pressure a number Nursing Conferences with a paper being • Ms. E. Hickey was appointed Clinical of patients had their haemodialysis presented at the EDTNA in Madrid by Ms Nurse Manager in the Coronary treatments facilitated at the newly-opened Victoria Coogan and Ms Carol Ann Flynn. Care Unit. Northern Cross Dialysis Unit. In the Four Clinical Nurse Managers from the • Mr. Joseph Morris was appointed meantime, a final decision to proceed to division successfully completed the Clinical Nurse Manager in the Stage IV of the planning process is Management Development Programme Whitworth Ward. awaited from the HSE. run in conjunction with Dublin City University.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 33 Director of Nursing Report
Accreditation Ward, Carol Lyons, CNM 2, Hardwicke combination of integrated care and The Renal Accreditation Team was a truly Ward, who were part of a group who documentation facilitated a more multidisciplinary team with medical, won the Sheppard Trust prize. Also, accurate picture of the patient's progress nursing, allied health professional and Fionnuala Duffy, CPSN, Banks Ward, and outcome. The pathway will be patient involvement. Among the “areas who was awarded the Charitable audited in six months. Infirmary Charitable Trust prize. of excellence” highlighted by the The changing health-care environment surveyors in May was the multidisciplinary poses new challenges for nursing. Accreditation approach to care for our client group and In response to this we organised a series Nursing staff continued to represent the the individualised patient care available of management days to up-skill senior division on the Accreditation teams. on a 24-hour basis. staff nurses. A total of 40 staff nurses A group is working on developing Following recommendations from the have undertaken this programme. Integrated Care Pathways on two of the surveyors we are hoping to have a surgical wards. number of Key Performance Indicators Research The department continues to be actively and an Integrated Care Pathway for Renal involved in research that promotes Patients in place by the end of 2007. NEUROSCIENCE & PAEDIATRIC NURSING DEPARTMENT excellence in patient care. Ms. Bernie We are also currently reviewing our Divisional Nurse Manager: Suzanne Corr, Clinical Nurse Specialist, Motor Virology Guidelines to ensure they are in Dempsey Neurone Disease, was awarded a Health line with the National Guidelines on the Research Board grant to allow her 2006 was an extremely busy year for the Prevention of Blood Borne Diseases in complete a Masters Programme through department, in particular the first half the Healthcare Setting. research. Ms Corr is examining “End of was focused on preparing for the Life Decisions and Advance Directives in Hospital Accreditation survey in May. SURGICAL DIVISION Motor Neurone Disease: Evidence-based This visit went very well for the Divisional Nurse Manager: Deirdre Carey guidelines for best practice in Ireland”. Neurosciences Team. Like previous years, 2006 was another Education busy period for all within the Surgical New Appointments Six RGNs completed the Higher Diploma Division. Ms Jayne O'Mahoney in Neurosciences and the Clinical Clinical Practice Support Nurse The Surgical Division comprises 151 Specialist Practice Course. beds in the following wards: A B Clery, Ms Denise Boyle The Summer events programme was Banks, Hardwicke, St. Luke’s and St. Clinical Nurse Manager 1, St. Brigid's Anne’s ENT. attended by 110 staff from nursing and Ms Ciara Ni Fhlathartaigh the allied health-care professionals. Topics Other areas in the division are: Stoma Clinical Course Co-ordinator covered included the bereavement Care, TPN, Breast Care/Cancer Nurse Co- process, stroke management, relaxation Ms Fiona Markey Ordinator, Radiation-Oncology and complimentary therapies and head Clinical Nurse Manager 1, RICU Co-Ordinator, Head & Neck Nurse injury management. Specialist and Colo-proctology Nurse Ms Margaret Ryan Specialist. Clinical Nurse Manager 1, EEG/EMG NURSING PRACTICE Ms Paula Fitzpatrick DEVELOPMENT UNIT(NPDU) New and Promotional Nursing Practice Development Co- Clinical Nurse Manager 1, RICU Appointments Ordinator: Susan Hawkshaw Ms Mairead Carty, CNM1, Staff Recruitment Staff Retention Hardwicke Ward 14.8 % Staff terminated. Support for the BSc Undergraduate General Nursing Programme Professional Education and 3.8 % Staff transferred to promotional Fifty-five of our first undergraduate BSc Development posts or other divisions within the Nursing Students graduated from Dublin The professional development of staff Hospital. City University. Most of these graduates continues to be an integral part of the 18.83% Staff recruited. took up positions as staff nurses here in support provided within the division. Beaumont Hospital. This is due to the commitment of the Clinical Clinical Practice Support Nurses along The clinical staff, with the support of In November 2006 the department with the Clinical Nurse Manager. Clinical Placement Co-ordinators (CPCs) introduced its first integrated care pathway and the Student Allocation Officer, I wish to express my congratulations to for Lumber Discectomy. The multi- supported and facilitated 270 student Angela O' Donnell, CPSN, AB Clery disciplinary team has indicated that the nurses on various clinical placements.
34 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Director of Nursing Report
The CPCs continued to prepare staff in Hospital Procurement Services Group in while the day theatre treated the clinical area to preceptor and assess order to ensure economic use of 2,261 patients. students, by running nine preceptorship resources, particularly in mattress The nursing staff are committed to courses, training a total of 117 nurse contracts and VAC therapy. providing an efficient service that is of preceptors. high standard. This was reflected and Audits from the NPDU The Nursing Practice Development celebrated when Theatre Nurses • Audit of CPC Role Coordinator, Student Allocations Officer hosted the National Theatre Conference and CPCs maintain strong partnership • Audit of Hospital-Acquired Pressure in Beaumont Hospital on September 30, links with Dublin City University. Ulcers. 2006. The conference had a large attendance from all over the country • Audit of aspects of Drug Administration Practice Development and was well received by all. Two of the priority areas for practice • Audit of Nursing Documentation The Post Graduate Diploma in Operating were drug administration and nursing • Audit of Urinary Catheters standards Nursing was conducted in partnership documentation. and documentation. with the Royal College of Surgeons in A warning poster was developed to raise Ireland. Seven nurses successfully • SWOT evaluation of the rostered year awareness with nurses administering completed the programme. drugs that they are the last line of defence NPDU Research papers against errors. Also a successful study • “An evaluation of the Tissue Viability Staff appointments day on “Medication Management and Ms Theresa Moran is the newly- Nurse's Role”, Midlands Wound Care Error Prevention” was run in November appointed Clinical Practice Support Nurse. conference. for staff. Theresa works closely with all the Clinical • “Nurses' Experiences and Knowledge Nurse Managers in aiding and assisting A review and update of all nursing of Urinary Catheterisation and nurse education and professional documentation is being progressed. Management” Trinity College Dublin development in the department. The Clinical Practice Development Nurse School of Nursing and Midwifery 7th Ms Elizabeth Oakes was appointed to the continued to support the staff in St annual Interdisciplinary Research role of CNM2 in Neurosurgery Theatre. Joseph's Hospital. All members of the Conference. NPDU and the Clinical Practice Support • “Using simulation to prepare nursing CSSD Nurses took an active part in developing students for their roles as Staff Nurses”. Productivity increased in the sterile nursing practice. Trinity College Dublin School of Nursing services department in 2006, with 35,036 and Midwifery 7th annual Inter- sets of reusable medical devices Tissue Viability Service disciplinary Research Conference. processed in comparison to 34,371 in The Tissue Viability Nurse (TVN) service 2005. This represents an increase of 1.9%. continued to develop a pressure area OPERATING THEATRE, GITU, management programme. To continue CSSD, RADIOLOGY,ST FINBARS Education continues to play a vital role in raising awareness among staff, the TVNs DAY WARD. staff development with in-house training provided regular in-service education and programmes provided for technicians. Divisional Nurse Manager: Paul Gallagher organised a Pressure Ulcer Study day for In addition, one member of staff is (January -August 2006) staff. The TVNs developed a process to undertaking a BSc in Sterile Services in monitor the prevalence rate of hospital Judy McEntee (August 2006 – ongoing) DIT, Tallaght, while another is acquired pressure ulcers (KPI). The first Staff in the division continue to offer a undertaking a MSc in Health Care prevalence was 6.2% in October 2006 professional service and strive to Management in the Royal College of whilst the EU average is 18%. They also ensure quality is delivered to clients Surgeons in Ireland. followed up on 211 reported pressure within an ever-changing environment. Ms Celine O'Keefe (CSSD Deputy ulcers, an increase of 58% on those We would like to take this opportunity Manager) retired in 2006 having worked reported in 2005, and carried out a full to express our sincere gratitude for the in Beaumont Hospital for a number of assessment of all reported high grade commitment and dedication years. We offer our thanks to Celine for pressures ulcers. demonstrated by all. her hard work and dedication. We wish The TVNs gave advice and assistance on her a long and happy retirement. 1,560 referrals regarding complex wound Operating Theatres Ms Lisa Carolan was appointed to the care and pressure area management, Overall activity in the Operating post of Deputy CSSD Manager. a 70% increase in referrals from 2003. Theatre Department for 2006 increased compared to the previous year. 10,600 One of the team's main objectives was Also they liaised with Supplies and cases were completed in main theatre to raise the unit's profile amongst
BEAUMONTHOSPITAL ANNUAL REPORT 2006 35 Director of Nursing Report
colleagues in various other departments nurses new to Beaumont ITU. This allocation of three trolleys for Emergency throughout the Hospital. An information enhanced programme is now operational. Department patients on a daily basis in leaflet was devised that explains the an attempt to help alleviate pressure on service and provides contact details. Radiology Department that department. The nursing staff in Radiology are in the The CSSD team worked closely with An audit was conducted over a three- process of organising a National clinical departments and the Infection month period in relation to Day Ward Radiology Conference that is to take Prevention and Control Team in prepara- Services. Feedback from this audit was place in April 2007. The conference will tion for the National Decontamination positive. focus on the developments within the Review that takes place in January 2007. area of interventional radiology. Abstracts for poster presentations were The overall aim is to ensure a service that accepted from the following National and is in line with international best practice. A local hygiene committee was formed International Conferences: within the department with nurses General Intensive Care Unit actively participating in promoting best 14th International Conference on Health Five nurses successfully completed the practice. Promotion Hospitals, Palanga, Lithuania Post Graduate Diploma in Intensive Care (May 2006) Work is underway to further develop the Nursing in conjunction with the Royal current induction programme for new College of Surgeons in Ireland. Dublin Castle Innovation nurses to the area. Awards 2006 One nurse completed a BNS Degree while 5th Annual National Council for the another nurse achieved a MSc in Nursing. St Finbarr's Day Ward Professional Development of Nursing, Activity remains high with 6,435 patients Ms Caroline Fallon was appointed to an RSCI (November 2006) attending for day procedures, an increase acting CNM3 position. of 439 patients in comparison to 2005. Sr. Noreen Brady Smyth continues to be Ms Niamh Duggan returned to the role of 1,934 patients were pre-assessed. 137 involved in the National Surgical and Clinical Practice Support Nurse on a part- patients attended for infusion therapy. Medical Day Service section of the Irish time basis while continuing in her CNM 2 Nurses Organisation. There are plans Education is ongoing with one nurse role for the remaining 19.5hrs. underway to organise the very first day- completing the CNM management service nursing conference in Ireland. The unit continued to work towards programme, while another works towards developing the service from a variety her degree. All staff attended the Personal HEALTHCARE ASSISTANTS of angles. Safety Awareness and Customer Care Nursing Support Services Manager: programme. One member of staff A new blood gas analyser was installed Rosemarie Derwin attended the Team Based Performance in close proximity to patient's bedside. Management Programme. At present there are 90 WTE Healthcare This allows the nurse to access up-to- Assistant posts within Beaumont date vital information while adjusting In-service training in relation to new Hospital. Healthcare Assistants work patient treatment in a timely manner. equipment, services and safety issues directly in patient care under the was provided through the year. Two recliner chairs were purchased for the supervision of registered nursing staff visitors' area. These provide greater and are employed to provide nursing Developments comfort during what can often be long support in general wards (surgical/ Ongoing developments continue in waiting periods for families of ITU patients. medical). Healthcare Assistants also play relation to patient information and an important role within the multi- Accreditation and hygiene remained a guidelines following surgery. A Staff disciplinary team in Richmond Intensive prominent focus, led by a very motivated Nurse introduced a new admission form care, Haemodialysis, Out-patients' team. Progress in these areas has for non pre-assessed patients. This aids Department and Emergency Department. resulted in the following improvements: in facilitating a smooth admission With the integration of St. Joseph's process. Another Staff Nurse developed • Restructuring of storage space Hospital, Raheny, into Beaumont Hospital information guidelines for patients including a new linen cupboard and a services, additional HCA posts were undergoing cerebral/femoral angiogram. designated area for cleaning staff to created to facilitate care in the 14-bedded work from. The service is now completing more Care of the Elderly Rehabilitation unit complex cases on a day care basis. opened in September 2004. • Review of patient documentation and flow sheet to optimise the level and There are plans to further develop the 2006 also saw the fifth rollout of the quality of information recorded. infusion service transferring the care of FETAC (NCVA Level 5) Certificate in all patients for infusion to the Day Ward. Health Care Support. Twelve students • The staff nurse induction programme The Day Ward has facilitated the from Beaumont Hospital are participating was reviewed to reflect the needs of
36 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Director of Nursing Report
in the course which runs from September Interviews are scheduled for early 2007. The ICPT organised a successful hand to May (academic year). This eight hygiene awareness programme Infection Control Committee (ICC). This modular course is facilitated in co- incorporating a week-long hand hygiene is a multi-disciplinary committee that operation with the Mater Misericordiae campaign in October. A total of over 600 meets four times a year. The committee Hospital, the Rotunda Hospital and staff members and 350 members of the has representation from hospital Temple Street Hospital. This course will public participated in the campaign. management, senior nursing, specialist create a basic qualification for Healthcare units, hospital support services and Assistants within a National framework Professional senior medical staff. The remit of this and is funded by the HSE. Toney Thomas was awarded Fellowship committee is to advise and support the of the Faculty of Nursing and Midwifery, Wednesday, October 18, 2006 was a day IPCT, review and ratify policies, Royal College of Surgeons in Ireland. He of celebration at Beaumont Hospital. documents and reports produced by the continued his secondment to the RCSI as Ten healthcare assistants graduated for ICPT. It reports to the hospital Chief course co-ordinator for the Postgraduate the first time with the Nursing Staff of Executive and Medical Board. Diploma in Nursing (Infection Control). Beaumont Hospital. John Walsh enrolled for and commenced Surveillance the Postgraduate Diploma in Infection Infection Prevention and Control Surveillance programmes on Control Nursing. Department bloodstream infections (BSI), The aim of the Infection Prevention and neurosurgical infections and alert Presentations Control Team (IPCT), with the support of organisms including, tuberculosis, The IPC team attended and presented all staff within the hospital, is to reduce MRSA, Vancomycin-resistant enterococci posters at various national and the risk of infection through education, (VRE), and Clostridium difficile continued International conferences as: the surveillance and action. through the year. International Staphylococcal Conference, The team is multidisciplinary, led by a Beaumont Hospital participated in the Maastricht, Netherlands: “Don't Panic Consultant Microbiologist. The nursing Hospital Infection Society (HIS) Prevalence Conference” in Sheffield: Hospital team consists of Tracy Doherty (CNM2), Survey of Healthcare-associated Infection Infection Society (HIS) Conference, Toney Thomas (CNM2) and John Walsh (HCAI) 2006. The overall HCAI rate was Amsterdam: Annual International Nursing (A/CNM2). They continued to be involved 4.9% for the Republic of Ireland. and Midwifery Conference, RCSI: in various hospital groups and Beaumont Hospital's rate was above that Antimicrobial Resistant Action Plan/SARI committees while maintaining a clinical of the average for hospitals in our group (North/South) conference Dublin. focus and offering advice, support and but that may be partially explained by the guidance on a wide range of issues. complex case-mix in this hospital. Achievements An extension of the electronic alert In order to further enhance and develop Education system in the Emergency Department the infection control team, the post of Educational sessions were provided by was introduced to highlight patients Assistant Director of Nursing in Infection the Infection Control and Prevention colonised or infected with MRSA and/or Prevention and Control was advertised. Team to a wide range of hospital staff. VRE. Electronic notification of infectious diseases to the Eastern Regional Health RETIREMENTS 2006 Area and Public Health was implemented. NAME GRADE DATE OF RETIREMENT Audits on hand hygiene, sharps disposal, Maureen Keane Staff Nurse 13/01/06 environmental hygiene and waste disposal Louise Power Staff Nurse 16/01/06 were conducted. A summary document on Beaumont Hospital compliance with Kathleen Kelly CNM 3 28/02/06 SARI Guidelines on MRSA and hand Bridget Hogan Divisional Nurse Manager 31/03/06 hygiene was prepared by the ICPT.
Anne Donovan Staff Nurse 30/04/06 All staff in Beaumont Hospital made Margaret Fitzgerald CNM 2 16/06/06 considerable effort in achieving and consistently improving hygiene standards Celine O'Keeffe CNM 2 12/07/06 in the hospital. This is clearly evident Celine Purcell CNM 2 18/07/06 from the second National Acute Teresa Magure CNM 2 31/07/06 Hospitals Hygiene Audit, undertaken by Desford Consultancy during the year Avril O'Leary Night Superintendent 31/10/06 where Beaumont Hospital scored an Marian O'Farrell CNM 2 31/10/06 overall 83%.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 37 + positive developments
Theatre activity Beaumont St Joseph's Surgery 3,884 2,311 Orthopaedics 1,595 35 Urology/transplant 1,560 312 ENT 1,146 - Neurosurgery 1,582 - Gynaecology 370 52 Other 319 - Total 10,456 2,710
38 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Surgery
EMERGENCY DEPARTMENT The department continues to face The Emergency Department of Beaumont significant challenges in accommodating is one of the busiest adult Emergency patients who have been deemed Departments in Ireland. The department appropriate for admission and in 2006 has fourteen Major cubicles, two side this accounted for 105% occupancy of rooms, a three-bay resuscitation room and the department with admitted patients. four Minor cubicles with a bereavement Research / Audit room, a Recall Clinic and a General Research performed in the department Practitioner Liaison Office. was presented at the International In addition to the emergency work Conference of Emergency Medicine in carried out, there are three Recall Clinics Halifax in Nova Scotia and at the Irish per week and a Dressing Clinic from Association for Emergency Medicine Monday to Friday. Annual Meeting and at the Research In 2006 we saw 47,284 patients of whom Forum for European Medical Students 2,359 were return patients. The depart- engaged in undergraduate research in ment provided critical care for and Berlin. Research regarding over- resuscitation to 6,550 seriously ill and crowding and patient care received The Department of injured patients, with 303 patients awards both in Ireland and Europe with Surgery continued requiring advanced cardiac life support. commendation being received for the to expand its There were 14,957 attendances with presentation in Berlin. services in 2006. minor injury and illness assessed in the Two undergraduate Medical students Several areas within Minors area. performed research towards the award of the sub-specialties 2006 saw a dramatic improvement in the the Bachelor of Medical Science in the department in 2006. One of the of general surgery hygiene audit report scoring for Beaumont Hospital in general and the Emergency Department Clinical Nurse were targeted for Emergency Department in particular. Specialists received a grant for further specific expansion. research from the Health Research Board. The department continues to provide dynamic education in advanced trauma The second series of Synopses of life support, trauma evaluation and Cochrane Reviews Applicable to management and advanced cardiac life Emergency Services (SOCRATES II) was support. Education is provided to developed and submitted to and undergraduate and post graduate medical accepted by the Emergency Medical personnel as well as nursing staff, Journal in 2006. radiography staff, paramedical and Fire We look forward to continuing to provide Brigade Services. In addition to the a high level of emergency care to the administrative, medical, nursing and patients in the catchment area of allied health care professionals there is a Beaumont Hospital and we would like to Clinical Nurse Specialist in chest pain thank all the Emergency Department staff assessment, a Clinical Nurse Specialist in and those involved in the provision of on- psychiatry, three Clinical Nurse call care for their continuing commitment Specialists in minor injuries assessment to emergency unscheduled care. and a middle grade doctor in the minors assessment area. We have two General GENERAL SURGERY Practitioners who provide a sessional DEPARTMENT commitment to the department. The Department of Surgery continued to We continue to have only one Specialist expand its services in 2006. Several Registrar in Emergency Medicine. areas within the sub-specialties of general surgery were targeted for The admission rate in 2006 was 18% of specific expansion. total attendances which compares favourably with many departments nationally and, indeed, internationally.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 39 Division Of Surgery
The Breast Unit services for the vascular department. patients with benign and malignant This service was expanded greatly in 2006 These include Professor Cathal Kelly, colorectal conditions within the current in line with the Government’s strategic Professor Austin Leahy, Mr Hugo Prins bed complement. and Mr Jacque Bordeaux. The depart- plan to develop Beaumont Hospital into a The Stoma Care Department continues ment continued its leadership role in the supra-regional cancer centre. The Breast to have an increased level of activity. vascular approach to abdominal aortic Unit is now supported by three consultant Marianne Doran (CNM2) continues to aneurysms. The unit currently has one of surgeons, Professor Hill, Mr Osborne and support development of standards of the largest databases in the country on Mr Allen. Two breast clinics per week are care for patients undergoing stoma endovascular aneurysm repair. run including a triple assessment clinic on surgery through her participation in the The department continues its close Tuesday morning. Irish Stoma Care and Colorectal Nurses collaboration with Dr. Frank McGrath in Association. She hosted a very The service welcomed the arrival of developing the endovascular programme. successful Annual Meeting of the group Dr. Deirdre Duke as a consultant with a A significant development during the in Beaumont in 2006. special interest in breast disease. year was the increased utilisation of St The arrival of Dr Duke has facilitated Joseph’s Hospital elective facility for In addition to a busy clinical year, the greatly the delivery of an efficient breast vascular surgery procedures. This is a department had a number of significant service to our patients. All patients now welcome development that has research and academic achievements in receive their breast imaging either on the expanded the service provided by the 2006. Mr Joe Deasy was President of the same day or within a week of their vascular unit. Irish Association of Coloproctology and consultation. the Annual Meeting in 2006 was hosted In the Radiology Department, the service The Upper GI and in Beaumont Hospital. Ms Deborah welcomed the use of a dedicated room Laparoscopic Unit McNamara continues as Secretary of the for breast imaging, in particular, the This service was led by Mr Broe and Mr Irish Association of Coloproctology. arrival of a new breast ultrasound Osborne who continue to develop very Ms Sarah Brophy, Colorectal Research machine. This has streamlined the extensive clinical practice in this area. Fellow in the Department was awarded pathway for patients within the Radiology Mr Broe has continued to provide not the degree of MD for her research into Department. only a regional but a supra-regional Colorectal Cancer. service for oesophageal surgery and has In the Pathology Department, Dr Anne- performed over 50 operations for GYNAECOLOGY Marie O’Shea was appointed as a oesophageal cancer this year. The department of Gynaecology Consultant Pathologist and is due to take provides an elective and emergency up her duties in mid 2008. A special He has continued to expand his own service in Beaumont Hospital. Two feature of the Breast Unit has been the series of laparoscopic anti reflux consultants, Dr Paul Byrne and Dr Barry strong collaboration that has developed procedures which have all been Gaughan, both of whom have shared with the Connolly Hospital Breast Unit. performed on a short-stay basis. One of appointments with the Rotunda Hospital, The weekly multi-disciplinary breast the challenges within the department is staff the department. conference is now held in conjunction access to the five-day ward and this has The management of women with urinary with the Connolly Hospital breast service. been due to the pressure from the Emergency Department. We look incontinence continues as one of the In the latter half of 2006, we were forward to working with management to special interests of the department. delighted that Ms Mary Harney TD, avoid postponement of elective surgery We now use the minimally invasive Minister for Health and Children, was when pressure builds within the procedure of Trans Obturator Tape (TOT) present at the official opening of the new Emergency Department. sub-urethral sling as our standard surgical symptomatic breast unit in Beaumont procedure for the management of Hospital. These new developments in The Colorectal Unit women with stress urinary incontinence. the symptomatic breast unit have had a Colorectal services in Beaumont Recent advances in the management of significant impact on the patient care continued to expand with 1,027 new out- menorrhagia using minimally invasive delivered to our patients. The average patients seen during 2006, increasing techniques such as endometrial ablation waiting time for an appointment for the from 998 in 2005, 940 in 2004 and 906 in have resulted in a reduction in the number Breast Unit in 2005 was over 60 days 2003. The overall number of patients of women needing abdominal hyster- and this is now less than one week. seen has also increased again to 4,314 ectomy. We are continuing to evaluate consultations in 2006. Colon and rectal The Vascular Unit new minimally invasive laparoscopic cancer cases continue to increase, The vascular unit continued its develop- techniques for the management of representing a major component of our ment throughout 2006. The service is women with benign ovarian cysts and mild workload. We continue to face greatly facilitated by the presence of or moderate endometriosis. challenges to improve services for four consultant surgeons to deliver the
40 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Surgery
We rely heavily on the excellent day Professor Walsh in his role as Vice Prizes ward facilities provided by Sr. Noreen President of the European Academy of The Sheppard Prize for Scientific Brady Smith and her staff. This allows us Facial Plastic Surgery hosted an Research to offer women a convenient date for International Meeting in Dublin in day-case surgery when they have been September. 'Tamoxifen induces tumour cell apoptosis seen in the gynaecology clinic. However, and blocks metastasis invasion in we must still use the waiting list system Anaplastic Thyroid Cancer' for major cases as we have inadequate Professor Walsh J P O’Neill - Beaumont Hospital, Feb access to seven-day beds. The provision President Irish Society of Otolaryngology. 2006 of one extra seven-day bed would reduce Secretary Irish Institute of our waiting list dramatically and avoid the Otolaryngology. need to send patients to other hospitals RAMI prize for best research paper. as part of the NTPF scheme. Vice President of European Academy of Facial Plastic Surgery. Dr Tara Mackle In 2006, the colposcopy service provided Royal Academy of Medicine in Ireland, by Dr Byrne, was moved from Beaumont Speciality Representative UEMS Otorhinolaryngology section. Tara Mackle Hospital to the Rotunda Hospital as part Member of British Academy in April 2006 of the rationalization of the cervical Otolaryngology Scientific Committee cancer screening service. Ms Emer Lang – IOS 2006 OTOLARYNGOLOGY / HEAD & Mr McConn Walsh Temporal Bone Course Medal and First NECK SURGERY Secretary, Royal Academy of Medicine in Mr Peter Lacy has been appointed to the Prize awarded jointly: Latif Kadhim, Ireland, Section of Otolaryngology/Head Department of Otolaryngology, Peter has Munish Shandilya. & Neck Surgery. specific expertise in Rhinology/Anterior Head and Neck Course Medal awarded Skull Base Surgery, airway surgery and Course organiser, annual Postgraduate jointly: Mona Thornton, Orla Young. paediatric ENT. His appointment will Teaching Course in Otolaryngology for MCQ for Structured Teaching Course, greatly enhance the academic profile of Specialist Registrars in Otolaryngology. First Prize: Michael Harney. the Department. Mr Lacy provides two Regional (national) Research Advisor to new weekly operating lists in St Joseph's the Specialist Advisory Committee (SAC) Hospital (exact activity not to hand from in Otolaryngology. Otolaryngology Section of Academy of there at time of writing this) and two Member of the National CJD Advisory Medicine Prize: Orla Young and Patrick new weekly out-patient clinics, with sub- Committee. Sheahan. speciality rhinology, paediatric and voice Registrars Prize: Mona Thornton. clinics each month. Tutor on the Manchester Temporal Bone Dissection Course for Specialist Patients referred for hearing assessment Registrars. are now fast tracked directly to the Department of Audiology, this initiative Courses has greatly reduced the waiting time for General Practice Study Day, Royal patients. An additional initiative is being College of Surgeons in Ireland, introduced this year patients referred for supervised by Professor M Walsh. tonsillectomy are now sent a A Structured Teaching Week held in the questionnaire and information sheet on Royal College of Surgeons in Ireland the procedure. If they satisfy specific supervised by Mr R McConn Walsh. criteria they are booked directly for a tonsillectomy. This will cut the waiting time for this procedure by approximately 6 months. The case mix for complex operative procedures is increasing each year, last year over 100 major complex operations were performed.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 41 + positive developments
Bed days used Surgical 46,415 Neurosurgery 25,794 Urology 7,547 ENT 6,158 Medical 99,209 Nephrology 16,201 Cardiology 14,271 Neurology 10,707 Other 4,797 231,099
42 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Medicine
DERMATOLOGY SERVICE carried out as out-patient procedures in The Dermatology service in Beaumont an allergy clinic in conjunction with our Hospital provides a service for 5-6,000 Specialist Nurse, Ann Buckley. patients per year. Dr Gillian Murphy is a Photodynamic therapy (PDT) is a trainer for the National Dermatology procedure designed to deal with Specialist training programme. extensive superficial cancers of the Dr Murphy runs the National skin and precancerous lesions. This is Photodermatology investigation also a nurse-led procedure carried out programme for investigation and in an out-patient setting. In the last management of photosensitive year we have introduced MAL PDT patients. Dr Murphy also runs a with a new lamp which is more research programme on skin cancer, effective than the previous ALA PDT. currently focussing on the genetic Day-case procedures, such as factors predisposing to skin cancer in treatment of extensive skin disease renal transplant patients. Dr Mary Laing and wound care, are also provided. has been studying genetic aspects of Management of leg-ulcers requires a carcinogenesis in renal transplant combination of investigative procedures including patch-testing The endocrine service, patients. She has discovered that polymorphisms in a gene which circulatory investigations and particularly pituitary influences folic acid metabolism specialised Profore dressings. endocrinology, continued confers significant risk of skin cancer in We run a cryotherapy clinic once to expand during 2006. renal transplant patients. Previously we weekly for rapid throughput of patients Currently, we care for have had 1 MD thesis, 1 PhD thesis requiring repeated treatment of recurring lesions. Dermatology clinics approximately 1200 and 2 MSc theses stemming from the run on Monday, Tuesday, Wednesday, pituitary patients with research programme. We also have a research programme into lupus Thursday and Friday. On average 35-40 80% of our referrals erythematosus and its impact on patients are seen, with a wide variety coming from outside the quality of life, mechanisms of of skin disease. There are more than Hospital catchment area, photosensitivity, photoprotection, and 3000 different skin diseases, thus a making us the de facto its effects, if any, on calcium consultant-led clinic is essential. Essential to diagnosis is the availability national pituitary centre. metabolism. Some photo-sensitive lupus patients were markedly vitamin D of excellent dermatopathology and deficient even despite vitamin D immunology services such as are supplements. We have discovered that available in Beaumont Hospital. patients with malignant melanoma are Dermatological surgery is a big part of four times more likely to get breast our service provision. We remove more cancer and that breast cancer patients than 500 lesions per year. As our in Ireland also have a similar level risk waiting list for out-patient visits now of melanoma. These findings change extends beyond 17 months, patients the way we screen and follow up these are triaged into the clinics on the basis patients. We are currently setting up a of diagnosis. We try to see patients database and biobank of melanoma with malignant melanoma within one patients to explore this together with week of receipt of referral letters, and other genetic risk factors. non-melanoma skin cancer within one A full range of Dermatology services is month of referral. Most lesions provided including photochemotherapy, removed are skin cancers. Our waiting phototherapy and iontophoresis list for surgical procedures has currently in the Physiotherapy improved greatly with the addition of Department. Patch testing and surgical lists in St Joseph’s Hospital. intradermal skin testing diagnose Beaumont Hospital is the National delayed hypersensitivity reactions and Renal Transplant centre; renal immediate hypersensitivity reactions transplant patients have a risk 250- such as occupational dermatitis and times that of the normal population, latex allergy. These procedures are detailed skin surveillance is required to
BEAUMONTHOSPITAL ANNUAL REPORT 2006 43 Division Of Medicine
detect skin cancers early in these ENDOCRINOLOGYAND sleep, appetite and metabolic disorders patients. Patients at relatively high risk DIABETES in craniopharyngioma patients for her need to be seen every three months MD thesis (in collaboration with and high-risk patients more frequently. Department of Endocrinology Professor Richard Costello). A major This puts considerable pressure on out- The endocrine service, particularly audit (the largest international series) patient services and on our surgical pituitary endocrinology, continued to on the natural history of pituitary lists. Renal transplant patients are expand during 2006. Currently, we care tumours is currently underway. assessed by our special research for approximately 1200 pituitary registrar, our main interest is in patients with 80% of our referrals Department of Diabetes preventing and detecting early coming from outside the Hospital Over 4,500 patients attend the skin cancers. catchment area, making us the de facto diabetes department as the epidemic national pituitary centre. There has of diabetes continues to affect the In-patients develop complications of been a significant increase in referrals Beaumont Hospital area. disease and drugs which impact on the as the results of the increased skin; we currently see 5-6 such In 2006 the new diabetes centre was awareness of effect of head trauma on patients every day and jointly manage officially opened by the Minister for pituitary function following the many with severe skin disease. Only Health and Children, Ms Mary Harney, landmark work on this subject patients with very severe skin disease TD. The new building has significantly undertaken by our department over the are admitted, most patients are improved the environment in which we last 5 years. As a result, the unit now managed as out-patients. There are are able to deliver care to patients with runs three medical pituitary clinics per three beds for Dermatology diabetes. In the centre, over 6,500 month in addition to a joint monthly admissions. With appointment of more patients were reviewed in 2006, staff neuroendocrinology-neurosurgery consultants it may be necessary to dealt with acute diabetes emergencies, clinic. Also, a new weekly general increase the quota of beds. Ideally delivered individual and group endocrine clinic started in December. such patients should be managed by education sessions for patients with Regular multi-disciplinary team specialist nurses. type 2 diabetes and offered continual meetings are held for pituitary, thyroid, support for patients with diabetes. Our service has a weekly Dermatology- parathyroid and adrenal cases. Diabetes Nurse specialist, Sonya pathology meeting to discuss and audit In August, Dr Amar Agha took up his Gleeson, and Eimear Fanning, Senior biopsies taken to confirm diagnosis and post as a Consultant Endocrinologist Dietitian, ran six DAFNE courses assess adequacy of removal. with special interest in pituitary (specialised 5-day education Dermatologists in North Leinster meet endocrinology and endocrine oncology. programme) for patients with type 1 monthly for a case discussion meeting, The aim of that appointment was to diabetes. The patient response to this the meeting rotates between further develop the pituitary service course has been extremely positive, Beaumont Hospital, Our Lady of with emphasis on providing endocrine many describing the course as a life- Lourdes Hospital, Drogheda, Children’s care for patients with head trauma and changing event. Care of diabetes on University Hospital, Temple Stree, and cranial radiotherapy and the the wards continues to be addressed the Mater hospital. Usually about eight development of integrated thyroid with a full-time diabetes nurse cases are presented and discussed. cancer (and endocrine oncology) specialist devoted to diabetes patient We have reconfigured our services so service in Beaumont Hospital, care on the Hospital wards. that we now run a weekly cancer clinic, particularly as a new radiation oncology In 2006, there was a significant with a monthly multidisciplinary clinic in unit is due to open shortly. increase in the number of general conjunction with radiotherapy/plastics diabetes out-patient clinics from four to to assess best care in complex cases. Endocrine research /audit nine per month. This has allowed us to We also have a weekly emergency The unit has developed an international reduce the out-patient waiting list from dermatology clinic for urgent cases. reputation in research into pituitary 24 to 6 months, this reduction has We run a clinic specifically for patients disease. It is considered a world leader been achieved without any increase in on significant systemic medication in research on pituitary dysfunction diabetes staff. The specialist clinics managed by protocols, a clinic for following traumatic brain injury and including the young adolescent clinic, infective/ inflammatory diseases, cranial radiotherapy. It is a key interna- the diabetes foot clinic and a new a cancer prevention clinic and an tional opinion leader in the endocrine insulin pump/DAFNE clinic continue on allergy service. This will enable more control of water balance. In 2006, our a weekly basis. A monthly combined efficient assessment of patients, better department continued to publish on diabetes renal clinic with Professor monitoring of treatment and better those topics in the leading journals in Peter Conlon was also established in audits of practice. the field. Furthermore, Dr. Rachel order to facilitate and improve diabetes Crowley is currently investigating care to this very high-risk population
44 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Medicine
group. The heads of department would with Spirasi – an NGO with internation- found very high rates of permanent like to express their gratitude to the ally recognised skills in helping victims cure for Hepatitis C infection. An out- diabetes multidisciplinary team who of torture, with Psychiatrists of Drug patient review of patient satisfaction continue to provide a high level of care Addiction, community psychiatrists, indicated very high levels of client for patients with diabetes and without the Rainbow clinic in Our Lady’s satisfaction for the out-patient services whom the significant reduction in the Hospital, Crumlin, for infections in that we provide. An out-patient review waiting lists would not have Pregnancy, Open Heart House for of the quality of education that we been possible. massages, friendship, psychological deliver is being analysed at present. support, and referrals to counsellors We have started recruitment into Diabetes research/audit and to many other organisations. Dublin City HIV cohort and continue The department is committed to an Prevention is a strong focus of our recruitment for platelets in ongoing audit and research work. For people with HIV we offer malaria study. programme. In 2006, a number of vaccinations for Hepatitis B, influenza, In financial terms our budget reflects audits started, examining diabetes pneumococcus, and Hepatitis A in the massive growth in the scale of the control in the young adolescents and some cases. We perform contact services that is provided by this metabolic control in the pancreas tracing for those newly diagnosed with department. The anti-retroviral drug transplant cohort. Dr Eoin O’Sullivan an infectious disease so that others at budget alone has risen from €1.3m in commenced his MD thesis examining risk can be tested. We give advice (and 2004 to €2.1m in 2006, reflecting the association between a bone hand out devices) to lower risks of increased number of patients on glycoprotein called osteoprotegerin and transmission. We offer services for treatment. We prescribe, dispense and diabetic vascular disease in lipid lowering and smoking cessation. monitor anti-retroviral medication for collaboration with the vascular We use modern pharmacogenetics to 284 patients, about half of those with laboratory and Dr Patricia Fitzgerald. identify people at increased risk of side HIV for whom we provide services. € Education effects of certain medications and then The cost is about 12,000 per person The department runs a very active avoid those medications for that per year, for life-saving treatment that training programme in endocrinology person. We anticipate and prevent completely revolutionises their lives. and diabetes for the trainees with four drug-drug interactions for those on the Most people are almost completely dedicated educational sessions per powerful anti-retroviral medications. well on treatment, and living their lives week, making Beaumont Hospital the The Tropical Medicine encounters a as they wish, fulfilling their plans - to most popular institution for trainees in wide and complex range of medical help their children grow up, or to buy endocrinology and diabetes in Ireland. conditions. These include: tuberculosis that second apartment in Spain which The department participates actively in of the scrotum, spine, brain, psoas they have had their eye on. teaching for undergraduate medical muscle and lungs, schistosomiasis, The challenges presently are related to students and also in teaching for the Boutoneuse fever, scrub typhus, human resources, particularly during first and second part of the MRCPI and neurosyphilis, loa loa, cerebral malaria, holiday times or staff development in a monthly endocrine club with to name a few. Two are being written events. We are working towards specialists from other hospitals in up as case reports. We have drawn up providing a regular service throughout the city. guidelines for clinic management of the year by engagement, discussion malaria in a hospital setting and and negotiation. The pressure on staff INFECTIOUSDISEASES implemented these as care plans. is greater when they are over-worked In 2006 we provided services to 57 These have been shared with other but presently because of rapidly- people newly-diagnosed with HIV infec- hospitals and could form the basis of changing advances in diagnosis and tion, which represents 17% of the Irish national guidelines. treatment, most of us who work in the total. The core infectious disease team Several audits and prospective pieces areas of chronic viral infections and in Beaumont Hospital provides multi- of research were performed. An audit tropical medicine find it rewarding, disciplinary care and links clients to of our care provided to people infected satisfying and very enjoyable. specialist services for assistance post- with Hepatitis C virus showed that we We would like to offer a more torture, with drug use, psychiatric co- are very good at diagnosing and continuous service for returned ill morbidity, support societies for people treating this infection, but highlighted travellers as people with undiagnosed living with HIV, GPs, NGOs, and the need for annual ultrasound tests fever, malaria and typhoid fever require services for immigrants and asylum and alpha-foetoprotein measures as urgent assessment and care. We seekers. We have developed within a recommended for cancer screening. would like to continue to expand the network of service providers in the Because the majority of our clients range and scale of services to those community and link with family have genotype 3 of HCV we have with chronic viral diseases. doctors, with the client's permission,
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We would like to increase the clinical numbers to allow a greater range of The recommendations of the research integrated in our services, trials to be on offer for patients with Needlestick Working Group will be ideally so each person who comes for cancer, and to become the premier launched in 2007. While no single care can be offered the opportunity to oncology clinical trial centre within intervention will eliminate needlestick participate in a trial, and thus contribute Dublin and the nation. injuries, much could be achieved by to incremental improvements in our introducing safety devices. Our audit The Oncology Pharmacy continues to knowledge of infectious diseases. this year showed greater availability of support and streamline methods to This, we believe, is the means, not just this equipment in clinical areas than enhance the patient’s experience to achieve excellence in our service in 2005. within the day unit, in conjunction with provision, but to exceed the current the dedicated, experienced oncology Rehabilitation is a major focus of our boundary of excellence and go beyond staff. The attention to detail involved in service and much can be done to it to new ideas, techniques and script development, agent improve outcomes of illness and injury interventions that could help people management, clinical trials and non- by taking a rehabilitative approach and with infectious diseases. trials based therapies is at the highest by accommodating impaired level, as per two separate independent employees on restricted duties as they MEDICAL ONCOLOGY SERVICE external audit teams. gradually return to full health. This is The European Society of Medical considered good practice and is also Oncology formally recognised Collaboration with the other disciplines required by law. We greatly appreciate Beaumont Hospital as a designated within the Beaumont Hospital campus the co-operation we receive from many Cancer Centre with integrated palliative have developed multidisciplinary managers in implementing this care in 2006. This enhances the meetings, enhancing the process of approach. We also greatly value our national and international recognition treatment planning for patients, while relationship with the Physiotherapy of Beaumont Hospital and adds to the providing an educational forum for Department to whom we refer a momentum for the future planned staff, medical and nursing students. growing number of staff for developments. Future developments for 2007 / 2008 rehabilitation programmes annually. Oncology Nurse Specialists were will include the initiation and 2006 saw the launch of the successful in winning competitive integration of an electronic patient Department of Health and Children’s travel awards to the National Cancer record for patients with cancer; guidelines on “Prevention of Institute, USA, for training in principles chemotherapy and radiation prescribing Transmission of Blood Borne Diseases of clinical research and methodology. via this system; unified database for all in the Healthcare Setting”. These The links generated during their six- cancer-related activity within the guidelines have implications for the week period have continued to campus; increased emphasis on employment of staff who perform strengthen the commitment to further translational research and ongoing exposure-prone procedures. development of all aspects of cancer development of Beaumont Hospital as care, both for patients and staff, and the Supra-Regional Cancer Centre for The significant increase in uptake of given new insights into the potentials North Dublin and the North East. influenza vaccination observed in 2005 of the Cancer Services at Beaumont (26% of staff) was not sustained in Hospital. OCCUPATIONAL HEALTH 2006. We believe that the high media DEPARTMENT profile of the risks of avian and The Medical Oncology service at Head of Department: Dr Blánaid Hayes pandemic influenza caused this Beaumont Hospital ranked as the increase and once the “fear factor” preferred location for training in 2006 proved to be a busy year for the was removed in 2006, overall uptake medical oncology at Registrar level. Occupational Health team and saw the reverted back to 19%. The atmosphere amongst staff, development of closer working the opportunity for research and relationships with other hospital With regard to research activities, a publication, and the associated departments under the aegis of the number of presentations, posters and mentorship were amongst the reasons. Integrated Quality and Safety papers were presented / published Department. In addition, the team’s during the year. Details of these, along The Cancer Clinical Trials Unit, funded efforts towards providing a healthy with a more comprehensive annual by the Health Research Board, has work environment received a report, are available from our further developed its portfolio of trials commendation during the process of administrative office. on offer, including collaboration with accreditation. the NSABP group in the United States, heightening the international profile of We continued to direct our energies the Hospital. The aim for the towards improving the safety of the forthcoming year is to increase staff work environment.
46 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Medicine
Manual Handling Presentations: An ongoing project on aftercare of Newly-published guidance on standards 23rd March 2006. ‘The Management & children with acquired head injury of best practice in patient handling for Reduction of Health & Safety Risks – between the Hospital school and an Irish acute health care setting Sharps Injuries: Safety Technology’ medical staff has been started with should bring significant benefits to presented at the ‘Safer Place to Work’ several constructive planning meetings. patients, carers and health care conference at the Royal Society, Our schoolteacher, Avril Carey, and her managers. London (Dr B Hayes). assistant provide educational support Prior to this, there was considerable 22nd April 2006. ‘National Guidelines for patients and liaison with patients’ confusion and uncertainty for on Bloodborne Pathogens’ presented at own schools during their stay on the practitioners as the only published the National Needlestick Injuries ward. Secondary level students in adult guidance was written for the UK health Conference at Dublin City University wards in Beaumont Hospital and service. It is widely acknowledged that (Dr B Hayes). children in Cappagh Orthopaedic clinical managers play a vital role in Hospital also benefit from our school ensuring that best practice in patient 18th November 2006 ‘National programme. Ms Carey has carefully handling is adopted in the workplace. Guidelines on Bloodborne Pathogens’ developed a fine service which is an This has been difficult to achieve in the presented at the Annual Study Day of integral part of the ward’s day activities absence of Irish guidance. The Minimal the Phlebotomists’ Association of for the children. Handling Advisory Group, of which Ireland, Mater Misericordiae Hospital, Sisters Edel Arthur and Bridget Beaumont is a member, published Dublin (Dr B Hayes). O’Connor, together with an excellent “Towards Safer Patient Handling (Part PAEDIATRIC MEDICINE staff of paediatric trained nurses, II):-Agreed Patient Handling The Children’s Ward benefited from provide a thoughtful and careful service Procedures” – incorporating agreed environmental improvements during in conjunction with other ward staff. core practical procedures for inclusion the year and these are ongoing with in a standard one-day training The paediatric registrars for the year the playroom and classroom. Parents programme. The manual handling were Drs Lisa Bradley and Youssef and children are generally very training in Beaumont Hospital is based Elfaki. Drs Sylvia Dockeray and appreciative of the ward environment on the principles outlined in this Dubhfeasa Slattery provided consultant and facilities. These are important as document. This facilitates a “passport general paediatric cover supported by some of the conditions treated system” of training which is the paediatric staff of the Children’s necessitate a long stay, the average transferable between employees in the University Hospital, Temple Street; length-of-stay for neurosurgical cases DATHs group since November 2005. Mr David Allcutt is our Paediatric is 8.23 days. Inanimate manual handling training has Neurosurgeon, and Paediatric not been included to date. The majority of admissions are ENT Neurologists Drs Mary King, Bryan (including the Cochlear Implant Lynch, Prof.Joe McMenaman and Corporate Induction for all new programme) and Neurosurgery, and Dr David Webb also visit the ward. employees in Beaumont Hospital admission numbers and length-of-stay began in January 2006, A new system were similar to previous years. PALLIATIVE CARE SERVICE of delivering manual handling was The Palliative Care Service is led by Dr. specially developed for interns this The Paediatric Clinical Standards Group Regina McQuillan, Palliative Medicine year, which was based on the group's organised and hosted a Paediatric Consultant, and has three full-time previous level of knowledge. Evaluation Critical Care Study Day in April which Clinical Nurse Specialists, a Palliative found 96% to be very satisfied with the was very well attended by Care Registrar, a Palliative Care Social programme and they felt it was Physiotherapy, nursing and medical Worker and a full time secretary. relevant to their job. delegates. The service has seen an increase in During 2006, 613 staff were trained in The Ward Service Plan for the year referrals for patients with both one-day moving and handling had seven objectives which included malignant and non-malignant diseases. programmes. In addition, a number of the production of ENT admission and 17% of referrals are for patients with people were trained “on site “in their discharge information and leaflets for non-malignant diseases. The team specific work areas including staff in St parents; improvements in ward continues to act as advisory, Joseph's Unit. The Manual Handling communication and implementation educational and support resource for team (and the Health and Safety team) of recommendations of the 2005 medical, nursing staff, patients and are working with the IT Department to pain Audit. their families. improve the recording of training and There was a hygiene audit, infection In 2006 the syringe driver policy was qualifications on the Storm System. control and sharps review. revised and updated. In conjunction with the Pharmacy Department new
BEAUMONTHOSPITAL ANNUAL REPORT 2006 47 Division Of Medicine
analgesia conversion guidelines were New Appointments reviews. The Irish Suicide Prevention written and have been distributed to all Dr. Siobhan MacHale was appointed as Working Group has collected wards in Beaumont Hospital. This Consultant Liaison Psychiatrist in information on deliberate self-harm policy and guidelines are also available October 2006. rates in all the major Emergency on the Beaumont Hospital Intranet. Departments nationally. Beaumont We are currently reviewing the use of Current Levels of Activity Hospital, with 840 cases of deliberate Graseby MS16A syringe drivers within self-harm in 2006, has the highest In-patient consultations rates for any general hospital in Ireland. the Hospital in conjunction with other The Department of Psychiatry carried hospital disciplines and examining the out a total of 1,158 in-patient psychi- The majority of ED assessments were use of sub-cutaneous needle-less atric consultations in Beaumont for deliberate self-harm. Patients with device system. Hospital depression, psychosis and alcohol and The team carried out an audit of opioid in 2006. Our consultation service substance abuse account for a drug errors. The audit was presented at encompasses all medical and surgical significant proportion of the workload Grand Rounds and was used as the wards with a dedicated registrar in in ED also. The numbers of individuals basis for other educational inputs. Neuropsychiatry. being brought from Dublin Airport for psychiatric assessment has increased Marking Beaumont Hospital's Out-patient consultations substantially over recent years. designation as one of the four The Psychiatry Department runs six radiotherapy centres for the country, out-patient clinics per week and one Service Developments the 2006 Annual Multidisciplinary monthly Behavioural Genetics clinic:- Dr. Siobhan MacHale commenced as Palliative Care Study Day focused on Consultant Liaison Psychiatrist in In addition, outside of formal clinics, cancer care including issues dealing October 2006. Dr. MacHale is working 179 additional patients were seen in with communication, symptom with Professor Cotter to further the Psychiatry Department and of management and the role of palliative develop the Psycho-Oncology service. these 12 were patients of Dr. Maguire chemotherapy and radiotherapy. As part of this development they have, and 42 were patients of Psychiatry of The increased numbers of participants in collaboration with Drs. Liam Grogan Old Age. from both Beaumont Hospital and other and Oscar Breathnach, submitted an application for the development of healthcare areas is encouraging and we Emergency Activity psycho-oncology Clinical Nurse look forward to next year's Palliative There were 1,242 referrals for Specialist position to the Irish Cancer Care Study Day in September. psychiatric assessment in the Society. There is an awareness that Emergency Department in 2006 (an future developments in the provision of PSYCHIATRY increase of 13% on referrals for 2005). The Department of Psychiatry oncology services within Beaumont These figures do not include follow-up continues to provide a range of consultation-liaison psychiatry services to Beaumont Hospital. These services encompass the assessment, diagnosis and treatment of subjects with Out-patient consultations psychiatric disorder in the setting of a Clinic Consultant New patients Reviews general medical hospital. We have a substantial input into the Emergency General Liaison Professor Mary Cannon 53 325 out-patient psychiatric Dr Anne Maguire Department and a considerable amount service Dr Siobhan MacHale of our work-load involves the assessment and management of the Neuropsychiatry Professor David Cotter 80 37 patients who present following deliberate self-harm. Psycho-Hepatology Dr McHale & Professor Cotter 30 37 The department can be divided into four main areas of sub-specialisation:- Substance Misuse Dr John O’Connor 22 463 General Adult Liaison Psychiatry, Neuropsychiatry, Psychiatry of Old Age, Psychiatry of Old Age Dr Mary Cosgrave 32 247 and the in-patient Detoxification service Behavioural Genetics Professor Kieran Murphy 36 based in St. Michael’s Ward.
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should be met with appropriate to the unit is provided by Consultant In the Spring of 2006 Peter trained as a developments within psychiatry. Psychiatrist Dr. John O’Connor and trainer in STORM (Skills-based Training Dr. MacHale is working with the Renal Psychiatry Registrars from Trinity Court on Risk Management) – a suicide Transplantation Service in establishing Drug Treatment Centre. prevention training programme. Peter and providing a dedicated Consultation has now joined a multi-disciplinary Liaison psychiatry service. Psychology team to deliver STORM training on The Psychology Service to Liaison behalf of the HSE Northern Area Health Psychiatry of Old Age Psychiatry met with 90 patients last Promotion Unit, to professional health The Old Age Psychiatry service is a year for a total of 601 sessions. One care staff. multidisciplinary service that operates Stress Management and Relaxation Both Eileen and Peter will continue in Beaumont Hospital, the community Training (SMART) group was held in their involvement with the and St. Ita’s Hospital. In Beaumont partnership with the Social Work Bereavement Support Service, Hospital, Department. In 2006 psychology provided under the auspices of the it provides a consultation service for staffing comprised two half-time senior Social Work Department in Beaumont elderly patients. In 2006 a total of 584 clinical psychologists as well as one Hospital. This service receives a referrals were made to us. These psychologist in clinical training for a considerable number of referrals from patients are screened by the non- period of five months. The psychology the Liaison Team. consultant hospital doctors and are service to liaison psychiatry provides reviewed on a weekly consultant ward neuropsychological assessment, Diplomas/Higher Degrees round. The department sees out- personality and psychopathology patients at home or in the Hospitals assessment, psychotherapy assess- PhD Awarded and 346 referrals were received in ment and individual and group Kyla Pennington: University of London; 2006. This service is organised from St. psychotherapy. ‘Cellular and proteomic analysis of the Ita’s Hospital. human cerebral cortex in schizophenia’. Social Work in Psychiatry Awarded April 2006 Three group therapy courses were run Peter McCartan and Eileen Reilly job- at Beaumont Hospital during 2006. share the single Senior Medical Social Research We also have a carers group and plan a Work post for the Liaison Psychiatry Research in the Department of reminiscence group. The team is service. Eileen Reilly has been in post Psychiatry encompasses a number of involved in the teaching of medical and since January 2006. The social work key areas including behavioural nursing students. We have students service provides individual, family and genetics and the epidemiology, from the MA in Psychoanalysis Dublin group therapy to both in-patients and genetics, neuroimaging, proteomics Business School on placement also. out-patients of the Liaison Psychiatry and animal models of psychosis. We have doctorate students in Team. psychology. A number of research Grants projects are underway or planned; Stress Management and Relaxation Resource for Psychoses Genomics, topics include delusional jealousy, Training (SMART) programmes were Ireland. (Wellcome) cognitive stimulation therapy in organised and co-facilitated by the A novel high-risk study of schizophrenia dementia and prevalence of dementia social work team on two occasions in susceptibility using a population-based and depression in nursing home 2006. All team members were involved cohort of people with velo-cardio-facial patients. in further training in 2007. syndrome. (HRB) Future developments include Eileen Reilly continued with her training Psychiatric Genetics. (RCSI) involvement in the development of a in Systemic Family Therapy with the proposed multidisciplinary team for Clanwilliam Institute. Peter McCartan Susceptibility genes for psychosis in outreach to nursing homes and the continued to be involved in teaching on individuals. (Wellcome) the undergraduate Medical Student planning of the Day Hospital. Characterisation of Neuronal & Gilal Programme in RCSI and as an Cytoarchitecture in major psychiatric undergraduate Fieldwork Placement Drug Detoxification Service disorders and the investigation of St. Michael’s Ward provides a Drug Tutor on the BSS Social Work Training potential mechanisms. (Wellcome) Detoxification service primarily for Programme with Trinity College Dublin. individuals who are dependent on An Investigation of Neuronal and Gilal Peter successfully completed his opioids. However, cross-addiction to Density size and organisation in the training in the Teaching and Supervision codeine, cocaine, benzodiazepines and insular cortex. (Stanley) of Systemic Family Therapy through alcohol is increasingly common. the Department of Child and Family There were 135 admissions to St. Psychiatry in the Mater Misericordiae Michael’s Ward in 2006. Medical input Hospital Dublin.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 49 Division Of Medicine
Proteomic Investigations of the matter in schizophrenia and bipolar following exposure to cannabis during dorsolateral prefrontal cortex, disorder. (Stanley) adolescence: a model for a gene- hippocampus & paraventricular Proteomic Investigation of subcortical environment interaction & increased nucleus, & the assessment of white matter in bipolar disorder and vulnerability to schizophrenia (Science paraventricular nucleus corticotrophin schizophrenia. (HRB) Foundation Ireland). releasing factor protein & gene expression. (Stanley) Proteomic investigation of subcortical RENALUNIT white matter in schizophrenia and 2006 proved an extremely busy year An Investigation of Axonal density and bipolar disorder. (NARSAD) for the renal service with considerable protein expression of myelin basic changes in senior personnel and in protein and proteolipid protein in Investigation of catechol-O- activities. Early in the year Ms Bridget dorsolateral prefrontal cortex and white methyltransferase mutant mouse Hogan, Renal Unit Divisional Nurse
TABLE 1 - Three-Year Activity Analysis (2004–2006)
2004 2005 2006 Hospital Activity In-patient Admissions 1,426 1,605 1,663 Out-patient Attendances 5,617 5,439 5,380 Renal Day Care Attendances 2,424 2,631 2,729
Transplantation Total Number of Transplants 146 129 146 Total Kidney Transplants 141 124 141 (Living Related) (2) (0) (2) (Paediatric Living Related) (1) (2) (1) Simultaneous Pancreas/Kidney 434 Pancreas only 000 Simultaneous Liver/Kidney 111 Transplant Waiting List (Year end) 287 350 305 Patients attending Beaumont for 696 692 671 transplant follow-up
Haemodialysis Total Haemodialysis Treatments 28,096 31,557 34,665 Maintenance Haemodialysis Treatments 21,461 24,856 26,956 Patients on Maintenance Programme (Year end) 185 205 207 Acute Haemodialysis Treatments 6,450 6,093 6,789
Plasmapheresis Treatments 203 221 162
Renal Biopsies (native kidney/transplant) 246/127 285/125 265/165
CAPD Programme Patients on CAPD programme (Year end) 67 62 50
50 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division Of Medicine
Manager, and Ms. Kathleen Kelly, The Renal Unit continued to develop an CNM3 for Haemodialysis, both of active research interest presenting at whom have been in the Renal Unit for all of the major scientific meetings more than thirty years, retired. Later in including the American Society of the year Dr John Donohoe retired also Nephrology, American Transplant after a long and illustrious career. Society and European Renal These retirements herald the end of an Association. The Unit also continues to era during which the Renal Service was participate in the training of Specialist established and developed to a very Registrars in all aspects of nephrology high standard. It is hoped that the and transplantation. consequent changes in personnel will enhance and build on the work of those that went before. The considerable pressures which have been existing for many years for the provision of haemodialysis services were somewhat alleviated towards the end of 2006 with the opening of Northern Cross Dialysis Unit, a satellite unit of Beaumont Hospital which is managed by Fresenius Healthcare. At the end of 2006 there were ten patients receiving dialysis there with funding committed for up to 32 patients.
Clinical Activity 2006 also saw the announcement of the commencement of the Living Donor Kidney Transplant Programme. Beaumont Hospital has been performing between 140 and 150 kidney transplants for the last number of years but the waiting list for transplantation has continued to grow. As a consequence a programme has been put in place initially hoping to do 15 living donor transplants in the first twelve to eighteen months and subsequently growing the programme as the need requires. Towards the end of 2006 two new locum nephrologists, Dr Niamh Kieran and Dr Frank Kelly, were appointed in order to try and further develop the living donor programme and to replace Dr John Donohoe who retired. The renal team continued to put a lot of effort into further developing plans for the development of the new freestanding haemodialysis unit on the campus of Beaumont Hospital. Planning permission was received during 2006 but tendering has not yet commenced.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 51 + positive developments
Beaumont Hospital is one of the largest departments in the country for training in anaesthesia
52 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Department of Anaesthesia & Intensive Care
The Acute Pain by Dr Irene Leonard with the introduction material. Our College Tutors are Dr Irene of a standardised request form to ensure Leonard with Dr Frances Maguire and Dr Service, co- proper patient preparation and to Anne Hennessy. SpRs in Anaesthesia ordinated by Sister facilitate audit and quality control. complete confidential reports on the Joanne O Brien, has departments they work in and Beaumont Our department cares for 20 ICU patients transformed the is consistently ranked in the top three in General and Richmond ICUs. These training departments in the country. management of post- beds are almost constantly occupied and operative pain in the shortage of ICU beds continues to be a The RCSI Academic Department of Hospital. major problem. Despite the pressure on Anaesthesia is headed by Professor ICU beds and infrastructural Anthony Cunningham and the Lecturer is shortcomings in ICU, outcomes in our Dr David Hourihan. In addition to under- Chairman: Dr Rory Dwyer ICU are comparable to international graduate teaching, the department has a Hon Secretary: Dr Michelle Halpenny norms as assessed by Standardised significant input into post-graduate training. Mortality Ratios (SMRs). Adminstrative Secretaries: Ms Anne Department members are prominent in Doyle / Ms Gemma Howard The provision of Anaesthesia in St national professional bodies: Joseph's Hospital, Raheny, was a major The department maintained its level of Professor Cunningham is a member of development for our department in 2006. activity throughout 2006 and developed the Medical Council, Dr Michael Power is Three new Consultants took up post to additional services in new areas. the President of the Intensive Care provide this service: Drs Anne Hennessy, Society of Ireland, Dr Keaveny was A total number of 11,027 patients passed Micheal Moore and Vivienne Larney. President of the Irish Hospital through Theatre Recovery Room in 2006 Increasing numbers of patients are now Consultants Association, Drs Dwyer, (10,684 in 2005). Numbers alone do not undergoing minor and intermediate Tracey and McDevitt are on the Council convey the complexity of this workload. procedures in St Joseph's, taking of the College of Anaesthetists, Dr A large number of these are major pressure off the services in Beaumont. procedures which are demanding in terms McDevitt is on the Council of the of complexity and duration. Minor and Dr James O Rourke took up a consultant Association of Anaesthetists of Great intermediate procedures are increasingly post with a special interest in ICU, during Britain and Ireland and is Vice-President performed in St Joseph's Hospital, 2006. of Anaesthetic Division of UEMS, Dr Dwyer is on the Postgraduate Medical Raheny, or in other institutions, and Our department initiated a Pre-Operative and Dental Board, Beaumont is restricted to major operations Assessment Clinic during 2006. which cannot be undertaken elsewhere. We anticipate this will optimise patient Priorities for the next few years include: preparation for surgery and reduce The requirements for Anaesthesia in the (1) provision of a new ICU / HDU with cancellations. Dr Michael Moore is Radiology Department continued to adequate beds to meet demands, increase and 426 of the patients passing running this service since last August. (2) development of the infrastructure in through Recovery originated in Radiology. Drs Keaveny and Pollard run one of the theatre (equipment and personnel) to During the year our department busiest Pain Medicine services in the support our increasingly complex increased the number of scheduled half- country. A post of Chronic Pain Nurse to workload, day lists in Radiology to three but there is support their activities was established a major additional commitment to and filled in 2006. (3) development of audit and quality Radiology on an ad-hoc basis for MRI, CT, assurance structures to meet the In addition to visible structured activities, Interventional Neuroradiology, TIPS new standards in these areas, our department provides patient care in a procedures and ERCPs. variety of settings around the Hospital: (4) develop our teaching programme to The Acute Pain Service, co-ordinated by cardiac arrests, multiple trauma in the meet the needs of new curriculum Sister Joanne O Brien, has transformed Emergency Department, transport of and structures in College of the management of post-operative pain ventilated patients to Radiology, Anaesthetists, in the Hospital. assessment of critically ill patients on the (5) develop expertise in new clinical ward and advice regarding management Post-operative epidural analgesia was areas and develop our research in many other areas. extended to all the surgical wards in the activities with existing personnel and Hospital during 2006. We are one of the largest departments in with new appointments. Our department provides a hospital-wide the country for training in Anaesthesia. service for the insertion of central venous Training is seen as a major priority for the lines. This service has been formalised department and the caseload in Beaumont provides ample training
BEAUMONTHOSPITAL ANNUAL REPORT 2006 53 + positive developments
Radiology activity General examinations 98,827 Ultrasound 7,844 CT brain scan 6,290 CT body scan 12,859 Isotope scans 2,487 Neurovascular 2,891 Neuroangio 1,047 MRI 7,953 Total Examinations 140,198 Total Patients 112,428
54 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Department of Radiology
After many years of the department and hospital in general spontaneously and we are grateful to that the Radiology Department would Professor Michael Lee who leads the campaigning, we not be what it is currently without his academic programme. A number of the finally received guiding hand. other consultants also serve on sanction for a committees, or as officers, in many After many years of campaigning, we second MRI national and international societies as finally received sanction for a second well as a number of faculties affiliated scanner in 2005 MRI scanner in 2005; much of 2006 to the RCSI. was spent planning for its installation and for the works required throughout Mark Logan the department which would facilitate Consultant Radiologist and Chairman the housing of the second MRI. Department of Radiology 2006 was a very busy year for the As I write this, I am pleased to say that Department of Radiology on a number those works have commenced. of fronts. They include an enforced redesign of the ultrasound department and the The clinical workload continues to building of new offices above the increase, with more than 147,000 existing department, adjacent to examinations being done, representing interventional cardiology. a 4% increase on the figures from 2005. The complexity of procedures The academic productivity of the also continues to increase with more department remains strong and is one interventional work being done, of the main reasons that places on the especially in the oncology and radiology training programme at neuroradiology sub-specialties. Beaumont Hospital continue to be very sought-after. This does not happen The symptomatic breast service received a huge boost with the return of Dr Deirdre Duke, newly-appointed consultant with special responsibility for breast imaging. Previously a trainee in our department, Dr Duke spent time with the Irish Breast screening programme and in the US undergoing special training before returning. She will lead the breast imaging programme and already has made a significant impact in this area. Dr Martina Morrin, who returned in 2005, has settled in well in our department and has developed a very successful CT colongraphy programme on top of her other extensive duties. She has also taken on the post of National Co- Ordinator for the Irish Radiology Training Programme.
At the start of the year, Dr O'Dwyer stepped down as head of the department, a post which he had held for many years. He has decided to concentrate on his clinical work and his work as Medical Administrator. The department owes him a huge debt of gratitude for all his hard work and there Installation of the new MRI unit. is a clear acknowledgement from within
BEAUMONTHOSPITAL ANNUAL REPORT 2006 55 + positive developments
The complexity of procedures continues to increase with more interventional work being done, especially in the oncology and neuroradiology specialities
56 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Neuroscience Division
The Comhairle report ring-fenced in-patient beds, more paediatric neurosurgeon. This report, general and specialist nurses and other however, shows clearly how the on Neurosurgery specialist staff, including anaesthetists. specialist areas of neurosurgery and, shows clearly how The Hospital’s proposal to the HSE, indeed, neurosciences as a whole, need the specialist areas together with the many changes additional investment and should be of neurosurgery and recommended by the Committee, planned and co-ordinated at a national neurosciences as a which includes important new protocols level. That is something which has long whole need additional to improve efficiency, would allow us to been advocated by Beaumont and we look forward to working with the HSE investment and should improve the availability of beds, to and the National Hospitals Office on be planned and reduce average length-of-stay and to treat some 3,000 patients a year, or the swift implementation of this co-ordinated at approximately 50% more than currently. important report. a national level. Crucially, that would allow us to rectify the existing serious imbalance between NEUROSURGERY emergency, urgent elective and other In 2006 Beaumont Hospital welcomed elective admissions, which in turn the long awaited Report of the would ease pressure on our Emergency Committee to Review Neurosurgical Department. Services in Ireland. This report The Hospital also welcomed other highlights severe deficiencies in the proposals in the Committee’s report, current provision of neurosurgical including increased emphasis on the services, clearly sets out how they can development of sub-specialities in be addressed and identifies the need neurosurgery and the recommendation for investment and change to improve that a major tertiary Neurosciences things. Centre be developed which would The new Report was entirely consistent encompass neurosurgery and related with a submission recently made to the disciplines. The latter mirrors the Health Services Executive which details hospital’s existing “Neurosciences how Beaumont intends to address the Cogwheel” group. deficiencies at the National Centre for The report quite rightly noted that a Neurosurgery. This submission, range of developments are already reflecting the consensus view of the having a significant impact on the type Board, management and consultant of neurosurgical services needed now neurosurgeons, is the latest in a and in the future. These include number made over the past decade by reduced incidence of trauma, the hospital on this subject to the genomics, new drugs, less invasive primary funding agencies. therapeutic treatments, such as stem Beaumont has been acutely aware of cell therapy for Parkinson's Disease, the deterioration in neurosurgical and the changing needs of an ageing services resulting primarily from a lack population. of investment in the area over recent The Committee has also noted that the years. This new independent report lack of peri-operative neurophysiological provides a clear focus and framework monitoring inhibits Beaumont in for the future. providing highly specialised services Additional resources will be required to such as functional stereotactic and comply with guidelines on best awake craniotomy and that there may practice, to reduce unacceptable be a similar need in the future for spinal waiting lists and to substantially cord monitoring. increase the number of patients treated Some improvements have been put in in any given year. This includes the train since this report was written – appointment of five additional such as approval for the much needed consultant neurosurgeons, additional appointment of a second specialist
BEAUMONTHOSPITAL ANNUAL REPORT 2006 57 Neuroscience Division
Neurosurgery Activity
Health Board Report Elective/Emergency Admissions 2004 2005 2006 Total % EHB 998 933 871 2,802 47% 1600
WHB 267 283 228 778 13% 1400
NEHB 208 228 233 669 11% 1200 SEHB 204 186 175 565 9% 1000 MHB 163 162 118 443 7% NWHB 138 134 101 373 6% 800 MWHB 65 62 62 189 3% 600 SHB 32 44 32 108 2% 400
EEC 15 11 15 41 1% 200 Unspecified Health Board 45312 0% 0 2004 2005 2006 Total 2,094 2,048 1,838 5,980 100% Elective Admissions Emergency Admissions
0
% of In-patient Admissions Neurosurgical In-Patient Admissions by Health Boards 2004 - 2006 80% 1000 70% 900 60% 800 50% 700 40% 600 30% 500 20% 400 10% 300 200 0% 2004 2005 2006 100 Elective Admissions Emergency Admissions 0 EHB WHB NEHB SEHB MHB NWHB MWHB SHB EEC Unspecified Health Board 2004 2005 2006
Admissions 2004 2005 2006 Elective admissions 705 606 537 Emergency admissions 1389 1442 1301 Total 2094 2048 1838
% of in-patient admissions 2004 2005 2006 Elective admissions 34% 30% 29% Emergency admissions 66% 70% 71% Total 100% 100% 100%
58 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Neuroscience Division
Discharges Average Length-of-Stay by days
Year 2004 2005 2006
In-patients 12.4 Total Discharges 2,072 2,005 1,785 14.5 Total bed-days 25,740 26,476 25,794 Average length-of- 12.4 13.2 14.5 stay by days Day Cases 253 295 277 13.2
Total Discharges 2004 2005 2006
2200
Attendance at Out-Patient Clinics of 2000 Neurosurgeons 2004 - 2006
Year 2004 2005 2006 Total 1800
New 740 832 712 2,284 Return 3,270 3,423 3,170 9,863
Number of Patients 1600 2004 2005 2006 Total 4,010 4,255 3,882 12,147 Year
Attendance at Out-Patient Clinics of Day Cases Neurosurgeons4 2004 - 2006 0
300 3500 3000 280 2500
260 2000 1500 240 1000
Y 500 220 Number of Patients 2004 2005 2006 0 2004 2005 2006 Year
Total Bed-Days New Return
26600
21600
16600
11600
6600 2 1600 2004 2005 2006
BEAUMONTHOSPITAL ANNUAL REPORT 2006 59 Neuroscience Division
CLINICAL NEUROPHYSIOLOGY and three junior technicians. Other staff Beaumont, providing a high level of DEPARTMENT members include a Clinical Nurse expertise in Neurology at Junior As an integral component of the Manager, an assistant technician and Hospital Doctor level. neuroscience division at Beaumont clerical support (1.5 posts). Beaumont provides a 24-hour on-call Hospital, the aim of this department is to The department also works closely service for Neurology, staffed in-house deliver the best possible service to all with the IT Department and Ms Mary with consultant cover. As with all patients referred for clinical neuro- Fitzsimons (Principal Physicist). disciplines, activity levels have physiology testing and to develop in A teleneurophysiology pilot project increased incrementally, and up to 60% parallel with other neuroscience services. which provided a teleneurophysiology of all admissions to the Neurology Demands on the Clinical Neuro- service link between the north-west service now come through the physiology Department continue to and Beaumont Hospital was completed Emergency Department. The presence increase. A range of services including in 2006. Results were encouraging and of integrated services in Epilepsy, electroencephalography (EEG), confirmed the feasibility of the Multiple Sclerosis and Motor Neurone electromyography (EMG) and video development of such a multidisciplinary Disease has had a positive impact on telemetry EEG, botulinum toxin clinic for service (see further details below, patient care. Clinical nurse specialists neurological disorders and carpal tunnel under Neurophysics section). provide an important liaison service – consequently there are fewer “crisis” clinics are delivered. Referrals are Future plans for the development of the admissions through ED of patients received both locally and from centres department include recruitment of availing of these specialty services. throughout the country. technologists, expansion of the Patient care is planned and those with numbers of Consultant Clinical Key developments in 2006 included a disease exacerbation are “fast-tracked” Neurophysiologists in keeping with the move to a new interim building with to specialist clinics, and admitted as Comhairle na nOspideal report on improved space. The appointment of a “urgent electives”, where necessary, Neurology and Clinical Neurophysiology Clinical Nurse Manager (Ms Margaret with a defined care plan. Ryan) in April and three Clinical services (April 2003) and appointment of an equipment manager. Further Measurement Neurophysiology Tech- Clinical Activity expansion of the existing services as nologists in the Autumn were also The Neurology Department provides an well as development of other welcome developments. in-patient service, with tertiary and neurophysiology services to include quaternary referrals in the specialist The construction of the interim building evoked potentials, ambulatory EEG, areas of Stroke, Epilepsy, Motor for the department was completed mid- teleneurophysiology and intra-operative Neurone Disease, Neuromuscular summer 2006. This area includes four monitoring are priorities for the Disease, Multiple Sclerosis and clinical laboratories, three offices, department. conference room, reception and clerical Migraine. Activity levels are increased area. Further expansion of service NEUROLOGY in all areas from 2005. delivery is anticipated with recruitment of Currently, the Neurology Department In-Patient Activity more technicians and purchase of comprises three consultant A total of 592 patients were admitted in equipment. Unfortunately, there is a neurologists, an RCSI senior lecturer in 2006. The commonest reasons for global paucity of clinical technologists clinical neurology, three specialist admission were for management of and recruiting has been a challenge. registrars, five research fellows, a epilepsy, stroke, multiple sclerosis, Currently there are two consultants in registrar, two SHOS and two interns. motor neurone disease, and Clinical Neurophysiology – Drs Fiona There are nine clinical specialist nurses: neuropathy. Mean length of stay was Molloy (nine sessions) and Valerie Reid four in epilepsy (two job-sharing), two in fifteen days. Thirty-two patients were (five sessions). The department has no multiple sclerosis, and one each in monitored in the Epilepsy Monitoring non-consultant hospital doctors as there stroke, motor neurone disease, Unit (EMU) in the second half of the are no trainee posts in the Republic of migraine. The department works closely year; the unit was closed during the Ireland for this neurology sub-speciality. with Neurophysics and the Department first six months of 2006 due to a shortage It is hoped that this will be developed in of Neurophysiology. of video EEG technicians. The mean the near future. Dr Kevin Murphy, In accordance with its position as the length of stay in the EMU was ten days. Senior Lecturer in Neurology, has largest and busiest Neuroscience The commonest reasons for delayed worked closely with the department centre in the country, Beaumont discharge were the need for input from and has reported the EEG telemetry Hospital continues to have the largest other medical and surgical services, and data. There are four Clinical number of Specialist Registrars in the development of a medical or Measurement Technicians comprising a Neurology in Ireland. Three of the 10 surgical complication – both reflecting Chief Technician (Ms Geraldine Browne) current appointments are located at the complexity of the patients
60 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Neuroscience Division
undergoing admission. However, the Out-Patient Activity Awards and Grants delay in availability of essential There are currently seven weekly public "Socio-technical challenges of investigations, including MRI, neurology clinics, including specialist telemedicine: The clinical contributed to delays in the discharge clinics in stroke, epilepsy, motor neurone neurophysiology exemplar” won a of a significant minority of patients. disease, neuromuscular disease and Health Service Innovation Award in Availability of neuroimaging will improve migraine, and a monthly multiple 2006. substantially with commissioning of the sclerosis clinic. An average of 100 new Mary Fitzsimons (PI). much-needed second MRI scanner later patients and 400 returns are seen each in the summer of 2007. HRB Health Services R&D Award – month by the Neurology service. value €1.25m – Revolutionising chronic Important research databases have been Waiting Lists for Admission disease management with information generated within the sub-specialist areas, The mean length of time from decision and communication technology: a socio- which have contributed to the success of to admit patient to admission was 44 technical project applied to epilepsy the Department as an important centre days (minimum 0, maximum 990 days). care in Ireland. for neuroscience research. There was no difference between (Mary Fitzsimons/Norman Delanty). public and private patients. Patients Future Plans Muscular Dystrophy Association USA. who were in receipt of “integrated It is envisaged that the specialist A Genomewide Association Study of care” through the sub-specialty clinic services will continue to develop with ALS - value $550,000. were more likely to be admitted and the expansion of the Neurology service. (Orla Hardiman) discharged expeditiously. Unfortunately, The department has particular strengths ALSA (USA) A population based study the waiting list for in-patient video-EEG in cerebrovascular disease, epilepsy, of cognitive decline in ALS – value monitoring remains unacceptably long motor neurone disease, multiple $80,000 starter grant. at 24 months, although some patients sclerosis, and more recently, in (Orla Hardiman) are prioritised on the basis of urgent movement disorders and clinical Beaumont Foundation Kennedy medical need. Notwithstanding the neurophysiology. New consultant Fellowship. relative efficiency of the service, a appointments with specialist interests Awarded to Dr.Julie Phukan and Orla substantial proportion of patients in epilepsy and stroke are planned for Hardiman for MND research. waited for longer than six months for 2007, with the concomitant expansion admission. Patients from remote areas of multidisciplinary services that provide Irish Motor Neurone Disease were over-represented in this group. integrated care. In addition, resources Association Research Award. for infusion therapy will have to Maintaining the Irish Register of MND Consult Service increase to meet the expected demand (€59,000) (Orla.Hardiman) The Neurology Department operates a for Tysabri (natalizimabab) for patients busy consult service (average 20 with multiple sclerosis during 2007. RCSI Grants Awarded in consults per week), which is staffed by 2005-2006 Combined clinical and basic science a specialist registrar with consultant Royal College of Surgeons in Ireland projects in epilepsy, motor neurone cover. A separate dedicated stroke Research Committee Award – value disease and stroke have successfully service is provided by a specialist €90,000 - Genotype to endophenotype- continued in 2006. It is envisaged that neurology team, led by Dr. Moroney A new standard for association. these programmes of translational and Dr. Leo Galvin. Up to 15 strokes are (Norman Delanty/Mary Fitzsimons). reviewed each week. There has been research will continue to develop in HRB Health Services Research an increase in the use of Interventional collaboration with neuroscientists at Fellowships 2006 Neuroradiology for patients with critical RCSI and other Dublin Molecular Awarded to Lisa Ronan to undertake a carotid or vertebral stenoses who are Medicine partners. study entitled: Improving Epilepsy Care suitable for stenting. We are engaged in with Novel Advanced Imaging ongoing discussions with the Research Activity and Output Techniques; An in vivo study of cerebral Consultant Geriatricians and Beaumont The department remains active as an cortical morphology value €90,000 Hospital management to develop a academic and research centre. dedicated neurology-led The main research strengths are in International League Against multidisciplinary stroke service, with epilepsy, stroke and motor neurone Epilepsy 2007 disease. Each subspecialty comprises priority access to sub-acute and chronic To fund a Clinical Information Manager rehabilitation utilising a satellite unit at a multidisciplinary team of clinicians and researchers. Post for the Epilepsy Programme St. Joseph’s Hospital and the National €50,000 Rehabilitation Hospital, where The service has had considerable appropriate. success in 2006. Irish Heart Foundation Scientific Research Grant 2006-2007
BEAUMONTHOSPITAL ANNUAL REPORT 2006 61 Neuroscience Division
Investigation of apraxia of speech and Non-Invasive Ventilation in ALS. National Conference, September 30th, linguistic dysprosody following acute International Symposium on ALS/MND, Hilton Hotel, Dublin. ischaemic hemispheral stroke. Drs. Yokohama, Japan, Dec 2006 Epilepsy and Chronic Disease Sinead Murphy/Joan T. Moroney Dr. Delanty Management. Electronic Patient Record Collaboration in Epilepsy Genetics Workshop. November 4th, Dublin. International Panels and Research. The Sixth Epilepsy Research Advisory Boards Vascular Epilepsy. South of Ireland Foundation Workshop. Oxford, Dr.Hardiman Clinical Club. October 28th, Killarney. March 2006. Member of the Data Safety Monitoring Committee for the international Phase II Exploiting Pharmacogenomics to Dr. Moroney clinical trial Ono 2506 as a therapy in Individualise Prescribing. European Irish Heart Foundation Stroke Study Day motor neurone disease (2006-2008). Epilepsy Congress, Helsinki, July 2006. (Session Chair). Dublin, Ireland. May 2006. Member of AAN International Sub- Epilepsy Pharmacogenomics (Session Committee (2005-2008) co-chair). European Epilepsy Congress, ACLS Stroke Management. Irish Helsinki, July 2006. Society of Intensive Care. Dublin, Member, UK MND Research Advisory Ireland. October 2006. Panel (2003-6) Dr. Moroney Post-Procedure Care. Congress Member of Steering Committee, Peer Reviewers Interventional Radiologists Annual European ALS Group (EURALS) (2004- and Editorial Boards Conference, Rome, Italy. present) Dr.Hardiman is a reviewer for Annals of September 2006 Neurology; Neurology; Lancet Member of HRB Neuroscience Panel Neurology, The Journal of Neurology, National Lectures Dr. Delanty European Journal of Neurology; Journal Dr.Hardiman Member, Retigabine Advisory Panel, of Neurology; Journal of Neurology, Integrated Care for Chronic Disease. Valeant Pharmaceuticals, European Neurosurgery and Psychiatry; ISQHC/HSE Annual Meeting, Clontarf Epilepsy Congress, Helsinki, June 2006. The Journal of Neurological Sciences; Castle, May 2006 Member, Vigabatrin Advisory Panel, Brain; ALS and Other Motor Neurone Geographic Inequity and Health. Irish Ovation Pharmaceuticals, American Disorders; Multiple Sclerosis; The Irish Rural Network, Annual Meeting, Epilepsy Society, San Diego, December Journal of Medical Science; The Irish Tullamore, May 2006 2006. Medical Journal; and Expert Review of The Complex Genetics of ALS: Ethnicity Neurotherapeutics. She is on the Dr. Moroney Matters. Institute of Molecular editorial board of ALS and Other Motor Member, Natalizumab Advisory Panel, Medicine, St.James’s Hospital, Neurone Disease and Modern Ireland. Biogen Pharmaceuticals. June June 2006 Medicine. 2007. Celtic Variations on a Theme in ALS. Dr. Moroney is a reviewer for Epilepsia, Member Stroke Section, American Neuroscience Ireland Inaugural Neurology, and Stroke. Academy of Neurology, April 2007. Meeting, Cork, Sept 2006 Dr. Delanty is a reviewer for The Member, Stroke Council, Irish Heart Acute Management of Headaches in Lancet, Epilepsia, Neurology, The Foundation, 2007. the A+E. The First Critical Hours American Journal of Medicine, The International Lectures Informed Research & Training Ltd. Journal of Neurological Sciences, Neurobiology of Disease, and The Irish Dr.Hardiman RCPI, Dublin Sept 2006, and London Journal of Medical Science. Clinical Trials in ALS. 3rd International England, April 2007 Neuromuscular Meeting, Havana Cuba, “That this house agrees that the NEUROPHYSICS February 2006 solution to the healthcare crisis lies in The neurophysics group continues to Complex Genetics of ALS. 3rd the private sector”. Pharmaceutical provide technical and scientific support International Neuromuscular Meeting, Managers of Ireland. Four Seasons to the Epilepsy Programme and the Havana, Cuba, Feb 2006 Hotel, Dublin Oct 2006 Clinical Neurophysiology Department at Beaumont Hospital. Activities of the Diagnostic Dilemmas in ALS. ALS Dr. Delanty group include: in-vivo MRI-based Teaching Session, European Irish Institute of Clinical Neurosciences quantitative assessment of the Neurological Society, Lausanne, May Annual Neurology Update Day (Chair). structure of the brain in epilepsy; the 2006 September 8th, Guinness Hop Store, design, development, implementation EURALS Workshop. ENMC meeting, Dublin. and evaluation of an epilepsy electronic Naarden, October 2006 Epilepsy Care in Ireland. Brainwave patient record; tele-neurophysiology – a
62 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Neuroscience Division
pilot project with the HSE North West; In October 2006, the group hosted a health service in Ireland - better health, equipment management guidance in workshop entitled: Revolutionising fair access, appropriateness and clinical neurophysiology. chronic disease management: the role responsiveness, and high performance. of the electronic patient record, at the + A six-fold increase in access to EEG Quantitative Brain Morphometry Carlton Hotel, Dublin Airport. 140 services for the population of the NW Ms Patricia Breen was awarded an MSc healthcare workers from a variety of and an improvement in waiting times in Physical Sciences in Medicine at disciplines and sectors of the Irish for CN appointment. Trinity College Dublin. Her research Health Service attended the day-long project for this postgraduate degree event. The workshop provided a forum + That the Government Virtual Private was a quantitative magnetic resonance for health service providers and health Network (GVPN) provided a secure and imaging based study of the entorhinal informaticians to exchange highly reliable link between SGH and cortex of the brain. Imaging research by perspectives on EPRs. A number of Beaumont Hospital in Dublin for the group is funded by the Health expert speakers contributed to the electronic transfer of, and remote Reseach Board (HRB) and the RCSI workshop including: Dr. Norman access to data. Research Committee. Ms Lisa Ronan, Delanty, Prof Jane Grimson, Ursula + A high satisfaction rating from CN PhD student and recipient of a HRB O'Sullivan, Prof Charles Normand, personnel who made practical career development fellowship, Mr Feargal McGroarty, Mr Damien suggestions for improving the model. completed a study of cerebral cortical McCallion, and Prof Denis Cusack. gyrification in temporal lobe epilepsy + Patient satisfaction with the TNP which has been published in Epilepsia. Telemedicine service who were pleased not to have Ms Cathy Scanlon, PhD student, During the year the group completed a to travel long distances for continues her study of brain structure Teleneurophysiology Pilot Project. investigation. endophenotypes in temporal lobe A teleneurophysiology (TNP) model for + Referring clinicians found TNP to be a epilepsy. This RCSI funded project aims service delivery was established. readily accessible service with prompt, to improve understanding of the This model resulted in a clinical efficient and clear reporting which underlying genetics of epilepsy. neurophysiology department being set- positively impacts on patient Our imaging research is conducted in up at Sligo General Hospital (SGH) management. collaboration with clinical neurology and which is a satellite of the specialist host neuro-radiology colleagues at Beaumont department in Beaumont Hospital. The + That the cost of EEG service-delivery Hospital, St. James's Hospital in Dublin, satellite and host are linked via the using the TNP model is comparable Trinity College Institute of Neuroscience Government Virtual Private Network with conventional CN service delivery. and Liverpool University. (GVPN). Electroencephalography (EEG) This pilot project was funded by the investigations can be conducted by a HSE North West and is a collaboration Health Informatics technologist at SGH, digitally recorded between clinical neurophysiology A HRB Health Service R&D funded five- EEG data is uploaded to a file server, personnel at Beaumont and Tallaght year programme entitled: and a consultant in Clinical Hospital, clinicians and management in Revolutionising chronic disease Neurophysiology can access the digital the HSE North West Region and IT management with information and data from Beaumont Hospital for personnel. The project won a Health communication technology: a socio- interpretation, over a secure Service Innovation Award in 2006. technical project applied to epilepsy telecommunication network i.e. GVPN. care in Ireland is being undertaken by Over a twenty-week period between the group in collaboration with the IT May and September 2006, 142 patients department and Epilepsy Programme at (over 18 years old) had EEGs recorded Beaumont Hospital, Dublin, the Centres at SGH. The digital EEG recordings for Health Informatics and Health Policy were accessed electronically from and Management, Trinity College Dublin Beaumont Hospital by a Consultant in and Dublin Institute of Technology. An Clinical Neurophysiology for electronic patient record (EPR) is being interpretation. designed, developed, implemented and evaluated by this project. During the The pilot project demonstrated: year Mr Jarlath Varley joined the group + The practicability of a telemedicine as the evaluation researcher. Ms Louise model of Clinical Neurophysiology (CN) McQuaid is the requirements engineer service delivery. for the EPR project. Both Louise and Jarlath are registered for PhDs at Trinity + The benefits of the TNP model and its College Dublin. alignment with the national goals of the
BEAUMONTHOSPITAL ANNUAL REPORT 2006 63 + positive developments
The great success of the GP courier service continues to swell demand for GP diagnostic services and reduces the number of patients needing to attend the hospital for tests.
64 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division of Laboratory Medicine
MICROBIOLOGY The Department of Microbiology provides Most of the increases represent high a fully externally accredited service to scientific input areas, where the growth Beaumont Hospital and to the wider in specimen numbers is driven by factors community through general practitioners, outside our control such as: clinics and external institutions. Increased surveillance and monitoring Staffing issues, a major concern in 2005, of healthcare associated infection, have been somewhat alleviated during including MRSA & VRE (+63%). 2006. The processing of TB work had to Increased requirement for TB testing be outsourced in 2006 due to critical staff and ova and parasites, partly due to the shortages, but a value-for-money initiative changing population demographic. was approved by the Hospital to allow the repatriation of this critical diagnostic area. An increase in complex respiratory Fungal work, outsourced in 2006, is also specimens from cystic fibrosis patients. covered by this initiative. Following the Increased awareness of Legionella sp. Pollock Report findings, which estimates infection and hence increased demand a total of 110 cystic fibrosis patients for for Legionella antigen (+57%). On the scientific front, Beaumont Hospital by 2010, a staff grade new methodologies medical scientist has been approved to The great success of the GP courier have been put in support the increasing diagnostic service continues to swell the demand pressures in this area. place to streamline for diagnostic services. Microbiology GP workload has increased by 109% the processing of On the scientific front, new methodologies have been put in place to streamline the since 2003 and by 24% since 2005. MRSA specimens, processing of MRSA specimens, resulting In the absence of adequate numbers resulting in improved in improved turnaround times and detec- of full-time staff, GP work is currently turnaround times and tion rates. The move to Clinical Laboratory being carried out after hours, with detection rates. Standards Institute (CLSI) methodology as additional medical laboratory a standard for antimicrobial susceptibility assistant support. testing had been delayed in 2006 due to The clinical service continues to place staffing difficulties. The approval to appoint significant demands on the medical a temporary member of staff will now staff. Diagnostic and therapeutic advice, allow the process to move to the imple- review of patients with sterile site and mentation stage. other complex infections and daily Two members of the scientific staff in review of the 20 ICU patients requires the department (Aoife Houlihan and the full-time commitment of two SpRs, Donal Doyle) are participating in MSc the SHO and the on-call consultant. In programmes. Eileen Nolan successfully 2006, the Department was involved in completed the Higher Diploma in Training the ongoing management of 1,622 and Quality Management and was patients, accounting for 8% of awarded a bronze medal. Dr Lorraine admissions to the Hospital. Power, SpR, passed Part 1 MRCPath and Dr Lilian Rajan gained her MRCPath.
The most critical areas of increased / decreased workload are outlined in Table 1
Specimen No. By Year Year 2003 2004 2005 2006 Variance 2003-2006* Specimen numbers 86,072 91,423 101,234 102,909 16,837 (+20%)
*2003 figures are used as a benchmark in the above table, as accreditation was awarded on the basis of 2003 workload / staffing ratios
BEAUMONTHOSPITAL ANNUAL REPORT 2006 65 Division of Laboratory Medicine
There were approximately 1,860 out-of- The Department of Pathology sought Academic Pathology Forum of Great hours calls to the consultant microbiolo- accreditation by the UK accrediting body Britain & Ireland gists during 2006, the majority for advice CPA. It was rigorously reviewed and External examiner – Trinity College and on patient care with the remainder for received full accreditation in 2005. This is UCD. infection control advice or permission for an affirmation that the laboratory functions out-of-hours specimen processing etc. to the highest international standard. Professor Elaine Kay In early 2007, the 1.5 consultants will be In 2005 the Department completed its Member of Histopathology Sub-group, joined by an additional consultant shared refurbishment and is now in line with Faculty of Pathology, Royal College of between the Health Protection Health & Safety standards by CPA. Physicians in Ireland. Surveillance Centre (6 sessions) and Member of the All Ireland NCI Scientific Beaumont Hospital (5 sessions). Research continues to be an important priority and papers are regularly presented Advisory Group. HISTOPATHOLOGY DEPARTMENT at scientific meetings. This research is Committee Member, Pathological clinically based and is focused on Society of Great Britain & Ireland. Mission Statement translational issues. A molecular facility “The Histopathology Department in HRB Cancer Biology and Haematological is not currently available in the Beaumont Beaumont Hospital is committed to Diseases Committee. Hospital Histopathology Laboratory. providing a high quality diagnostic service It is hoped that the Beaumont Assessor - UKNEQAS. to all its patients, while striving to Histopathology Laboratory will have its External Examiner maintain a safe and professional work own molecular diagnostic facility within environment for its staff. The department QUB, Pathology, 3rd Medical Year one year. Such a facility is essential for also seeks to support the educational modern histopathological evaluation and QUB, Clinical Science (BMS Pathways) needs of all hospital staff and to promote is particularly important given Beaumont Course an environment conducive to research.” Hospital’s commitments as a cancer University of Cambridge – Undergraduate centre for up to one million people. Summary Pathology & Graduate Entry Pathology The Beaumont Hospital Histopathology Postgraduate training in histopathology Board Member – Postgraduate Medical & Department provides a comprehensive and cytopathology is an integral Dental Board service in histopathology. This includes component of the Department and much Board Member – IACR surgical pathology, cytopathology, autop- time and effort is invested in the training sies, clinico-pathological meetings, of higher specialist registrars in Board Member – CRI research, education and training. histopathology, and in supervising ICORG – Translational Research Group The workload of the surgical pathology research projects for scientific and Dr. Anthony Dorman department continues to increase. medical staff. Chairperson Division of Laboratory The expansion of the breast service has Audit and Clinical Governance are an Medicine, Beaumont Hospital. significantly increased the number of integral part of the activities of the cases received. Additional appointments Histopathology Department. These are Representative of Division of Laboratory in gastroenterology have also increased currently being reviewed and updated. Medicine – Medical Executive, Beaumont the workload. These have placed a great Hospital. strain on the service as the department Professor Mary Leader President, Irish Branch, Association of has insufficient additional scientific, Member of Medical National Education Clinical Pathologists. medical and secretarial staff. The work- Research and Training Committee load in cytopathology also continues to Dr. Derval Royston Member of Board of British Division of increase and further increases are International Academy of Pathology (Irish Member of Beaumont Hospital Ethics expected with the roll out of the National nominee) Board Cervical Screening Programme. The Cytology Service intends becoming Member of Editorial Board of Current Ms. Pauline McGrath has completed an part of the National Cervical Diagnostic Pathology MBA in Healthcare Management with the Academy of Laboratory Sciences and Screening Programme. Member of Editorial Board of is Chairperson of the Cellular Pathology Histopathology Dr. Christian Gulmann has commenced Body, AMLS. practice in the Histopathology Member of Board of Beaumont Hospital Department having returned from the Foundation NIH Washington. His main research Member of Council of Irish Hospital interest is GIT Pathology. Consultants Association Member of Committee of International
66 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Division of Laboratory Medicine
Renal Histopathology Department Fluorescence Microscopy slides are The renal histopathology service prepared in the Department of provides a diagnostic renal biopsy Immunology. service to Beaumont Hospital, the Mater CLINICAL INVESTIGATION UNIT- Hospital, Our Lady's Hospital for Sick PATHOLOGY. Children, Crumlin, Temple Street The department of pathology continues Hospital, Limerick University Hospital, to be involved in research in the clinical Merlin Park Hospital, Galway, Waterford investigation unit. This facility is staffed Regional Hospital, Cavan General by Professor Mary Leader, Professor Hospital and Letterkenny Hospital. Elaine Kay, Dr. Kilian Perrem, Ms. Ailish Renal biopsy pathology incorporates Lynch and Mr. Pauric Flavin. direct immunofluorescence, light This laboratory works in conjunction with microscopy (which includes routine and the larger research facility of the special stains) and electron microscopy. Pathology Department in the Royal As well as examining native biopsies, a College of Surgeons in Ireland. very important aspect of our service Current research examines the role includes the national renal transplant of telomerase and of the factors which service. The latter includes on-call control cell proliferation in disease assessment of frozen sections from biology, supported by a research grant marginal donors with a view to from Science Foundation Ireland. optimising a limited source of organs serving an ever-increasing waiting list. In 2006 we reported on 430 renal biopsies in comparison with 311 in 1996. All biopsies are reported by telephone within twenty-four hours of receipt, with discussions of clinico-pathological correlation. There is a weekly renal biopsy conference. The renal biopsy pathology archive has accumulated a unique collection of renal biopsy pathology, which is available to doctors training in histopathology. In addition it has served as a source of clinical research with many papers published using this archive as a source of cases. Our clinical research activities, which include publications in 2006, in collabora- tion with clinical nephrology and trans- plant surgery are familial interstitial nephritis, allergic tubulo-interstitial nephritis in the allograft, thrombotic microangiopathy in allografts, familial membranoproliferative glomeru- lonephritis and recurrent membranoprolif- erative glomerulonephritis in allografts. Light Microscopy, (including routine, histochemical stains and immunoperoxidase) is performed in the Histopathology Department.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 67 + positive developments
The division is actively working on delivery of quality patient services in the most economic fashion.
68 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
2006 has been a hectic year in the Language Therapy with a number of Clinical Services Division. Nationally, Clinical Specialist upgrades. the Health and Social Care Professionals' Clinical Services are also reviewing Registration Board has been set up and change management processes in line will be chaired by Finbarr Flood, former with the Hospital review of service Chairman of the Labour Relations Court. delivery. This will link with the introduction This is to protect the public from rogue of Business Units/Directorate models. practitioners and will also protect titles of The division is actively working on the professionals involved. It is the first delivery of quality patient services in the health professionals' board that has been most economic fashion. Ginny Hanrahan, set up with a predominant number of lay Clinical Services Co-ordinator members on the board and should be up 40th Anniversary and running by the summer of 2007. Congratulations to Dr. Joe Tracey and The professionals involved are: Ms. Patricia Casey on celebrating the Physiotherapy, Occupational Therapy, 40th anniversary of the National Poisons Speech and Language Therapy, Dietetics, Information Centre. Please see the Social Work, Psychologists, department's report for more details. Radiographers, Biochemists, Medical During 2006, Scientists, Orthoptists, Podiatrists and Workloads additional resources Social Care Workers. Across all departments, there has been were received to an increase in workload – see individual support the new New Services department reports for details. This is During 2006, additional resources were status of Beaumont due to demands being placed on these received to support the new status of services by the additional new consultants, Hospital as the Beaumont Hospital as the Regional who have commenced work in Beaumont/ Regional Cystic Cystic Fibrosis Service. Dedicated St. Joseph's Hospital. This includes the Fibrosis Service. staffing has been provided and it is our addition of a gastroenterologist and hope that there will be capital plastics surgeon, urologist, development within the next year. Within neurosurgeon, ENT surgeon, with a the division, this has meant additional respiratory physician due to join the staff. staff for physiotherapy, dietetics, With in-patient beds running at an almost psychology, social work, pulmonary 100% occupancy, this would indicate laboratory, microbiology and pharmacy. that this should not be the case. The setting up of the Living-Related However, this is due to patients with Donor Programme has also brought increasing complexities being treated and additional resources to allow the support greater demands being made through for this new programme, in particular out-patient services In the Pathology Transplant Co-ordinators, NHISSOT service 34% of all the lab work is now (Tissue Typing), Psychology, Social Work received from general practitioners and and Pharmacy. Finally, the division also continuing to grow. This has placed a received two new posts to support our particular pressure on a number of areas, Neurology services – for Psychology and including Microbiology, Chemical Speech and Language Therapy. The Pathology, Endocrine, Haematology, division was also involved in the recent Immunology and Histopathology. review of the National Neurosurgical The increasing pressure from patients Service, outlining what will be required to requiring admission from the Emergency provide an appropriate level of service to Department presents significant these patients with the addition of new challenges in accessing appropriate neurosurgeons. Posts which had been placements and support services for funded in 2005 were filled this year, in patients requiring discharge. Social Work, the Symptomatic Breast/Oncology Occupational Therapy, Dietetics, Speech services and two additional posts were and Language Therapy and granted following national competition Physiotherapy, along with our nursing for Clinical Tutors for Physiotherapy, colleagues, have been responding Occupational Therapy Speech and
BEAUMONTHOSPITAL ANNUAL REPORT 2006 69 Clinical Services Division
promptly and creatively to ensuring the been working to set up five additional with very high care needs, as currently early discharge of patients with appropriate teams in this area. Each primary care there are only 30 beds in this area to resources and home care packages. team will look after approximately 7- meet these patients' needs. 8,000 people, starting with areas of high Staffing needs. The core team will include Clinical Services Office Recruitment has continued to be a general practitioners, nursing, Developments challenge in particular areas: physiotherapy, occupational therapy, In recognition of the volume of work in Radiographers, Audiologists, and Cardiac mental health workers with a more the Clinical Services office, it has been Catherisation Technicians in particular. specialised service being provided by agreed to assign a Grade 8 post to the I wish to thank the staff in these areas in psychology, dietetics, speech and office, which will occur during 2008. particular who have continued to provide language therapy. Ballymun Primary Care Finally I would like to thank each of the a patient-centred service. team was established in 2004, as one of Heads of Departments for their Kara Cullen became the permanent In the national pilot sites. This has worked committed work and their dedication to Charge 3 of Nutrition and Dietetics. Claire well and is being rolled out through the patient-centred delivery of services, Byrne took leave of absence from her role rest of the service – the first ones have while working hard to support and as COPD Outreach Co-ordinator and has been identified as Darndale, Edenmore, develop staff. It is a tremendous been ably replaced by Brenda Deering. Coolock, Whitehall and Killester. Des reflection on the managers that despite O'Toole, Trauma Co-Ordinator, and I have the increasing demands on the services, Capital Projects been actively representing Beaumont we have motivated and dedicated staff. In 2006, this office acted as project Hospital on these developments. Personally, I would also like to thank sponsor for the delivery of the new Locally, the development of the North Adrienne O'Connor who does such an Diabetic Day Centre, Cochlear Implant Fringe region will ultimately result in an excellent job in the organisation of Programme and the new Neurophysiology additional 40,000 people living in our this office. department, which were all completed in catchment area. This area is between Ginny Hanrahan 2006. Chest Pain is another service that Donaghmede, Baldoyle, Malahide Road – Clinical Services Co-ordinator we have been trying to complete, but the Clare Hall. Dublin City Council has been funding has only allowed us to offer a taking a lead on planning the development ++ Some reports of services provided by minimal service and applications have to ensure that the appropriate Clinical Services staff are within other been made to provide services on a 24/7 infrastructure is in place – schools, departments' reports, ++ basis. Ongoing project involvement transport, primary health services, gardai, include the Day Hospital for the shopping, pre-school services. Beaumont CHAPLAINCY Psychiatry of Old Age and Care of the Hospital has been at the table, with two Fr Bryan Nolan, Head Chaplain Elderly (now at Stage 2), the 44-station major issues, one is transport to the The Chaplaincy Department is an integral Haemodialysis Unit, and the Hepatology Hospital and, secondly, the requirements part of the multidisciplinary team. Unit. In Radiology, planning for the for the people in this area; this Our Chaplains cover the entire hospital installation of the second MRI and the involvement was reflected in the Hospital and so are in a unique position of having large amount of associated work is Strategy Document. an overall view of how the system works underway, with a time line of having the and how care is provided. The work takes MRI in by the middle of 2007 and the Long-Stay Services many forms: from meeting new patients project completed by late Spring 2008. One of the frustrating issues for in the Emergency Department, where Fr Work has also been ongoing in preparing Beaumont Hospital this year has been James provides a most welcome service, for PACS – Picture Archiving the lack of suitable long-stay beds in to bringing a prayerful presence to Communication System, which will see North Dublin for our patients. This has patients before surgery, sitting with and the replacement of x-ray by digital put pressure on the Hospital and Martin comforting relatives in our Neuro and imaging. This will be a huge change McCormack, Head Medical Social General Intensive Care units; finding management programme across the Worker, and his team have maximised appropriate words and rituals that try to Hospital. Thanks to staff in all of these the use of any beds that have been bring meaning and closure for families areas for their assistance and patience in allocated to our hospital. This has after traumatic deaths, supporting delivering these projects. resulted in a number of patients moving patients as they are dying by developing to services out of area, which has relationships with them and listening to Community Developments challenged how we work. Beaumont their concerns, often exploring questions With the HSE National Transformation Hospital are working closely with the that they could never ask anyone else. Programme, there is a great emphasis on HSE PCCC to try to improve this situation the development of Primary Care Teams. and it is hoped to have a 100 bedded unit This year the community services have on St. Joseph's site in 2007 for patients
70 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
The service we provide attempts to We continued with our commitment to MEDICAL MEASUREMENT journey with the patient and provide a non- education and took part in many of the DEPARTMENTS judgmental supportive presence. We help post-graduate courses in the centre of patients try and answer these limitless education. Fr Bryan became part of the CARDIAC CATHERISATION questions. Questions such as where is accreditation team for ICU. Chaplaincy TECHNICIAN SERVICE God? How could God do this to me? was represented on the multi disciplinary Thelma Morgan, Chief I Cardiac Is there really anything after this? Why teams for RITU, ED and ITU, at clinical Catheterisation Technician. me? Why us? Why now? Big questions services and general services meetings. The ever-increasing workload continued in that maybe they have never given much We also supported the Social Work 2006 with 24,537 tests performed during thought to before, for all sorts of reasons. Department in contributing to the Hospital the year. With no increase in staffing Patients can become vulnerable and may bereavement course. We also supervised levels this proved a challenging year. feel powerless and out of control. students from All Hallows College The planning of the Chest Pain Unit and There is endless time; independence and completing their Master’s programme. allocating the space required was a major freedom seem to have been taken away. Members of our department played a accomplishment. All things going well, the In such situations the chaplain’s role is significant part in the preparation a unit should open in 2007, which will more important than ever. Chaplains are document called policies and procedures greatly benefit the ECG department and present to those of all faiths and none, for chaplains. This is a national document patients alike. The demand for ECHOs for those who profess faith in a particular and was launched by President Mary continues to grow. The hospital has creed but have not practised it for many McAleese at the National Chaplains' supported initiatives to reduce waiting lists years and now in illness wish to access Conference in April. using Saturday sessions for out-patients. their spirituality but are not sure how to The completed installation of the go about it. Fr Bryan helped bring to completion the negotiations for contracts and salaries Transoesophageal probes, with designed Many people faced with terminal illness with the HSE and a full-time chaplain's sterilisation equipment in place has been have issues that they need to resolve; salary is now at grade six level. Fr Bryan a welcome addition to the department, sometimes they need reconciliation, was also invited to become a member of a special thanks to Josette Galligan, sometimes it is they who need to the National Steering Committee for the Vigilance Officer. forgive and sometimes they need to Hospice Foundation. He also continued A big welcome to Amy Whelan, the first forgive themselves. his work as national chaplain to the secretary in the ECG department since Healing in Beaumont takes many forms Catholic Nurses' Guild and led the the Hospital opened. and that healing is not always a physical national pilgrimage for nurses in May. Our pacemaker clinic continues to grow one but one where the patient can come Fr. Eoin managed our Ministers of the with plans for the clinic to increase to terms with his or her story and be Eucharist; he ran recruitment drives and from twice a week to four times a week supported on the way. training sessions. He also has in 2007. The chaplaincy service in Beaumont responsibility for St Michael's Ward and The outlook for 2007 is for the workload Hospital is inter-denominational and the makes a significant contribution there. to increase further; however, the ongoing main Christian traditions work together Fr Paddy Ryan retired on health grounds recruitment drive should provide some as a team of equals. We celebrated in August and was not replaced. This had more staff early in 2007. Remembrance Services for adults and a significant impact on our ability to children. Reconciliation Services for staff provide a service. We are fortunate in NON INVASIVE VASCULAR UNIT called ‘Give up your auld sins’ which having the help of two excellent locums - Director: Dr. Patricia Fitzgerald proved very popular. Services of Fr Dan Callaghan and Fr Sony Sebastian. Chief Technologist: Mr. Dermot Murphy celebration for Lent, Advent and Thanksgiving for our volunteers. I would also like to give special thanks to The Non-Invasive Vascular Unit continues There were services to help bring closure Sr. Brenda Swan and to Sr. Therese to provide a diagnostic vascular for staff after the loss of a colleague and Dillon for their commitment, creativity, ultrasound service for both medical and different services around death, dying and enthusiasm. In the last year they surgical divisions of the Hospital plus and bereavement. have managed to change the way we do local community General Practitioners. things forever. It is wonderful to have Mass is celebrated daily and is generally them with us. Clinical Activity well attended. There are two masses The Unit continues to see a mixture of I would also like to thank the staff in each Sunday and this year the Filipino both in and out-patients for assessment. general and the nurses in particular for their community, which has become such an In 2006, 7544 examinations were support and acknowledgment of our role. integral part of the Hospital, formed a performed, 60% on an out-patient basis. music group. It is a huge success. This is similar to 2005 activity.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 71 Clinical Services Division
Staffing We are confident that as we get closer to For all the hard work thanks to all the The level remains static; however, our full staffing complement, we will be staff: Drs Molloy, Reid, Murphy, O'Rourke; changes in personnel resulted in a able to decrease our waiting list for the Technologists Alma O'Donnell, Senior reduction of skill-mix. This is secondary EEGs. The number of in-patient referrals Technologist, Sheila O'Connell and Mark to the national paucity of qualified and has increased by 25% with the Rowe, Junior Technologists. Thanks to experienced vascular technologists. This introduction of a Carpal Tunnel Clinic. Ciara Duggan for all her help and the is currently being addressed by ongoing Patients requiring EEGs have to wait a secretaries Bride, John and Rebecca who training within the unit. considerable period before they can be are led by Martina Breen. called for appointment. Recruitment Educational Training And remains a priority. THERAPEUTIC SERVICES Research The Technologists dealing with the COPD OUTREACH In 2006 the Department expanded its Epilepsy Long-Term Monitoring Unit Brenda Deering, a/COPD Co-ordinator training role. are part of a very active, positive and Full involvement in undergraduate clinical supportive multi-disciplinary group. Staffing Two full-time staff members, CNM2 and training for Technician staff, as well as They work closely with Dr Norman Senior Physiotherapist, provide an 2nd and 3rd year Radiology Registrars Delanty, Dr Niall Pender, Head of Clinical extended hours of service Monday to rotating through the unit to enhance their Neuropsychology, Ms Patricia Ennis and Friday, 8am to 6pm. For a period of time Duplex Ultrasound skills. Ms Paula Corr, Ms Maire White and Ms Cora Flynn, Epilepsy Nurse Specialities. we received funding for a third person • Dermot Murphy was awarded an MSc under the National Health Services Our department was invited by the (Portsmouth University) for work on the Partnership Forum which allowed for a Neurophysics Group, led by Ms. Mary predictive value of vein diameter in the weekend service. haemodialysis access patent. Fitzsimons, to take part in a pilot study with Sligo General Hospital: • Dr. P Fitzgerald was awarded an MD Clinical Activity “Teleneurophysiology project”. The aim (UCD) for Vascular Haemodynamics in 1.Early Discharge Programme is to deliver an EEG service to the North off-spring of Abdominal Aortic Aneurysm 2.Assisted Discharge Programme West of Ireland and the data will be patient. 3.NIV assisted Discharge Programme reviewed and interpreted here in the 4.Prevent Readmission Programme • The Unit hosted the Autumn Meeting Neurophysiology Department in 5.Pulmonary Rehabilitation of the Society for Vascular Technologists Beaumont Hospital. The pilot project has of Great Britain and Ireland. been successful. It will certainly be the Early Discharge model for other hospitals to take up and The average length of stay for COPD New Initiatives follow. We are delighted to be part of this exacerbation patients without Ongoing collaboration with DIT Bolton innovative development. catastrophic complications who did not Street, to develop an in-flight excercise fit our criteria was 7.7 days in Beaumont device aimed at DVT prevention. Dr Molloy and Dr Reid are developing the EMG service and the technologists are Hospital in 2005. In 2006, 48 patients Duplex mapping of abdominal wall happy to be involved will the delivery of availed of our Early Discharge vascular for the Oncology patient prior to the Nerve Conduction Clinic. The waiting Programme with an average LOS of 1.43 breast reconstructive surgery. list for Carpal Tunnel studies is up-to- days with a saving of 303 bed days. date. Early next year the department will CLINICAL NEUROPHYSIOLOGY Assisted Discharge be hoping to secure new equipment for DEPARTMENT This new programme was developed for EMG studies. There is a heavy demand Geraldine Browne, Chief 11 CNP the more chronic patients on nocturnal on the existing old machinery. Technologist NIPPY and to those new to portable or Dr Kevin Murphy and Dr Deirdre O'Rourke The Clinical Neurophysiology long-term oxygen to assist their transition are involved in the interrelation of EEGs Technologist team is led by Ms. from hospital to home. It has decreased in the department. Both of them present Geraldine Browne, Chief the long-term stay for those with at our Epilepsy Review meetings on Neurophysiology Technician, and the catastrophic complications from 10.7 Friday where, along with a large multi- service is clinically led by Dr. Fiona days in Beaumont in 2005 to 8.85 days, disciplinary group, the monitored patients Molloy, Consultant Neurophyiologist, which is a saving of 85 bed days. 46 are discussed and dedications reached with Dr. Valerie Reid, Consultant patients were seen under this initiative. regarding their treatment. Neurophysiologist. The team provides Prevent Readmission EEG, Long-term Epilepsy Monitoring, and Margaret Ryan is Clinical Nurse Manager Our ability to prevent readmission for Carpal Tunnel Clinics for both in-patient in the department and her input and help patients previously enrolled in COPD and out-patient referrals. is invaluable to each and every one of us. Outreach has helped keep down the
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number of patients attending the Service Development Departmental Developments & Emergency Department with 16 revolving Development of inclusion/exclusion Innovations door patients benefiting in the six months handy-card for doctors. Clinical Specialist: Carmel O'Hanlon was from June 2006 to Jan 2007 which is a appointed Clinical Specialist in Critical Prevent Re-admission and Assisted saving of 123 bed days in 6 months. With Care and Nutrition Support in 2006. this projection for a year 32 patients could Discharge NIV programmes. benefit from this service with a potential Cystic Fibrosis: Rachel O'Reilly was In House Education saving of 246 bed days a year. appointed Senior Dietitian in Cystic Nursing education in St Joseph's Fibrosis in 2006. She continues to monitor In total, 511 bed days were saved Hospital, Raheny, A&E nurse education, the Nutritional status of the Cystic Fibrosis through these initiatives. School of Nursing final year nurse population and measure outcomes with students, GP Study Day, World COPD differing nutritional therapies. Pulmonary Rehabilitation Day promotion. 32 patients benefited from pulmonary Oncology: Paula O'Connor was rehabilitation in 2006. A cost analysis Poster Presentation appointed Senior Dietitian in Oncology comparing patients who participate in Irish Thoracic Society Poster and commenced her post in January pulmonary rehabilitation to those who do Presentation on Pulmonary Rehabilitation 2006. The addition of a third post in not has show a saving of €172,812 per Reduces The BODE Index Score For Oncology has led to an increased service 12 patients per annum, which is a saving Certain Chronic Obstructive Pulmonary for the Oncology Day Ward. of €461,000 last year for the Hospital. Disease Patients. Diabetes: Beaumont Hospital is one of a However, the real cost to the patient can few national centres to provide DAFNE be seen in an increased prognosis for Publications (Dose Adjusted For Normal Eating) survival, decreased dependency on Article in the HSE Newsletter Health training for people with Type 1 Diabetes. Emergency Department services and Matters, February 2005 Eimear Fanning, Senior Dietitian in improved quality of life. Endocrinology, completed four courses in NUTRITION AND DIETETICS COPD Outreach Services are cost- 2006, with a further six courses planned DEPARTMENT effective and driven forward by patient for 2007. Eimear has also established a Dietitian Manager – Kara Cullen need and best practice. Short-term and specific clinic for people commencing insulin pump therapy. long-term follow-up ensures patient Staffing satisfaction and the success of all The Nutrition and Dietetics Department PN Policy: Carmel O'Hanlon co-ordinated programmes. Only through audit and currently has 20.25 staff. the update of the Hospital PN policy in research can evidenced-based practice December 2006. Department members be provided. The COPD Outreach service Clinical Activity were also involved in the PN contract continues to expand with additional Referral rates and clinical activity decisions in 2006. programmes being developed annually remained very high in 2006 with 26,365 Care Pathways: Members of the through the identification of patient in-patient consultations completed. department were involved in the needs. Overall, 140 patients were development of various Care Pathways recruited to these programmes in 2006 during 2006 – Carmel O'Hanlon was (see figure 1). involved in co-ordinating the Care Pathway for patients undergoing elective open AAA repair and Niamh Maher was involved in the development of a Care Pathway for patients undergoing Neck 23 Disections. Carmel was also involved in 34 Early Discharge the development of a patient information Assisted Discharge leaflet to accompany the AAA Care Prevent Re-admission 11 Pathway. This information leaflet is to be Pulmonary Rehabilitation implemented in 2007.
31 Nephrology: The Senior Dietitians in this area were involved in the development of a Chronic Renal Failure Patient Information book, which is due for Figure 1. Percentage of patients allocated to each programme for the year ended 2006. publication in 2007.
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Cardiology: A Patient Satisfaction Dietetics staff also attended many Forum kindly agreed to fund a research- Questionnaire was completed for patients education and training meetings. Overall based evaluation of the bereavement attending the Cardiology OPD service. 2006 was a busy and productive year for service, which was carried out in 2006. Out-patients: Group Nutrition Education the Nutrition and Dietetic Department. We would like to record our sincere Sessions were continued for people with thanks to those involved for their support. MEDICAL SOCIAL WORK Type 2 Diabetes and those attending The results of the research will be made Martin Mc Cormack, Principal Medical Cardiac Rehabilitation. A Patient available early in 2007. Social Worker Satisfaction Survey was completed for As part of the department commitment patients attending the OPD service, the Referrals to the Medical Social Work to continuing professional development, results of which are to be collated in 2007. Department grew by 25% in 2006. Our Fiona Mc Inerney delivered lectures as staffing allocation rose by 0.5%. This Surgery: In liaison with the Stoma Care part of the Diploma in Oncology Nursing related to the 0.5 WTE SMSW post for Department, the department developed Course on “The Psychosocial aspects the Cystic Fibrosis service and Annette new diet sheets for patients post associated with Cancer Survivorship”, Winston was appointed to that post. Ileostomy and Colostomy surgery. and “Communication skills with the In 2006 we delivered a service to 7,500 Cancer patient” and Emma Gannon Catering: Dietitians were involved in patients and their families. The majority delivered a lecture on “The Cancer development and delivery of a Nutrition of referrals were for counselling and Journey from diagnosis to end of life”. Education Programme for catering staff. support to those impacted by trauma, Joan Mc Connell taught on the FETAC Professional Supervision: Non-Managerial illness and hospitalisation and in relation programme delivered to Health Care Clinical Supervision which provides to patient and family support around Assistants. Celine Deane, Siobhan O clinical supervision in a group setting was discharge planning. Prof Drumm, Chief Driscoll, Peter Mc Cartan and Martin Mc introduced in the department in 2006. Executive of the HSE, has placed great Cormack collaborated with TCD staff to Five department members received emphasis on the concepts of social gain deliver the Trauma Course offered to final training during 2006. and of innovative practice since he came year Social Work students in TCD. into post. We saw many examples of Accreditation: 12 members of the We are extremely grateful for the that in the MSW department in 2006. department were actively involved in support we received from Catherine the Hospital Accreditation process Shirley Brennan SMSW established a McGrath, Anne Robinson, Ciara Baker, during 2006. group for young women who were Barbara Clarke, and Sylvia Mc Connon coping with having a diagnosis of cancer. who are the heart and engine room of Research Fourteen young women attended the the department, and the support we Members of the department have been course and got an opportunity to meet received from Ginny Hanrahan, Clinical involved in various audits in 2006: others, network, ask questions, and take Services Co-ordinator. • PN Audit - Carmel O'Hanlon co- some time out with others who knew ordinated an audit of parenteral nutrition what they were going through. PHARMACY practices and complications in Beaumont The feedback was very powerful and the Peter Jacob,Chief Pharmacist /Manager Hospital. A report of the audit was group format was deemed very useful. presented to the PN Committee meeting The social work team played a key role at Staffing in December 2006. local ward level in the establishment of Staffing remained fairly stable during local discharge teams and spearheaded 2006. The staffing stood at 16 • The Oncology dietitians conducted two the co-ordination of home care packages Pharmacists and 14 Technicians. Towards audits looking at dietetic activity in the and long-stay placements to patients the end of the year a senior pharmacist Oncology Day Ward. under the Delayed Discharge initiative. post was approved and recruited for the • A hospital-wide audit of weighing provision of pharmacy services to St Siobhan O Driscoll and the administrative scales was conducted to determine Joseph's Hospital. Preparatory work team organised the “Annual Beaumont their accuracy. needs to be done before services can Hospital Public Lecture on Loss and commence in 2007. The old pharmacy • Audit of dietetic service offered to Bereavement”. Nell Mc Cafferty needs to be fitted out and procedures gastroenterology and haematology delivered the lecture, and gave an drawn up. patients. intimate overview of her personal experience of grief. It struck a chord with The report on pharmacy services, Education and Training many people. The feedback from the 300 completed in 2005, is still active through The department continues to be a people who attended was overwhelmingly a committee of two pharmacists, two training hospital for student dietitians, favourable and reaffirms our commitment technicians and the Clinical Services Co- with a wide variety of lectures given to to this format. Beaumont Hospital and ordinator. It is hoped a proposal will be many staff groups in the Hospital. the Health Services National Partnership put to the Senior Executive in early 2007
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to resolve the many issues addressed in Transplant personnel and recipients are We have maintained links with several the report. indebted to families who make the very clinical psychology training courses and brave and unselfish decision to donate now regularly accept trainees from Trinity Services their loved one's organs providing life- College Dublin, University College, The pharmacy remained very busy in saving operations to so many patients. Dublin and the National University of 2006. Clinical, dispensing and We acknowledge the ongoing support Ireland, Galway which significantly chemotherapy continue to supply every from our colleagues in all the participating improve our clinical resources. However, increasing demands from the clinical hospitals around the country. sufficient and appropriate clinical space areas. Plans to alleviate the chronic space remains a problem which we will attempt problem were drawn up and approved. PSYCHOLOGY to improve in 2007. We also continue our This extra space should be available in Dr Niall Pender, Head of Department of successful undergraduate student 2007 and will address many problems. Psychology internships with the American College A replacement programme for shelving in The department has seen further growth Dublin and the European Study Abroad the pharmacy was initiated and approved in demand for services over the past year Programme. We started a very on a phased basis for 2007. The Drugs with over 1,000 patients seen across successful post-qualification course in and Therapeutics Committee and the 2,000 sessions of assessment or clinical neuropsychology for clinical Pharmacy Department continue to push treatment. In 2006 we have 7 wte, with neuro-psychologists which lasted 10 for the appointment of a Medication Ms Coleen Kernekamp joining us in a months. The course was very well- Safety Officer and for the start of a half-time post in the cystic fibrosis team received and we are running this again project to computerise the prescribing in which represents a significant in 2007. the Hospital. improvement in the psychological management of these patients. Research Education and Training All department staff are now research New staff continued their in-house There has been a great recognition of the active and we are continuing to deliver training in dispensary, chemotherapy and beneficial role of psychology in the on our Research Strategy 2005. We clinical work. Two staff gained their MScs Hospital and support for the have continued our collaborations with in hospital pharmacy and two more development of psychological services to the Trinity College Institute of started MSc programmes. We wish different patient groups. Despite the Neuroscience examining patients with them well in their studies. increased demand in services, we have focal brain lesions and have developed been successfully addressing the length new research links with the ORGAN PROCUREMENT & RENAL of waiting lists in the department. Department of Psychology, University AND PANCREAS Neuropsychology continues to carry long College Dublin and the Department of TRANSPLANTATION waiting times due to the lack of staffing Psychiatry RCSI. At present we have 5 Phyllis Cunningham, Senior Transplant and the considerable demand for post-graduate research students (2 PhD Co-Ordinator services. Services to neurosurgery are and 3 Masters) pursuing research in the The department had 143 potential particularly problematic. However, the department and many staff are involved donors referred for organ donation in psychology input to liaison psychiatry and with external collaborations. We have 2006. There were 91 actual donor old age psychiatry is offering an efficient also fostered further internal research retrievals, yielding 23 donors per million and responsive clinical service. We collaborations with medical teams of population (pmp). The remaining 54 continue to expand our community focus within the Hospital. Many of our staff cases were either medically in the Old Age Psychiatry services and Dr have presented research and position unsuitability or consent was declined. Edgeworth has developed several groups papers in national and international for psychological management of older conferences in 2006. There has been a record number of adults. Furthermore, in cochlear implant We have ongoing research programmes multiple organ transplants performed in services, Angela Murphy developed, in in Dementia (and neurodegenerative Ireland with much fewer organs being collaboration with the multi-disciplinary disease) as well as conditions such as sent abroad in 2006. team, a resource pack for teachers and conversion disorders. Further research In spite of this, the number of patients ancillary educational staff on 'Working with the Epilepsy Programme examines requiring renal transplantation has with a child who is deaf in the the psychological impact of Epilepsy continued to rise and the demand is educational setting'. The cochlear implant Surgery and the efficacy of the Intra- ever-increasing. The live kidney donor team currently have 0.5wte psychology Carotid Sodium Amytal Test which is run programme is expanding to address this which is insufficient to meet the fortnightly in collaboration with the situation. There were 4 such considerable demand on the service. Department of Radiology and St Finbarr's transplants performed in 2006 and it is We will be working with the team to Day Ward. Members of the department hoped that a further 15 will take place enhance this service in 2007. have now been trained in Dialectical in this coming year.
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Behaviour Therapy and are running this Meeting, San Francisco, 2006. Journal of Royal Hospital for Neuro-disability, programme for the management of Cognitive Neuroscience. London. He is also honorary Clinical Self-Harm as well as investigating its Lecturer on the Clinical Psychology Pender, Edgeworth and Dinneen (2006). efficacy in patients with borderline programme at the National University of Protecting vulnerable patients in acute personality disorder. Ireland, Galway. He is the Western hospital care: the importance of mental Europe Representative of the We hope to see further growth in both the capacity. Psychological Society of Ireland International Neuropsychological Society, clinical and research elements of the Annual Conference, November. department in 2007 which will result in Chair of the Psychological Society of Pender, N. (2006). Fractionating substantially improved services to patients. Ireland's Special Group in recognition memory: the dual process Neuropsychology and is the Irish mode. Trinity College Institute of Publications/ Posters/ Seminar & representative for the European Neuroscience, November. Conference Presentations Federation of Neuropsychological Murphy Angela (2006). Children who are Pender, N. (2006). Neuropsychology, Societies. deaf who present with complex needs. mental capacity and the brain. Speech and Language Special Interest Psychological Society of Ireland Annual OCCUPATIONAL THERAPY Dearbhla Birdy, Grade 3 in Charge Group on Deafness, May. Invited Lecture. Psychological Society of Ireland Annual General Meeting, May. Occupational Therapist Edgeworth, Jennifer (2006). Mental Capacity. Highfield Nursing Home and McIntyre, D., Walkin, M., Dinneen, C., Staffing Mater Hospital Geriatric/Psychiatry of Philips, J., Murphy, K., Delanty, N., and Despite ongoing intermittent staffing Older Adult Journal Club. Pender, N. (2006). Re-evaluating the role level difficulties due to unpaid leave and of Wada testing prior to selective Edgeworth, Jennifer (2006). gaps between employment hippocampectomy for patients with right Management of Behavioural and commencement, the department for the sided temporal lobe epilepsy in an Irish Psychological Symptoms of dementia. most part managed to maintain a cohort. Irish Neurological Association St Ita's Hospital, Dublin. relatively stable level of service provision Annual Meeting, Galway. staffing level. The department also Edgeworth, Jennifer (2006). Othello White M, Ennis P, Corr P, Flynn C, welcomed the:- Syndrome: a review and case series. Murphy K, Pender N, Phillips J, Delanty N Psychological Society of Ireland Annual • Commencement of a dedicated (2006). Resource frustrations in epilepsy Conference, November. permanent senior Occupational Therapist surgery evaluation in Ireland. Irish for Oncology/Symptomatic Breast Care Wilson O'Raghallaigh (2006). Neurological Association Annual Services as sanctioned in 2005. Psychoanalysis and Illness. Psychological Meeting, Galway. Society of Ireland Annual Conference, • Commencement of a 0.5 Clinical Pender, N. (2006). Managing challenging November. Practice Tutor Post. This post is neurological behaviour. 1st Annual dedicated to providing a strong student Pender, Niall (2006). Co-organiser and Rehabilitation Conference, Dublin, April. learning environment within the Chair of symposium on Diverse Issues in departmental setting and facilitating an Acute Hospital Care. Psychological Academic affiliations effective working relationship between Society of Ireland Annual Conference, Dr Jennifer Wilson O' Raghallaigh, Senior therapist, hospital and university. November 2006. Clinical Psychologist in Liaison Psychiatry, has an honorary lectureship in • Commencement of the clinical Co-organiser and Chair of Course the Department of Psychiatry, Royal specialist upgrade for the Occupational Committee for monthly post-qualification College of Surgeons in Ireland (RCSI) and Therapy Services to the Clinical course in Clinical Neuropsychology regularly teaches on courses at the RCSI. Neurology caseload. (2006). Clinical Neuropsychology Course, Beaumont Hospital, Dublin (February- Dr Jennifer Edgeworth, Senior Clinical • Initiation of a portable equipment pilot December). Neuropsychologist in Old Age Psychiatry, project between Beaumont Hospital has an academic affiliation to the Occupational Therapy Department and Dinneen, Reidy, Edgeworth, Wilson- Department of Psychology at UCD. Community Occupational Therapy O'Raghallaigh, Pender (2006) Dialectical Services in Local Health Offices North Behaviour Therapy at Beaumont Hospital. Dr Niall Pender, Principal Clinical Dublin, North West Dublin and Dublin DBT Course, Dublin September. Neuropsychologist, has an honorary North Central. The pilot will aim to allow lectureship in the Department of Hoerold, D., Pender, N.P., O'Keefe, F., & Beaumont Occupational Therapists to Psychology, Trinity College Dublin; is an Robertson, I.H. Neuropsychological directly supply essential pieces of associate member of the Trinity Institute performance, error monitoring and self equipment to facilitate patient discharge. of Neuroscience and is also honorary awareness in focal lesion patients. This process will relieve pressure Consultant Neuropsychologist at the Cognitive Neuroscience Society Annual demands placed on our community
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counterparts and make for more timely guidelines of practice in many areas, pre- Modality Assessment Response access to essential patient equipment surgical assessments in rheumatology Technique (SMART) training course in the needs. The pilot project also allows for prior to hand surgery and guidelines for Neuro-rehabilitation Hospital, Putney, the provision of a dedicated additional A&E Hand Therapy Services. London. This has assisted in the Occupational Therapy Assistant post to commencement of an Occupational • Lymphoedema service provided and provide essential follow up requirement Therapy service to patients in a minimally ongoing training taking place to ensure of the patient after discharge. responsive state in Richmond ITU. continuity of this service. • Ms Geraldine Foley, Clinical Specialist Clinical Activity • Involvement in multi-disciplinary team Occupational Therapist. These articles Referral rates and activity levels approach to patient issues, e.g. Mr include “What are the care needs for continued to increase in 2006 with Walter Leahy, Senior Occupational people with motor neuron disease and almost 3,800 (3,769) new patients seen Therapist, continues to remain a strong how can occupational therapists between in-patient and out-patient member of the “Restraint Committee”, a respond to meet these needs.” services. As noted in the 2005 annual multi-disciplinary body dedicated to the published by the British Journal of report, an increase in referral rates implementation and review of the new Occupational Therapy (BJOT). continues to challenge staff resources hospital restraint policy. This committee across all clinical areas, with continued has overseen the participation of • In addition she forms part of the inability to provide any follow up services Whitworth Ward utilising a restraint research study “A phenomenological for in-patients once discharged i.e. via reduction programme and the trial of study to explore perceptions of quality of OPD or outreach. some specialised equipment that could life for persons with amyotrophic lateral reduced the risk of falls in the elderly. sclerosis: Determined by coping and New Service Developments As well as assessing a Falls Risk affected by healthcare.” This has been • Development and commencement of Assessment Tool, Ms. Nicola Doyle has submitted and awaits publication in an internal staff weekly education also been involved with devising an MDT Amyotrophic Lateral Sclerosis. training programme. This programme book for children with Acquired Brain which is presented and compiled by the Injury returning to school Other information senior therapists aims to educate and In 2006 the department continued to • Development of the Psychiatry of Old further upskill all Occupational Therapy support and contribute significantly to Age service including establishment of a basic grade and assistant staff. professional matters and workings of the carers' support group. professional body “Association of • A senior Occupational Therapy staff Occupational Therapist of Ireland/AOTI” member has remained a strong Research/Presentations/Training with membership to various committee representative on the Association of • Ms Carole Murphy, Senior as follows:- Occupational Therapists of Ireland (AOTI) Occupational Therapist commenced a education committee, the Practice research project entitled “Effectiveness • Ms Derabhla Birdy, Chairperson of the Education Forum. This forum addresses of an Occupational Therapy Service in working group for the involvement of national professional issues in relation to Accident and Emergency”, sponsored by Occupational therapy assistants in the the practice education for students of the the Partnership Department in Beaumont SKILL Project. Hospital. profession. Recently it addressed • Ms Ann D'Arcy (Occupational Therapy standards of practice and facilitated third- • Ms Mary Naughton, Clinical Specialist Assistant) secretary of the AOTI level education facilities in the WHO Occupational Therapist, presented at the Occupational Therapy Assistant work accreditation process of the Occupational following: group, and is also a member of the Therapy degree course. • 1) AOTI annual conference May 2006 - aforementioned SKILL Project. • Strong participation in the multi- “Changing hand therapy practices in an • Ms Geraldine Foley is a working disciplinary forum for the Hospital policy acute Dublin Hospital”; member of National Neurology Steering on “Management of patients with • 2) NAROTI study afternoon 12th May; Group for review of Neurology services behavioural disturbance in the acute in the HSE. An official report in hospital setting”. The guidelines identify • 3) British Association of Hand Therapy association with AOTI has been the legal, ethical and professional Course Level 1 March 2006 “ Tendon submitted to the group on behalf of principles that guide good practice in this Management “ and Level 2 November occupational therapy services in Ireland. area, particularly in the use of restraints. 2006 “Introduction to Hand Therapy”; Geraldine is also a board member of the • Ongoing local service improvements • 4) Splinting Study Day November 2006 Irish Motor Neuron Association (IMNDA) including increased use of standardised in Naas General Hospital • Ms Nicola Doyle is the departmental assessment tools, eg SAFER in • Ms Nicola Doyle Senior Occupational representative of National Association of Emergency Department, individual Therapist completed the Sensory Neurological Occupational Therapists.
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• Ms Mary Naughton holds the current assessment and/or therapy. The creation • The Speech and Language Therapist chair of the Irish Association of Hand of a post dedicated to meeting the Managers of Beaumont, Mater and Therapy (IAHT), she remains as the Irish demands of this group remains a priority. Connolly Hospitals in collaboration with delegate/representative for the their counterparts in the HSE LHO of International Society of Hand Therapy Initiatives during 2006 include North Dublin, North West Dublin and (IFSHT). Mary also remains a member of • A 0.4 WTE Practice Tutor Speech and Dublin North Central wrote a report the AOTI validation committee. Language Therapist was appointed to 'Communication Connections' (Barrow et oversee the clinical education of Speech • Mr Alex Businos is the acting treasurer al, July 2006) which outlines patient and Language Therapy students attending of the Association of Rheumatology pathways through the speech and Beaumont Hospital. In line with this Occupational Therapist Ireland (NAROTI) language therapy service. The report development the number of students and a member of the Irish Rheumatology identifies how the needs of this group attending the department has increased Health Professional Society. are currently met and drawing on significantly from Trinity College Dublin, evidence of best practice, makes There remains high level of involvement the National University of Ireland Galway recommendations for service in national special interest groups for the and the University of Limerick. developments to meet these needs. profession such as in Stroke, Mental • There has been an increase of 1.0 WTE Health, Palliative Care, Care of the Basic Grade Speech and Language Other Information Elderly, Rheumatology and Emergency Rozanne Barrow is a visiting lecturer to Therapist for Neurology services. Special Interest Groups. undergraduate students attending TCD • The Speech and Language Therapy and University College Cork on aphasia SPEECH AND LANGUAGE department in Beaumont Hospital in and the application of qualitative research THERAPY collaboration with the Mater Hospital, methods in clinical practice and to post Dr. Rozanne Barrow, Head Speech and Connolly Hospital, Trinity College and graduate students attending TCD on Language Therapist Connect (the Communication Disability disability, working with people with Network) in the UK are participating in the acquired communication impairments and Staffing Connect Conversational Partner Scheme communication access. She is a member The department comprises 12 WTE Project for people with aphasia (difficulty in of the Education Board of the Irish Associ- Speech and Language Therapists (this language processing as a result of acquired ation of Speech and Language Therapists includes the 0.4 WTE Practice Tutor brain injury). This scheme aims to provide and is the Irish Association of Speech and Speech and Language Therapist and people with aphasia, particularly those who Language Therapist Managers' representa- those working in Cochlear Implant and in are isolated and 'hard to reach', the tive on the National Implementation Group St. Joseph's Hospital Rehabilitation Unit, opportunity to engage in conversation with for the Clinical Education of Therapy Raheny) and 1 WTE Speech and Speech and Language Therapy students. Students. In addition she is the first Asso- Language Therapy Assistant. There was Students receive specific training on ways ciate Trainer for Connect (The some movement of staff during 2006. to support conversation with people who Communication Disability Network) in the Owing to the national shortage of experience difficulties in communication. UK whereby she delivers training to a wide Speech and Language Therapists it is While this scheme is not a substitute for variety of healthcare workers on issues difficult to recruit to temporary or locum therapy, it does reduce social isolation for relating to stroke and acquired communi- positions and therefore the department this group of people. For students it cation disability in both the UK and Ireland. was operating at reduced staffing levels provides opportunities to develop skills in Beaumont Hospital is reimbursed for her during periods between resignation and supported conversation which is a key time to enable to undertake this work. recruitment to posts. Savings accrued competency for their chosen profession. Antonio Hussey is chairperson of the from this allowed the department to The Practice Tutor provides support and Overseas Committee of the Irish Associa- appoint a temporary Speech and supervision for these students. tion of Speech and Language Therapists Language Therapy Assistant. • The MDT Voice Clinic resumed during and so plays a key role in the validation of Clinical Activity the year with the appointment of an the qualifications of speech and language therapists from overseas. It continues to be difficult to determine additional ENT Consultant. The Speech details on clinical activity due to a lack of and Language Therapist is an integral Jennifer Robertson is a visiting lecturer to systems; however, a 'snapshot' revealed member of this team and despite no under graduate students attending TCD approximately a 30% increase in activity additional resources for this post, and NUI Galway on Cochlear Implant. provides a service to this clinic. Such during 2006 as compared to 2005. The Elaine Whelan is a Speech and Language MDT clinics facilitate an integrated, ongoing increasing demands on the Therapy representative on the SKILL evidence-based and efficient approach to service mean that out-patients continue to (Securing Knowledge Intra Lifelong the assessment and management of have to wait an unacceptable length of Learning) project. The two main aims of patients with voice conditions. time (up to one year) before being seen for this national initiative are, firstly, to
78 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
establish a competency framework for objectives for the year ahead and to • Profile of staff referrals to a support workers in the health service deliver on those objectives within the physiotherapy department. J Eadie, R (e.g. therapy assistants) and, secondly, year, and earlier in many cases. Egginton, F Keogan, B Hayes. Irish to advise FETAC in the development and The objectives identified and delivered Society of Chartered Physiotherapists planning of appropriate courses to meet upon improved both patient care and conference. Poster presentation the identified competencies. effectiveness of service delivery. • A randomised controlled trial to There was ongoing commitment to the investigate the effects of open and closed PHYSIOTHERAPY provision of undergraduate student chain quadriceps strengthening in subjects Ann Marie O'Grady, In Charge 3 placements to both Royal College of with OA of the knee. F Keogan, C Gilsenan Physiotherapy Manager Surgeons in Ireland and University P O’Connell. American Rheumatology In 2006, there was an 18% increase in College Dublin. conference - Oral Presentation, Irish referrals to physiotherapy and a 33% Society of Chartered Physiotherapists increase in out-patient referrals compared Research conference - Oral Presentation to 2005. This occurred on the back of no There was ongoing support of research • Literature review of the pathogenesis increase in bed capacity within Beaumont within the Physiotherapy Department, of Osteoarthritis. F Keogan. IRHPS Hospital. Dependency levels of in-patients with Dr Paul O’Connell, Consultant Bursary June 2006 referred to physiotherapy indicated that Rheumatologist, and Dr Orla Hardiman, 19% required two or more staff to treat Consultant Neurologist, providing funding • A randomised controlled trial to the patient safely and effectively. for 0.5 WTE physiotherapist each to investigate the effects of open and The increased activity presented undertake research in their specific closed chain quadriceps strengthening in difficulties in maintaining the necessary fields. Their ongoing support is very subjects with OA of the knee. F Keogan, intensity and frequency of interventions much appreciated and has contributed C Gilsenan. EULAR Bursary required. Each clinical area reviewed their significantly to the culture of research • ‘A profile of Pain in Irish Polio work practices to ensure that optimal within the Physiotherapy Department. survivors’. Deirdre Murray, Irish Society usage of all resources was occurring. of Chartered Physiotherapists conference Presentations, Publications, During 2006 there were a number of very – poster presentation Bursaries and Funding welcome additional staff sanctioned and • Literature review of continuing • “Profile of patients referred to appointed. They were as follows: Professional Development: models and physiotherapy CVA service and the use of 1 WTE senior physiotherapist for cystic current practices. 'Physiotherapy: Theory the Orpington Prognostic Score as an fibrosis and Practice', Sep-Oct 2006. Michelle indicator of discharge destination.”Julie Shanahan - Irish Heart Foundation Stroke 1 WTE senior physiotherapist for Shannon in conjunction with DATHs Study Day May 2006 - Poster presentation oncology/symptomatic breast care project group. • “A profile of the level of dependency 0.5 WTE senior physiotherapist/practice • The efficacy of open and closed kinetic of patients referred for physiotherapy tutor top support undergraduate chain strengthening exercise in patients after CVA in an acute hospital and the placements for students from University with knee OA – Fiona Keogan, American use of physiotherapy assistants in College Dublin. College of Rheumatology, Nov 06 rehabilitation.”Julie Shanahan, Irish Heart • The management of Rotator Cuff 0.5 WTE staff grade physiotherapist for Foundation Stroke Study Day May 2006 - impingement – A review – Clare Gilsenan, neurology out-patients funded by Dr Orla Poster presentation Hardiman, consultant neurologist – Occupational Physicians Conference • Profile of physiotherapy service post recoverable • The Inter and Intra- rater reliability of a CVA in an acute care setting. Julie GAITrite® system in Quantification of 0.75 WTE physiotherapy assistant – Shanahan. Irish Society of Chartered Temperospatial gait parameters in funded by Dr Ciaran Donegan/Dr Allan Physiotherapists conference. Poster subjects with RA, F Keogan, R Egginton, Moore, consultant geriatricians – presentation recoverable – 1 year duration G Kearns, P O’Connell - Therapy Conference May 2006 Oral presentation • Health Promoting Hospitals Networks’ All these appointments allowed 14th International Conference, Lithuania. • A randomised controlled trial to development of additional and more Orla Daly – poster presentation intensive services to these areas of investigate the effects of orthotics on physiotherapy practice. tempero - spatial parameters.R. Egginton, F Keogan, G Kearns, P O’ New Developments Connell. British Rheumatology Team Based Performance Management Conference, Glasgow May 06. Poster was successfully introduced and allowed presentation each clinical area to identify their
BEAUMONTHOSPITAL ANNUAL REPORT 2006 79 Clinical Services Division
€ Research funding of 26,000 obtained Additional involvements • Dignity & Respect facilitators, from the Post Polio Support Group to Members of the Physiotherapy Beaumont Hospital- Helen Heery and support the following ongoing research: Department in Beaumont Hospital Orla Daly • Follow up study comprising annual continue to contribute on a hospital and Quantitative Muscle Analysis testing for national basis to physiotherapy and DIAGNOSTIC SERVICES Prior Polio cohort - numbers increased organisational needs. This involvement RADIOGRAPHIC SERVICES to approximately 100 by end 2006. enhances their contribution to not only Anne McMenamin, Radiographic Deirdre Murray individual patients but also the broader Services Manager picture. These include the following: • 'An Investigation of Subjective and Activity Motor Fatigue in Prior Polio Patients and • Securing Knowledge Intra Lifelong In 2006, 112,428 patients were the relationship with the Energy Cost of Learning (SKILL) Project. Eithne Waldron examined in the department and Walking'. Deirdre Murray – physiotherapy representative 147,502 cases carried out (excluding • Vice Chairman of Irish Society of cardiac interventional cases). The Lectures Chartered Physiotherapists (to June Hospital, once again in 2006, supported • Case study on care of the organ donor 2006) – Ann Marie O’Grady initiatives to reduce waiting lists in areas patient in the ICU setting to the such as CT, Ultrasound and MRI and Physiotherapy National ICU working • Chair of Publications Committee Irish provided prompt in-patient examinations party. Janet Levingstone Society of Chartered Physiotherapists – Editor of monthly publication Firsthand using extended working on a sessional • Post-graduate neurosciences nursing and biannual scientific journal basis for CT and Saturday scanning in course: Ailish McDermott/Janet Physiotherapy Ireland , Member of the MRI area for in-patients. Levingstone Executive and Council of ISCP -Orla Daly • Physiotherapy Respiratory Assessment Developments in Mammography • Irish Society of Chartered - Nursing inservice training programme, in 2006 Physiotherapists Website Editor - Julie Beaumont Hospital. Helen Heery 2006 saw the appointment of two new Shanahan Breast Surgeons and a dedicated Breast • Respiratory management in the • Health Management Institute of Radiologist to Beaumont Hospital. The paediatric setting at the paediatric study Ireland, Honorary Editor – Ann Marie department welcomed the appointment day, Beaumont Hospital. Janet O’Grady of Jacqui McGovern as Clinical Specialist Levingstone in Mammography. Subsequently the • Irish Society of Orthopaedic Medicine - • Role of the Physiotherapist and the development of the mammography Thelma Murphy Pelvic Floor Urology Nurses Annual service has been significant, we now Conference. Cinny Cusack • Committee member of Chartered offer a full mammography service as Physiotherapists in Women's Health - opposed to the two-day service that had • Role of the physiotherapist for Post Cinny Cusack been previously available. Also there has prostatectomy Patients. Irish Cancer been a large increase in the availability of Society Public lecture. Cinny Cusack • Alternate rep for IOPTWH (International organisation of breast ultrasound. This increase in • Assessment and Management of Physiotherapists in Women's Health) service provision has allowed us to Urinary Incontinence Physiotherapy post Cinny Cusack significantly reduce the waiting times for graduate course: Cinny Cusack. mammography and breast ultrasound. • Chairperson of Physiotherapy Clinical • Clinics in Motion Urology DVD: Specialist interest group - Cinny Cusack Furthermore, we now offer a “Triple Presenter: Cinny Cusack Assessment Service” whereby many • Chair of musculoskeletal physiotherapy • Irish College of General Practitioners. - patients attending the Breast Clinic will clinical specialist sub group – Clare Orla Daly have their mammography, breast Gilsenan ultrasound and image guided core biopsy • Presentations relating to developing • Honorary Secretary of Chartered carried out the same day. culturally sensitive healthcare Physiotherapists in Neurology and environment: Orla Daly Gerontology - Michelle Shannon • Dignity & Respect in the Workplace - • Honorary Secretary Physiotherapy Beaumont Hospital external showcase Intensive Care working party, a sub-group event. Orla Daly of the Chartered Physiotherapists in • Alpha-1 antitrypsin patient support Respiratory Care - Janet Levingstone group. Claire Egan
80 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
On-going Projects Accreditation conferences of BMUS (British Medical • PACs In May 2006 the department, while not Ultrasound Society), RSNA (Radiological Priority was given in 2006 to the assessed as a single unit, took an active Society of North America), the appointment of a PACS Project Leader on part in the Hospital-wide accreditation International Breast Cancer meeting and a contract basis to deliver a service in a process. Radiographers were actively a CT Symposium both held in Dublin. two-year timeframe. A PACs Steering involved and fed into all Clinical and Andrew Brown, Radiographer, completed Group has been established and it is Surgical teams, as part of the multi- a Post Graduate Diploma in MRI, while planned to submit a business case by disciplinary team. On non-clinical teams, Louise McDermott, Radiographer, May 2007. Beaumont Hospital Imaging representatives were involved in the completed a Post Graduate Diploma in services are currently 90% digital which Environmental team. A site visit was Ultrasound. gives it a great opportunity to go to a full carried out in Radiology by the Accreditors. Four Radiographers commenced a Post PACS installation and reap all the benefits Graduate course in Mammography, in the from this system. This will be a huge Staffing University of Nottingham. This course change management initiative From a staffing point of view the was in line with the expansion in the throughout the organisation and the staff department commenced the year with a Mammography service and following the in Radiology are committed to the full complement of staff; however, due to recommendations of the O'Higgins successful implementation of this a number of factors, by the end of the Report. It was funded through the project. Ultimately this will provide an year the department experienced a Symptomatic Breast Service. enhanced service for patients, with deficit in the number of Radiographers. improved turnaround times. This varied from one to nine members of David Reidy submitted his MSc thesis in staff below complement. The average September 2006 to UCD - 'To investigate • CT Radiographer vacancy rate for 2006 was the effect of Kvp and the anti-scatter grid A six slice CT scanner has been installed 3.7 WTE. This is a chronic situation in Direct Radiography (DR) of the PA in St. Joseph's Hospital, Raheny, and which is reflected nationally for Chest using simulated lung nodules and operational funding is awaited. Radiographers. The department did ROC analysis. A phantom study'. • MRI endeavour to maintain a full radiology Kate McKenna, RSO, completed her Post Plans for the installation for a much- service despite the staff shortages. Graduate diploma in Health Informatics, needed second MRI Scanner were We are indebted to the commitment of but deferred taking Post Graduate advanced as planned. By end 2006 the Radiography, Nursing and Medical diploma in favour of commencing her tenders were received. A new Siemens staff in Radiology who ensured continuity MSc in Health Informatics. MRI scanner is due to be installed by of care to the patients. June 2007, though will not be fully In 2006 Aine Quinn, Senior Radiographer, The post of Radiation Safety Officer at operational until later in the year. This has was conferred with her MSc from Trinity Clinical Specialist Radiographer level was necessitated extensive building works for College Dublin, having completed her also filled, by Kate McKenna in mid-2006. the placement of the new scanner and thesis entitled 'User Requirements: Their The RSO plays a vital role within the also arising from the need to increase Elicitation and Evaluation in the Radiology Department. The RSO has and upgrade patient waiting space. Development of an Interventional Neuro- many responsibilities which include the Radiology Information System'. • Ultrasound implementation and monitoring of Una Connellan, Superintendent The upgrade of the MRI Department has radiation protection procedures, Radiographer, is at present embarking on led to the relocation and planned supervision of individual dose assessment an MBA programme in Health Services expansion in the Ultrasound Department. of persons subject to monitoring and Management with the RCSI/UCD, while Ultrasound will now move to the front of reporting and investigating any incidents, Sean McArt, Radiographer, is currently the Radiology Department. Plans for this accidents or other abnormal situations undertaking an Msc in Law and Ethics. area include an increase in the number of involving radiation. The RSO reports to the ultrasound scanners, with a separate RSM, and works closely with the Jennifer Hanrahan, Superintendent interventional room. The plans also Radiation Safety Committee under the Radiographer, took part in the rewarding include improved and separate waiting guidance of the Chair of the Committee, LIPD (Leadership in Partnership areas for in-patients and out-patients. In who is the Head of the Department and Development) programme, which was a order to facilitate these planned service the Radiation Protection Adviser. joint venture between Beaumont expansions, plans have been drawn up Hospital, the Royal Hospital in Belfast which will include the expansion of the Training and Development and our Union Partners. There were ten Radiology Department and the building of In 2006 staff in the Radiology participants from Beaumont Hospital and a second floor to house offices, stores Department were active both ten participants from the Royal Hospital and a staff area. professionally and academically. in Belfast. Participants were drawn from Members of staff attended the annual both management and union personnel.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 81 Clinical Services Division
In 2006 the three Radiography services were launched in line with we have experienced in recent years. Assistants, Sean Bruen, George Poutch Hospital developments. Analysis to We have also been able to transfer some and Cyril Hoey took part in two dedicated support the Living Related Donor other assays onto this platform, thus Radiography Assistant modules carried Programme, molecular markers for reducing our turnaround times. out in conjunction with the School of oligodendroglioma and cardiac troponin I Test sets increased by 24% continuing Diagnostic Imaging in UCD. These were among the new services developed. the upward trend in recent years. This modules lead to a FETAC Level 5 award For 2007, the Division of Laboratory increase is partly a natural consequence as part of the SKILLS (Securing Medicine retains its core ethos of of new consultant appointments but we Knowledge intra lifelong learning) project. continuing to meet or exceed the needs are also seeing increased test requests This is a national initiative to establish a and requirements of its users while at from GPs and other external institutions. competency framework for support the same time achieving analytical workers in the health service. Anne excellence. MEDICAL PHYSICS AND McMenamin, the Radiography Services CLINICAL ENGINEERING (MPCE) I would like to use the opportunity to Manager, was a National Subject Matter Dr. Lesley Malone, Head of Department Expert Adviser to the HSE-EA on this thank all of the laboratory staff for their programme. hard work and professional standards. General Electromedical/ It is a pleasure to be ranked among Finally, at the beginning of 2006 Ms Una Anaesthetic Equipment them. I would also like to thank those in Kinsella, Clinical Specialist in CT, retired In addition to a very busy workload, the background without whom, we could from the Radiology Department. Una Tony Enright and Des Kelly contributed not continue to operate. came to Beaumont from the Richmond to the work of the committee dealing with upgrading for theatre electrical Hospital in 1987. We would like to take IMMUNOLOGY infrastructure. During the year they also this opportunity to record the Rena Willoughby, Chief Medical Scientist Department's thanks to Una for all her provided information with respect to a Unfortunately we had to bid farewell to hard work and diligence, maintaining the review of facilities and equipment for one of our medical scientists, Paul extraordinary high standard that we the expansion of Neurosurgical services McArdle, who departed to take up a associate with CT in Beaumont. in the Hospital, expected within the position in Roscommon Hospital. Regardless of pressures attending next two or three years. However, we were lucky to recruit Sonia advancements in technology and Skaff in his place, who joined us from Renal Dialysis increased throughput, Una retained her Kings College London. Anita Foran, our Paul Lowe and Peter Browne continued keen patient focus throughout. clerical officer, also moved on to new to provide a comprehensive technical and LABORATORY MANAGER ON pastures but remains within Beaumont in clinical support service to the Renal unit. BEHALF OF PATHOLOGY Nursing Administration and we Additional equipment purchased this year DIVISION welcomed Stephanie McShane as her provided the facility for high volume Pauric Reilly Laboratory Manager replacement. Two of our post graduate Renal Replacement therapies in the trainee medical scientists, Aileen Conville Critical Care areas. Further, MPCE The Division of Laboratory Medicine and Fiona Gaffney, completed their continue to provide advice in planning the comprises seven major laboratories, training programme successfully and new dialysis unit to be built on the Histopathology, Microbiology, became eligible for membership of the Hospital campus. Immunology, NHISSOT, Haematology, Academy of Medical Laboratory Science. Chemical Pathology and Blood Vigilance Committee We were happily allocated some new Transfusion. It also includes Phlebotomy Josette Galligan continued to act as space adjacent to our department which and Laboratory Administration. The Vigilance Officer. She has set up an has now been converted into a laboratory, workload is shared by many dedicated efficient system for dealing with medical providing much needed additional area for professional teams including medical, device alerts received from the Irish both staff and equipment. scientific, non-scientific, nursing, clerical Medicines Board (IMB) which ensures and portering staff. We introduced new test assays in the final sign off with the relevant staff. She 2006 was the busiest year on record for areas of Rheumatology and Coeliac also dealt with a number of issues arising the Division of Laboratory Medicine. disease and repatriated a number of from device problems arising within the assays in particular for complement Hospital. An article on the Vigilance In total 1,020,102 requests for analysis components and functional activity. process in Beaumont Hospital was were conducted, of which 439,807 came published in the IMB Newsletter. from general practitioners. The year also We were delighted to be able to upgrade saw many developments. Of particular our allergy screening to a fully automated note was the transfer of NHISSOT to a analyser which is coping very well with new purpose-built laboratory. Several new the increased workload in this area which
82 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
Non-Ionising Radiation and Maureen Heavey, Department Secretary, quantitative magnetic resonance imaging Endoscopy made a significant contribution to the based study of the entorhinal cortex of MRI safety training was set up for staff organisation of a Radiation Safety Course the brain. Imaging research by the group including TSD members and Security for doctors and nurses and other health is funded by the Health Research Board officers. professionals. (HRB) and the RCSI Research Committee. Ms Lisa Ronan, PhD student and Lectures on radiation protection and laser Input was also made to the tendering recipient of a HRB career development safety were also given to the Theatre process for MRI and Endoscopy fellowship, completed a study of cerebral Nurses' course. ultrasound equipment. A new washer- cortical gyrification in temporal lobe disinfector was commissioned for Members of the department were also epilepsy which has been published in Trans-oesophageal endoscopes. part of a team investigating radiation Epilepsia. Ms Cathy Scanlon, PhD dose and protection of patients attending student, continues her study of brain Accreditation and Audit for Neuroradiology studies. structure endophenotypes in temporal Members of the department contributed A final year undergraduate physics lobe epilepsy. This RCSI-funded project to a number of the clinical and non- project in the measurement of therapy aims to improve understanding of the clinical teams preparing for the ultrasound output commenced in underlying genetics of epilepsy. Accreditation Audit and also took part in collaboration with Dr. Jacinta Browne, Our imaging research is conducted in the Accreditation interviews and visits, DIT Kevin Street. collaboration with clinical neurology and including those for Endoscopy, Renal neuro-radiology colleagues at Beaumont Unit, Radiology and Environment. Representation on National Hospital, St. James's Hospital in Dublin, The pending decontamination audit also Bodies Trinity College Institute of Neuroscience required considerable attention. Josette Galligan is an executive member and Liverpool University. Environment Task Group Members of the of the Association of Physical Scientists department continued to be active on in Medicine (APSM). Lesley Malone is a Health Informatics this group and helped to produce a Board member of the Radiological A HRB Health Service R&D funded section of the Hospital Hygiene Manual Protection Institute of Ireland and a 5-year programme entitled: which dealt with cleaning and member of the Medical Ionising Radiation Revolutionising chronic disease decontamination of patient equipment. Committee of the Medical Council. Marco management with information and Kuntzsch is a member of the Radiation communication technology: a socio- Radiology/Nuclear Medicine Protection Special Interest group of the technical project applied to epilepsy care An inspection of the Nuclear Medicine APSM. Head of Department: in Ireland is being undertaken by the Department by the Radiological group in collaboration with the IT Protection Institute of Ireland had a NEUROPHYSICS GROUP Department and Epilepsy Programme at favourable outcome. New requirements Mary Fitzsimons, Principal Physicist, Beaumont Hospital Dublin, the Centres with respect to security of radioactive Neurophyics for Health Informatics and Health Policy sources will be implemented. Over fifty The neurophysics group continues to and Management, Trinity College Dublin patients from Beaumont and Connolly provide technical and scientific support to and Dublin Institute of Technology. Hospitals were treated for over-active the Epilepsy Programme and the Clinical An electronic patient record (EPR) is thyroids with radio-iodine. Plans were Neurophysiology Department at being designed, developed, implemented advanced for the use of a new Beaumont Hospital. Activities of the and evaluated by this project. During the radioactive treatment for Non-Hodgkins group include: in-vivo MRI-based year Mr Jarlath Varley joined the group as Lymphoma in collaboration with the quantitative assessment of the structure the evaluation researcher. Ms Louise Oncology and Haematology of the brain in epilepsy; the design, McQuaid is the requirements engineer Departments. Radiation shielding development, implementation and for the EPR project. Both Louise and calculations were completed for the evaluation of an epilepsy electronic Jarlath are registered for PhDs at Trinity proposed new developments on the roof patient record; tele-neurophysiology – College Dublin. of the Radiology Department. a pilot project with the HSE North West; In October 2006, the group hosted a equipment management guidance in Education, Training and Research workshop entitled: Revolutionising clinical neurophysiology. Students from the Dublin Institute of chronic disease management : The role of Technology (Kevin Street) and Dublin City the electronic patient record at the Quantitative Brain Morphometry University joined us for work experience Carlton Hotel, Dublin Airport. 140 Ms Patricia Breen was awarded an MSc and to perform projects in Endoscopy healthcare workers from a variety of in Physical Sciences in Medicine at Trinity /Non-ionising radiation and in the disciplines and sectors of the Irish Health College Dublin. Her research project for Radiology Department. Service attended the day-long event. this postgraduate degree was a The workshop provided a forum for health
BEAUMONTHOSPITAL ANNUAL REPORT 2006 83 Clinical Services Division
service providers and health informaticians transfer of, and remote access to data. Embedding the ‘e’ in Neurology – The to exchange perspectives on EPRs. socio-technical challenge. Presented at • A high satisfaction rating from CN A number of expert speakers contributed Irish Neurological Association Annual personnel who made practical to the workshop including: Dr. Norman Meeting, Galway 2006. suggestions for improving the model. Delanty, Prof Jane Grimson, Ms Ursula Ronan L, Scanlon C, Breen P, Murphy K, O'Sullivan, Prof Charles Normand, Mr • Patient satisfaction with the TNP Doherty C, Delanty N, Fitzsimons M The Feargal McGroarty, Mr Damien Mc service who were pleased not to have to spectrum of structural brain Callion, and Prof Denis Cusack. travel long distances for investigation. endophenotypes as quantitative traits for • Referring clinicians found TNP to be a genetic studies in epilepsy. Presented at Telemedicine readily accessible service with prompt, Irish Neurological Association Annual During the year the group completed a efficient and clear reporting which Meeting, Galway 2006. Teleneurophysiology Pilot Project. positively impacts on patient Mc Quaid L, White M, Doherty C, A teleneurophysiology (TNP) model for management. service delivery was established. Murphy K, Kenny T, Delanty N, • That the cost of EEG service delivery This model resulted in a clinical Fitzsimons M The Role of the Electronic using the TNP model is comparable with neurophysiology department being set- Patient Record (EPR) in Epilepsy conventional CN service delivery. up at Sligo General Hospital which is a Research Presented at: American satellite of the specialist host department This pilot project was funded by the HSE Epilepsy Society, Annual Meeting, San in Beaumont Hospital. The satellite and North West and is a collaboration Diego 2006. Presented at Healthcare host are linked via the Government between clinical neurophysiology Informatics Society of Ireland (HISI) Virtual Private Network (GVPN). personnel at Beaumont and Tallaght Conference November 2006. Electroencephalography (EEG) Hospitals, clinicians and management in Ronan L, Scanlon C, Breen P, Murphy K, investigations can be conducted by a the HSE North West Region and IT Doherty C, Delanty N, Fitzsimons M. technologist at SGH, digitally recorded personnel. The project won a Health The Potential of Quantitative EEG data is uploaded to a file server, and Service Innovation Award in 2006. Endophenotype Measures for Genetic a consultant in Clinical Neuro-physiologist Studies in Epilepsy: An MRI-Based, Non- can access the digital data from Invited Presentations 2006 Lesional Temporal Lobe Epilepsy Study. Beaumont Hospital for interpretation, Fitzsimons M ‘At the coal face’- over a secure telecommunication Introducing information systems that Presented at: American Epilepsy Society, network i.e. GVPN. change patient care. Annual Meeting, San Diego 2006. Over a twenty-week period between Health Research Board Conference - Publications in 2006 May and September 2006, 142 patients Today's health research is tomorrow's Ronan L, Murphy K, Delanty N, Doherty (over 18 years old) had EEGs recorded at health care June 2006. C, Maguire S, Scanlon C, Fitzsimons M. SGH. The digital EEG recordings were Fitzsimons M Chronic Disease Cerebral cortical gyrification: a preliminary accessed electronically from Beaumont Management supported by Telemedicine. investigation in temporal lobe epilepsy. Hospital by a Consultant in Clinical National Nursing and Midwifery Neurophysiology for interpretation. Epilepsia. 2007 Feb;48(2):211-9. Informatics Conference September 2006. The pilot project demonstrated: Ronan L, Doherty CP, Delanty N, Fitzsimons M Socio-technical challenges of • The practicability of a telemedicine Thornton J, Fitzsimons M. Quantitative telemedicine: The clinical neurophysiology model of Clinical Neurophysiology (CN) MRI: a reliable protocol for measurement exemplar Telemedicine in the Irish Health service delivery. of cerebral gyrification using stereology. Service: Current and Future Perspectives, Magn Reson Imaging. 2006 • The benefits of the TNP model and its Engineers Ireland April 2006. alignment with the national goals of the Apr;24(3):265-72. health service in Ireland - better health, Conference Presentations 2006 fair access, appropriateness and Fitzsimons M, Delanty N, Breen P, Current Grants Principal Investigator Grants Awarded in responsiveness, and high performance. Murphy K, Molloy F, Connolly S, Doherty 2005 C, Reid V, Hickey P Socio-technical • A six-fold increase in access to EEG challenges of telemedicine: The Clinical HRB Health Services R&D Award – value services for the population of the NW Neurophysiology Exemplar. Presented at €1.25m – Revolutionising chronic disease and an improvement in waiting times for Healthcare Informatics Society of Ireland management with information and CN appointment. (HISI) Conference November 2006. communication technology: a socio- • That the Government Virtual Private technical project applied to epilepsy care Mc Quaid L, Breen P, Murphy K, Kenny T, Network (GVPN) provided a secure and in Ireland. Connolly S, Reid V, Doherty C, Molloy highly reliable link between SGH and FM, Delanty N, Fitzsimons M. Co-investigator Grants Awarded in 2005 Beaumont Hospital in Dublin for electronic
84 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Clinical Services Division
Royal College of Surgeons in Ireland Publications Presentations Research Committee Award – value Feargal O'Connor and Dr Joseph Tracey € Papers 90,000 - Genotype to endophenotype- attended the EAPCCT Congress in Pack-size legislation reduces severity of Anew standard for association. Prague in April 2006, including the one- paracetamol overdoses in Ireland. HRB Health Services Research day Continuing Education in Toxicology Fellowships 2006 Donohoe E, Walsh N, Tracey JA. symposium prior to the Congress. They presented four posters at the meeting. Awarded to Lisa Ronan to undertake a Ir J Med Sci. 2006;175(3):40-2. study entitled: Improving Epilepsy Care Renal and liver transplantation for toxin- Staff with Novel Advanced Imaging induced organ failure. Edward Baston BSc took up post as Techniques; An in vivo study of cerebral Tracey JA, Casey PB, Cunningham P, Poisons Information Officer in November cortical morphology value €90,000 Counihan A, Fleming J, Hickey D, 2006 (Maternity Leave Locum). POISONS INFORMATION CENTRE Hegarty J. Clinical Toxicology 2007; 45: Noted changes in activity Dr. Joe Tracey, Director, and Ms. Patricia 31-35. The Centre received a total of 11,905 Casey, Manager, National Poisons Abstracts enquiries in 2006, a 5.9% decrease Information Service Morbidity from paediatric iron poisoning. compared to 2004. This is a similar The Poisons Information Centre provides Donohoe E, Tracey JA. decrease to 2005 and may reflect the a 24/7 national telephone information fact that most emergency Departments Clinical Toxicology 2006; 44 (4): 493. service on the toxicity, features and are now registered to use TOXBASE. management of poisoning. Enquiries are Inadvertent overdose with N- TOXBASE use increased by 9.7% from answered by our own Poisons acetylcysteine: An unusual case. Cassidy 8,224 user sessions in 2005 to 9,018 Information Officers between 8am and N, Tracey JA. Clinical Toxicology 2006; 44 in 2006. 10pm (seven days) and night-time calls (4): 502. While total call numbers decreased by are automatically diverted to the National Changing pattern of poisoning in Ireland 5.9% in 2006 we noted a greater Poisons Information Service in the UK. over 40 years. Tracey JA. Clinical reduction in calls at night (14.3% Toxicology 2006; 44 (4): 531-532. decrease in calls between 10pm and Developments/innovations 8am vs 2.8% decrease in calls between The Poisons Information Centre Repeat enquiries to the National Poisons 8am and 10pm). We are checking celebrated 40 years of service in 2006. Information Centre of Ireland. Cassidy N, whether this indicates problems with the To mark the occasion a one-day Current Tracey JA. Clinical Toxicology 2006; 44 coding of Irish calls in the UK rather than Toxicology conference was held on (4): 546-547. a true decrease in night-time calls. November 3, 2006. The Minister for Health and Children, Ms Mary Harney TD, opened the conference which was attended by 61 staff from Emergency Departments and Intensive Care Units in Ireland. We continue to divert our calls to the UK National Poisons Information Service (NPIS) between 10pm and 8am. Calls are answered by the centres in Birmingham, Cardiff and Newcastle on a rota. Elaine Donohoe, Poisons Information Officer, joined the TOXBASE editing group in 2006. Work commenced on checking that all pharmaceuticals listed in the Irish MIMS and the OTC Directory are on TOXBASE.
Ms Mary Harney T.D., Minister for Health and Children, at the Toxicology Conference, November 3rd, 2006.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 85 + positive developments
Alcohol gel usage Beaumont Hospital: 9.6 litres per bed per annum = 87% compliance NHS standard: 8 litres per bed per annum = 73% compliance
86 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Non-Clinical Services Division
INTRODUCTION Performance Management: 2006 was an extremely busy year for all A performance management system of the Non-Clinical Services was introduced on a trial basis in early Department. Our bed occupancy level 2006. All staff and management of continued to hover at 100% utilisation Patient Services Department (circa 360 and much attention was placed on people) are now fully engaged in an balancing Emergency Department open, transparent and pro-active admissions with elective admissions. performance management system.
A number of major projects were Standard Operational completed in 2006. These included the Peter Connolly, Procedures (SOPs) new Out-patients Department [OPD] Acting General Manager A Patient Services Working Group, which extends the hours of OPD consisting of both management and coverage from 8.00 a.m. to 6.00 p.m. staff, was established in March 2006 to Benefits include shorter waiting times conduct a comprehensive review of all for patients and earlier intervention in standard operating procedures (SOPs) the patient treatment cycle. Other key within the department, which influence projects included the construction of a and determine the day-to-day working The new Out-patients new waste management compound, activities of all departments within completion of the 24 hour CCTV/Access Department [OPD] Patient Services. This initiative has Project, completion of the new extends the hours of proven to be successful with a positive permanent staff change and also the coverage from 8.00 impact on the business activities of the Telephony system upgrade. a.m. to 6.00 p.m. department. A Hygiene Services Co-ordinator was Benefits include Over 50 SOPs have been reviewed/ appointed with a clearly defined role for shorter waiting times updated/approved. Arrangements are in co-ordinating all hygiene activity. Hygiene place to train staff and to publish these for patients and progress was demonstrated in increased SOPs on the Hospital’s document earlier intervention education programmes, the management system by the end of in the patient establishment of a Hygiene Discharge June 2007. The SOP Working Group Team, a physical upgrade works treatment cycle. continues to meet. programme, and daily and weekly hygiene audits. The result of these Admissions Process initiatives was reflected in an In August 2005 the Admissions Process improvement from 61% to 83% Group was established. This Group was between the first and second National facilitated by Partnership and consisted Hygiene Audits. of representation from staff who were involved in the process of admitting PATIENT SERVICES DEPARTMENT a patient. OPD - 3 Clinics Per day: The purpose of this project is to Objectives: implement 3 clinic sessions per suite per + To improve efficiency in the overall day. An OPD Update Group was formed administrative management of the and a ten-week trial involving four clinics Emergency Department and admission (Cardiology, Immunology, Neurology and of patients to hospital wards. Renal) commenced in July 2006. + To maximise internal capacity Progress reports were given to Union including decreasing length-of-stay and and staff representatives at the six-week improved discharge planning stage and at end of trial. By the end of 2006 three clinics per day were + To optimise existing resources i.e. successfully introduced in the four personnel and space, by re-assigning nominated clinics. Plans are now in place workloads in an effective and fair to repeat this initiative within the manner, to ensure all activity is remaining out-patient clinics by the end consistently and accurately recorded to of 2007. reflect work performance.
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+ To ensure equal access of care for our structure and control of the Medical Permanent Staff Change Facility / patients by identifying and utilising all Record and management of the medical New Accommodation/Relatives capacity available. records service. These standards will Area for Richmond ITU. apply to all hospitals. Currently we are The group continues to meet. The work on the new permanent staff implementing Phase 1 of the NHO change facility was completed in Healthcare Records Management National Treatment Purchase December 2006. This new facility has Programme. These draft standards Fund (NTPF) the capacity for over 1,100 lockers for were circulated to all hospitals and key Beaumont Hospital continues to refer staff, along with lounge/rest rooms, stakeholders in 2006. Feedback and patients for treatment under the new toilets/shower facilities, and comments were returned to the NHO National Treatment Purchase Fund breast-feeding room. The Health and incorporated into the document of (NTPF). There are a number of specific Promotion Department has a standards which is to be signed off by timeframes in relation to patient designated room for massage facilities the NHO. These standards are to be eligibility for referral and treatment in this new building. In addition the issued in April 2007. A self-assessment which are dependent on the speciality. work on the new accommodation / programme will be initiated during May relatives areas for RITU was completed In 2006 Beaumont Hospital referred 2007 to ensure compliance with the in December 2006. 597 patients (In-patient and Day cases) relevant standards. An external audit for treatment under the NTPF. The will be carried out at a later date with New Taxi Rank / Set-down Area target for referrals in 2007 is 1,200. results being issued in October. Discussions/proposals on the Beaumont Hospital participated in an development of a new designated taxi Out-Patient initiative funded by NTPF. Microfilming Medical Records rank at the side of Car Park 1 beside the During 2006 a working group was 86 patients were referred for multi-storey car park commenced, to established to investigate and research Orthopaedic consultations and include drawings, costings etc, the advantages of microfilming patient approximately 160 patients were in consultation with the key medical records. A microfilming referred to the Northwood Clinic for stakeholders who use the set-down programme is scheduled to commence ultrasounds. Other out-patient initiatives area/front entrance, i.e. Dublin Bus and in February 2007. At present Medical are planned for 2007. the Taxi Services. Records of deceased patients are being Clinic Secretarial Work Practice microfilmed and following the Computerised Help Desk Review completion of these, microfilming of Following a presentation of a charts which have been inactive for A revision of secretarial work practices computerised “Help Desk” system five years will commence. All was carried out in late 2006. This which was introduced in the Technical microfilmed Medical Records will be entailed comparison of the Beaumont Services Department, it is now available 24/7/365 which will greatly Hospital secretarial services with those intended to introduce this computerised enhance the retrieval rate of charts in of other hospitals, exploring differing system in the Portering and Cleaning a timely manner. technological solutions and critically services. Work commenced on the assessing other innovative ways of screen layouts for this project with a delivering the service. This study led to GENERAL SERVICES view to phasing in the system in 2007. recommendations for the introduction DEPARTMENT The General Services Department had a of digital dictation to streamline the Insurance/Claims Division number of staff changes in 2006; Derek workflow of typing duties. This will also In June 2006 this division within the Darbey, General Services Manager assist with the re-introduction of General Services Department moved to moved to the position of A/Patient teleworking (specifically for typing the Integrated Safety and Quality Services Manager and Fiona Edwards duties only) in the future. A pilot study Department. returned to General Services. is currently underway for a typist-only We welcomed Dorothy Costello to the post to ascertain the levels and flow of Hygiene / Cleaning post of Liaison Manager and Helen Cox work which can be achieved in a Following the disappointing results of transferred to the role of Household teleworking capacity. 2005 Hygiene Audit; a hospital-wide Services Manager. The staff showed approach to increasing standards was National Hospitals Office huge commitment to transforming our undertaken. A multidisciplinary steering Healthcare Records Management hygiene scores and involving group and task group were formed and Programme themselves in various projects an action plan developed. The throughout the organisation. The National Hospitals Office (NHO) commitment of all staff resulted in an have developed standards and 82% score in the 2006 National recommended practices for the Hygiene Audit.
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Cleaning Security 157 access control systems on doors Corporate Cleaning Services held the At the commencement of 2006 the throughout the campus. tender for the cleaning services to the staffing level in security included; 1 Hospital in 2006. A new tender Manager, 1 Deputy Manager, 4 Team Switchboard 2006 saw a few changes for the specification was written up taking into Leaders, 22 Security Guards (2 telephony switchroom, with staffing account the frequencies and standards vacancies) and 2 car park attendants. and upgrading of the switchboards. outlined in the National Cleaning As well as on-going training in the Manual issued by the HSE. The contract Two telephonists retired: Nora Dunphy courses such as fire training, etc, in is due to be awarded in 2007. who had transferred from the Richmond 2006 the Security Department launched Hospital and was with us from the An increased emphasis was placed on a new training programme for their staff opening of Beaumont in November 1987, cleaning throughout the organisation in conjunction with the Health and and Stella Higgins who joined us in 1988 with every grade of staff involved. Safety Department. This programme as a locum and then became a full-time New furniture and bins were purchased was specifically designed for Beaumont member of staff. Both are greatly missed in order to replace non-compliant and Hospital. The training is provided by a for their knowledge and experience. We broken furniture and bins. Chairs in all professional expert trainer, who welcomed Marie Fitzpatrick who joined clinical areas were recovered in specialises in de-escalation techniques, us as a full-time member of staff in impermeable material and this process defensive tactics and control and March 2007 having worked with us as a is still ongoing throughout the restraint. This is an on-going training locum in 2006. entire Hospital. programme with frequent refresher courses. Some nursing staff have also The Switchroom has a new look, new The Environment continued to be audited availed of this specialised training. switchboard and desks, all of which weekly as part of the Hygiene Audit and make for much better working daily by General Services Staff. In addition to normal rostered duties conditions for the operators. Security Staff attended to or gave In March 2006 the Discharge Team was assistance to 632 documented The new switchboards have directories introduced on a trial basis. incidents from January to December. which are updated daily. Directories are The Discharge Team clean the entire also available on the new digital phones bed space following patient discharge A new emergency response system around the Hospital. The Internal during peak hours 7 days a week. (mobile units) has been installed in the Directory has also been made available This is proving very successful and is Emergency Department. This system is on the Hospital intranet. assisting in the turnover of patients linked to the Security Control room and from the Emergency Department. five of these mobile hand units are also Aside from the switchroom, the used by the security staff in the telephone system was replaced with Contract Cleaning supervision increased Emergency Department. Hi-path 4000, and the Hospital re- from one supervisor per two floors to cabled. We now have a state-of-the-art one per floor and also a Deputy Site The Hospital Watch meetings involving system in Beaumont, which has given Manager was introduced. our liaison Garda from Santry Garda us the comfort of knowing that if we Station, with multi-disciplinary experience a fault in the system it Window Cleaning personnel from various departments of should not affect all areas. This is due Emerald Cleaning Services have held the Hospital, continued throughout the to the way the Hospital was cabled with the contract for 2006. A new tender year. Increased emphasis was placed the cables going to primary and specification was written up taking into on our work with local Gardai and secondary locations on all floors. account the frequencies and standards regular meetings taking place to review outlined in the National Cleaning incidents and advise on best practice. To add to the safety and resilience of Manual issued by the HSE. The contract our phone system, a DECT PHONE, Additions and improvements in our is due to be awarded in 2007. (digital enhanced cordless telephone) CCTV and access control systems system was also installed; this is a continued. The Hospital now has 63 Laundry complete stand-alone system. There internal cameras, 22 external cameras, Celtic Linen continued to hold the are now over 100 DECT phones in RCSI 11 and Private Clinic 2. All the car contract for 2006. Discussions were operation, and are available on all parks have intercom systems with held with Celtic Linen in relation to the wards and in all clinical areas for direct connection to the security introduction of a Curtain Exchange emergency use. control, which also has the capability to Programme to commence monitor all entrances and exits of car in 2007. parks and to raise barriers to allow access to vehicles. There are a total of
BEAUMONTHOSPITAL ANNUAL REPORT 2006 89 Non-Clinical Services Division
Our intercom system was also + New franking machine purchased for A discharge team service was replaced. This is also another form of post-room. The staff in this area introduced as a short-term solution to communication for the Hospital which continue to make savings for the address unallocated tasks and deep can also be used to communicate in Hospital by grouping GP letters together. cleaning issues identified in the original emergency to key areas, i.e. hygiene audit. Throughout 2006 the Emergency Department / X-ray/ MRI / Waste Management service has been identified as being CT / Theatre / Physio / Endoscopy / As a result of the 2005 Hygiene Audit, successful through both feedback from Histo Lab. the position of Waste Manager was users and internal audit results. introduced. Martin Stephens, Deputy Following the success of the discharge DAKS System was also installed. Portering Services Manager, was team the trial of hygiene operatives is This is an Alarm System and is working seconded to this role. Many changes to be undertaken with a start date very well in the Emergency Department were made in 2006 including: planned for June 2007 as a potential and Out-patients, making for safer long term replacement of the discharge working conditions for staff in these + Bin Replacement Programme team service. departments. + The new waste management During 2006 benchmarking exercises We also have a Microwave link to St. compound is under construction have been carried both nationally and Joseph’s Hospital in Raheny and can + Recycling mixed dry recyclables, internationally involving multidisciplinary now dial from extension to extension. cardboard and plastics commenced visits to other Irish hospitals and to We look forward to 2007 and hopefully Groningen University Hospital in the + Training programmes took place in- will be working towards many more Netherlands which is recognised as house for selected wards on a pilot improvements for our department being an organisation with particularly basis and will expand to all ensuring that we retain state-of-the-art low levels of infection rates. In October wards/departments in 2007. systems in Beaumont. 2006 a decision workshop was held + Training programmes were including representatives of all Portering undertaken by Waste Manager stakeholders in terms of the delivery of This service continued to support + Healthcare Risk Waste and hygiene services. The result of the clinical and non-clinical services Healthcare Non-Risk Waste are now workshop was a decision to adopt a throughout the organisation with the collected and transported separately to delivery model based on that observed following new developments: waste compound. at Groningen University Hospital in the Netherlands. + New porters’ office area BSFM Consultancy assisted the 2006 saw commencement of an upgrade + The porters assigned to the Waste organisation in identifying changes to programme for non-compliant Disposal Department are now working be made in Waste Management. equipment. Bedside lockers and over-bed an extended day i.e. starting earlier and With the assistance of BSFM a service tables which were identified as being in a finishing later, especially at weekends level agreement for tendering purposes poor state of repair have been replaced. + A porter has now been assigned to has commenced and the Hospital will All non-compliant waste bins in the the Day Oncology Unit; this has go to tender for Waste Management Hospital have been replaced and speeded up bloods being sent to the Services in 2007. improved waste bin signage has been lab, and the chemotherapy being In relation to proper segregation and introduced to meet current requirements. brought from the Pharmacy. This has recycling, procurement for a new plant Weekly multidisciplinary internal audits been achieved from within the present will commence in 2007 and should be have been carried out since January 2006 staffing complement. Nursing staff are on stream for June/July 2007. in both clinical and non-clinical areas. The very pleased with this outcome. results of the audits are fed back to the + Four porters have been released to HYGIENE SERVICES relevant manager within 24 hours and are the Skill FETAC courses on an ongoing In 2006 a Hygiene Services Coordinator published on a quarterly basis in the form basis. This is to assist with the was appointed on a temporary basis to of a league table. The audit results have upskilling of the portering staff. oversee effective coordination of demonstrated consistent improvement in hygiene activities on a site-wide basis. the results over the period. + Portering staff agreed to service the The Coordinator is responsible for the Transit Lounge in the Emergency A new contract for the supply of hand update and progression of the hygiene Department. This has been achieved at hygiene products was awarded to action plan. The progress of the action no extra cost at present. Pureel, incorporating a significant plan continues to be monitored on a increase in the number and visibility of monthly basis by the Hygiene Audit hand gel dispensers in the Hospital. Implementation Group.
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In November 2006 a ward manager The Croi Na Bi settled into its first full survey was carried out in relation to the year of service. The introduction of delivery of hygiene services, the results exciting food choices from the deli bar from which have been incorporated into and themed events also proved to be the hygiene services action plan. effective and favourably received.
A quarterly hygiene newsletter has been SUPPLIES DEPARTMENT launched with the first two editions The Supplies Department continued to being published in December 2006 be involved in numerous projects during 2006. These included procurement of CATERING DEPARTMENT supplies for the Admissions Lounge, During 2006, the focus of the Catering OPD Refurbishment Programme, Chest Department was on the development of Pain and Breast Services. hygiene management, and a Catering Officer post was assigned to this role in Preparation work began in relation to order to address the new aspirations of the upgrading of Supplies Department excellence now required through the software programme. In the future, this ISHAB standards. Ward Pantry “Policy will facilitate a more efficient transfer of and Procedure” documentation was information between Supplies and the produced and implemented. Training, Finance Department. group and singular de-briefings were The Supplies Department continued to also facilitated in order to achieve participate and be active in a number of higher standards. This was enhanced multi disciplinary groups i.e. Non-Pay with regular spontaneous ward pantry Committee, Hygiene Audit, audits. New improved cleaning Accreditation Group, Environmental schedules and records were applied Task Group, Decontamination, throughout the department with a Cardiology and Vigilance Committees. renewed thought-provoking energy adapted in conjunction with HACCP and The Supplies Department facilitated an ISO standards. increase in the number of tenders at both local and EU-level and assisted the The Catering Department has been Hospital Procurement Services Group striving towards achieving the “Happy (HPSG) in relation to hospital group Heart at Work” award from the Irish tendering, resulting in a broader and Heart Foundation. The provisos for this cheaper category base spend award include combining the being captured. knowledge of the Catering, Dietetics and Health Promotion Departments, and the availability of healthy options throughout the “bill of fare” for patients and staff alike. This is also based on the nutritional recommendations which are issued and updated by the Department of Health and Children.
Catering staff have also participated in the SKILLs FETAC Training programmes. Staff continue to attend and complete a number of these courses and are bringing their new- found skills to the fore in their day-to-day duties.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 91 + positive developments
As part of the hospital’s ongoing organisational development and change programme it is clearly recognised that staff are the key resource in implementing and sustaining change.
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HUMANRESOURCES training for interview board members in DEPARTMENT relation to their obligations under HR Director: Patricia Owens equality legislation and the review and refinement of recruitment policies Introduction and procedures. The HR function provides a key service in supporting the managers and staff HR Administration throughout the organisation to provide The HR Administration Section our services to the public and has an continued to play an integral role in the integral role in strategic planning and Human Resources function during 2006. More staff changes took place Patricia Owens, development at executive level. during the year which involved on-going Human Resources Manager As part of the Hospital’s on-going training. organisational development and change programme it is clearly recognised that Absences throughout the Hospital staff are the key resource in continue to be monitored and the zero implementing and sustaining change. absence draw took place in November. The HR Department is a vital link to Changes in legislation e.g. Maternity combining HR policy and people Recruitment and Leave and Parental Leave involved management initiatives which create updating policies and notifying retention of staff in frameworks for supporting staff and Department Heads/ Section Heads of the public health managers to work together to develop the relevant changes to employee service is a high excellence in patient care whilst entitlements. priority for pursuing the service and developmental An exercise commenced reviewing and objectives of the Hospital’s strategy. Beaumont Hospital. updating all HR Admin Policies in the The HR Department, therefore, through last quarter of 2006. the work already underway, and by the development of a HR strategy to The HR Admin Team continues to work support the objectives of the Hospital closely with Employment Control/HR strategy in 2007, is positioned to Information Technology Section in provide a key influencing and strategic supporting a more robust people in post role in the Hospital change programme. module while continuing to develop HR systems that ensure greater levels of Recruitment accuracy all times. Recruitment and retention of staff in the public health service is a high Employee Relations Section priority for Beaumont Hospital. In order Much of Employee Relations workload to provide high level speciality services throughout the year constituted to an existing and ever growing range providing support and advice to of national and supra regional managers and employees on a range of specialities it is vital that we attract and individual grievances and disciplinary retain the highest calibre of staff. matters. There was also significant Obviously we are competing in a input from industrial relations staff in market often categorised by skill the management of complaints which shortages and under supply relative to resulted in mediation/investigation. overall demands. Despite these In addition, industrial relations staff was pressures the recruitment division is involved with relevant managers in succeeding in minimising vacancies addressing claims lodged by trade particularly in the specialist allied health unions on behalf of individual staff and professions. Overseas nurse groups/grades. Employee Relations recruitment continued with two new staff and Line Managers can be groups of approximately 39 nurses in justifiably proud of the fact that in most 2006. Development work in the instances such claims were resolved Recruitment area included participation locally. A small number of claims were in the overall HR Team in the referred for third party consideration accreditation process, providing and in such cases the employee
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relations staff presented such cases develop more effective modules to 2006 was particularly busy as a result of before the Rights Commissioner's support a more accurate complement the implementation of Department of services, the Labour Relations control management system in line Health and Children Circular 23/2005 Commission, the Labour Court, as well with the national strategy. The regarding the superannuation of part- as the Equality Tribunal. production of various management time staff in the health service. In Employee Relations staff are leading on reports for managers in order to addition, the introduction of a revised the completion of work on the produc- enhance their strategic and operational Purchase of Notional Service Scheme tion of the new staff handbook. decision making capabilities continues along with the Pension Incentive Tax to play a major part within this section. Credit Scheme for SSIA holders brought This is expected to be available in the about significant benefits to staff. autumn of 2007. This work has been The total staff employed in Beaumont done on a joint union management Hospital as at 31 December, 2006 was The Superannuation staff act as basis and is a good example of the 3,343 (2,906.63) wte. Secretary and Treasurer of the positive working relationships which Beaumont Hospital Active Retirement Information Technology Association. It is a particularly the section and the department have This area continued to concentrate on fostered with line managers and trade pleasurable part of the work of this further developing the Personnel Infor- section to be able to work with our union representatives from across mation systems currently in operation the Hospital. previous employees and to assist them in the Department i.e. (STORM – HR in maintaining contact with each other Work is nearing completion on the System). The Time and Attendance and with the organisation. In 2006 integration of procedures for system is currently being upgraded in members went on several day trips, investigations within the Hospital. order to undertake further both in Dublin and around the country, This work has been done in enhancement of the training module of as well as a short vacation in Westport collaboration with the Quality & Safety the Personnel Information System. and a week long holiday to Rome and Department. The outcome will be a Development work is also being carried Florence, Italy. The year ended with the clear set of procedures for the in order to allow mangers to record sick AGM and the annual Christmas party. management of all incidents which may leave information within their own loca- occur within the Hospital and should tions thereby eliminating the In addition to the above this section prove to be a useful resource to requirement for manual absence looks after the administration of managers, staff and trade union returns to HR. Recoverable Salary posts e.g. representatives. authorisations, contracts, setting up Staff in the department have been salaries etc. All Employee Relations staff continue to working in collaboration with the participate in relevant training Finance Department on a feasibility ORGANISATIONAL CHANGE programmes and to keep abreast of the study on the possible implementation ANDDEVELOPMENT constant changes in employment of an integrated HR/Payroll System. In the latter part of 2006 the Senior legislation while the Employee It is expected that a proposal will be put Executive endorsed the creation of a Relations Manager has also forward to Hospital management by new role i.e. Head of Organisational represented the Hospital on a number the autumn. Change & Development. This role of management negotiation committees formed part of a restructured Executive and working parties at national level. Superannuation Management structure which included 2006 was a very busy year for the the formation of an office of the Chief Employment Control Superannuation Section as it continued Executive aimed at integrating, The National Employment Monitoring to provide a comprehensive service to operational and clinical management Unit (NEMU) was established in 2006 to hospital staff as well as to retired with strategic planning, transition and manage the employment control hospital staff. In particular, this year has whole systems change. Anne McNeely, framework in the HSE. Employment seen the implementation of many formerly HR Director, was appointed to ceilings will be issued annually and it is changes in legislation relating to the post of Head of Organisational imperative that all hospitals/agencies pension entitlements. Change & Development. stay within the allocated ceiling. It is It is the responsibility of this section to now a requirement that all categories of Beaumont Hospital is committed to apply the terms of the Local staff are reflected in the census returns improving the quality and range of Government Superannuation scheme to e.g. secondments, student nurses, staff services, to patients through aligning pensionable staff and implement any on recoverable salaries etc. and connecting structures systems, superannuation changes as directed by processes and resources to an overall The Employment Control Section of the the Department of Environment and common purpose and objective. Human Resources Department in Local Government and/or the Moving decision-making closer to the Beaumont Hospital continues to Department of Health and Children.
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point of service delivery is a key INTEGRATED QUALITY & the following functions: Accreditation principle guiding the organisational SAFETY DEPARTMENT and Quality, Risk/Insurance, Freedom development and change strategy. Head of Quality & Safety, Ms Pauline of Information, Patient Representative, In order to achieve this there is a need Fordyce. Occupational Health, Health Promotion, to create and maintain effective Ethics, Staff Counselling and Health The Integrated Quality & Safety (IQS) working partnerships between clinicians and Safety. Department was established in 2006. and managers and to involve The IQS Department objectives are as multidisciplinary healthcare Risk Management Department follows: professionals in the planning and Project Manager: Deirdre Carey. management of services. To assist in facilitating a culture of A team of Consultants who Continuous Quality improvement in the The existing formal reporting recommended the development of Hospital in partnership with patients, relationships and management Integrated Quality and Safety staff and other stakeholders, ensuring structures are, in the main, hierarchical Department prepared a Risk best practice and an ongoing standard and segregated on the basis of Management Strategy. As a result of of excellence. individual professions. However, the this strategy a Project Manager – (Risk/ To improve the openness of our delivery of care and services to patients Insurance/Claims) was appointed. culture ensuring that errors and service on a day-to-day basis more typically The following are the objectives for the failures can be reported and discussed involves multidisciplinary teams of Risk Management Department: within a unified framework. healthcare staff and clinicians. The Improve the openness of our culture. hospital is seeking to implement The establishment of robust Establish a more unified mechanism management structures that encourage mechanisms to ensure the translation for reporting and analyzing incidents. and support clinical professions, i.e. of lessons learnt into positive action. Develop robust mechanisms for doctors, nurses, allied health To enable the organisation to ensuring that, where lessons are professions and scientific staff, to work appreciate the value of Quality and identified, the necessary changes are with managers and administrators in Safety systems in preventing, analysing put in place and all corrective actions the strategic planning and operational and learning from error. are closed out so to prevent recurrence. management at all levels, i.e. the The IQS Department is comprised of comprehensive organisation-wide level and the individual specialities service within the hospital. This Organisational Development Programme is aimed at delivering lasting change that significantly enhances overall performance of the hospital and improves the range and quality of services for patients. As 2006 draws to a close, efforts to scope the characteristics and approaches for implementing whole systems change were well underway, and a high-level aim of achieving excellence and transformation in Beaumont was firmly implemented throughout the various departments and echelons of the hospital.
Harry Mulhearn of Beaumont’s Portering Staff won the NISO National Safety Represenative Award 2006. He is congratulated here by (from left) Seamus Aylward, Chief Operations Officer, Nifast, Stephanie O’Gara, H&S Co-Ordinator, Beaumont, Paul Donnelly, Portering Department Manager and Evelyn O’Donohoe, Senior H&S specialist.
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Develop a much wider appreciation Staff Counselling Health Promotion of the value of the systems approach in Barbara Lynch and Pauline King Head of Department: Michele preventing, analyzing and learning The Staff Counselling Service provides McGettigan. from errors. a free and confidential counselling The Health Promotion Department in Accreditation and Quality. service to all employees. Work and Beaumont Hospital provides a health Acting Accreditation Manager: Susan personal related issues are processed promotion service for staff, patients and Moloney. in a safe and therapeutic manner. links with the local community. The The objectives of the Accreditation and Pauline King received IAHIP department continues to work in Quality Department are to: accreditation this year and Barbara partnership to re-orientate the Hospital Lynch became an accredited supervisor services to achieve a greater balance Assist in facilitating a culture of with both IACP and IAHIP. This service between health promotion and curative continuous quality improvement by incorporates the role of Employee services. providing strategic vision, leadership Assistance Officer whose role is to and direction for quality in partnership Our focus is to empower people to take provide financial advice and support. with staff and patients of Beaumont responsibility for their own health and Hospital. The Counsellors facilitate the Beaumont work together to put supportive Wellness Initiatives alongside the structures in place to make it easier to To lead and facilitate the accreditation process. Health Promotion department. The choose a healthier lifestyle. main focus of the Staff Counselling The Health Promotion Department The Hospital voluntarily participates in service is the provision of one to one provides a Smoking Cessation Service Irish Health Services Accreditation counselling, stress management strate- for staff and in-patients. In 2006 the Scheme, which offers a framework for gies, care post critical incidents with Hospital was awarded the Silver Level maximising quality and safety. During educational inputs on communication of European National Network for 2006, Beaumont participated in a peer and participation in Dignity and Respect Smoke Free Hospitals. review survey, which is part of the at work incorporated into the brief. three-year cycle of accreditation.
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Beaumont Hospital is a registered 6,000 member of the All Ireland Health promoting Hospital Network. Work load by staff group 5,000 Freedom of Information Freedom of Information Officer: Carmel McDonald 4,000 This department deals with all requests dockets related to Freedom of 3,000 Information/routine access.
During 2006 the department dealt with No. ofrk wo 2,000 1,220 requests made through routine access and 132 requests through Freedom of Information. 1,000
Beaumont Hospital Ethics 0 (Medical Research) Committee Plumbers Fitters Oper/Con Electrical Paint/carp. Administrator: Gillian Vale. Staff On March 9, 2006, the committee cele- brated its first year of recognition, under Regulation 7 of the European Shown below are the work load tables for the year and the chart of work groups Communities (Clinical Trials on Medici- nal Products for Human Use) Regula- tions 2004. Year 2006 2006 2006 2006 2006 2006 93 full applications were reviewed by Discipline/TSD Plumbers Fitters Oper / Con Electrical Paint/carp. TSD TOTAL the Committee in 2006, as follows: January 322 133 56 478 352 1,341 CLINICAL TRIALS: February 325 141 31 350 470 1,317 Medicines 21 March 345 188 54 474 613 1,674 Medical Devices 3 April 217 137 36 293 368 1,051
OTHER RESEARCH 69 May 407 163 45 413 467 1,495 June 195 153 50 311 367 1,076 One of the Committee’s goals in 2006 was to provide additional training for its July 224 159 49 406 493 1,331 members. The highlight of the year was August 248 123 46 400 424 1,241 an on-site training day facilitated by the September 220 135 33 403 500 1,291 Centre for Professional Ethics at Keele October 334 195 75 435 446 1,485 University. Forty current and November 350 176 63 458 457 1,504 prospective members of the Beaumont Hospital Ethics (Medical Research) December 234 106 39 352 252 983 Committee, the Beaumont Hospital Total 3,421 1,809 577 4,773 5,209 15,789 Clinical Ethics Forum and the Royal College of Surgeons in Ireland Research Average / day 16 7219 21 63 Ethics Committee availed of this Average / mt. 285 151 48 398 434 1316 training opportunity. % of total. 21.67% 11.46% 3.65% 30.23% 32.99% 100.00% In addition, the committee was pleased to avail of ongoing training from the Data Protection Commissioner and a number of other guest presenters in 2006.
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Health and Safety Department immunisations (work related and annual Attendance at conferences: influenza), moving and handling training, Health and Safety Co-ordinator: August 3, 2006: Colorado health surveillance, infectious disease Stephanie O’Gara. The Rocky Mountain Vascular Club follow up, staff education on related The Health and Safety Department is a Topic: A changing environment for issues, and management of all work proactive and preventative department medical governance. related health issues and incidents which aims to improve the safety of the including occupational blood exposures. February 14, 2007: Antalya Turkey patients, staff and visitors of Beaumont Our most recent projects include Turkish Quality Association. Topic: Hospital. Our department advises and running a ‘Sharps Awareness’ week on Developing a clinical governance assists the Hospital to achieve a safe an annual basis. format. place of work with safe systems, plant April 20, 2007: Cork and equipment and competent co- CLINICAL GOVERNANCE Surgical Travellers, Cork workers. A Clinical Governance Committee was Topic: Adapting clinical practice for established in December 2006. It meets The Function and Role of the better governance. Department: on a monthly basis. Chairs and secretaries of the clinical cogwheels are Statutory and Common Law PROJECTS AND ESTATE Compliance invited to attend, in addition to the MANAGEMENT Chief Executive, Head of Finance, Head of Department: Paul Nadin Health and Safety Policies and Medical Director, HR Director, Director Procedures The development of the group, of Nursing and Head of Quality and incorporating the Technical Services Accreditation Safety. Department (TSD) has shown many Workplace Risk Assessments A half-time secretary has been ap- benefits through the year. The Internal Emergency Planning pointed to the Governance Office and integrated service approach has seen Incident Investigation plans are underway to appoint a Gover- benefits in the implementation of Health and Safety Training nance Manager. There is a recognition projects and their natural progression Occupational Hygiene that further development of peer-re- through to handover and operation. viewed medical audit in the hospital will Capital Development The year has seen a number of key require further appointments. In addi- H&S Promotion and Consultation projects developed with the completion tion to peer-reviewed medical audit of the main Out-patients Department Dangerous Goods Safety Advisor meetings, the Governance Office has and the building of a new Diabetic Day monitored the development of multidis- Centre. The main infrastructure of the Patient Representative ciplinary and clinical practice meetings. Department site has been enhanced with the Head of Department: Angela Connolly. In 2006, Clinical Care Pathways have completion of a new high voltage been developed by multidisciplinary electrical ring main doubling the During 2006 the Patient Representative groups including pathways on spinal, Hospital’s capacity for electricity. Department continued to provide a carotid and abdominal aortic aneurysm Further improvements have been valuable service within the Hospital surgery. Risk management has been achieved with the demolition of the old offering support and assistance to identified as an area which needs to be boiler house chimneys and their patients, relatives and staff in the closely connected to clinical replacement with new stainless steel management and resolution of governance. chimneys designed to meet the boiler complaints. The department welcomes needs for the next 20 years. comments about the care and services Finally, the hospital continues to support The boilers themselves also had to be provided by Beaumont Hospital to National Accreditation and is anxious to replaced as they had exceeded their life ensure the ongoing provision of quality respond to the establishment of the expectancy and have been replaced care to our patients. The expanding Health and Information Quality Agency. with new high efficiency boilers, again interpreting service within the Hospital The widespread recognition that audit designed to meet the Hospital’s needs is also co-ordinated by the department. and governance issues need to be carefully recorded, has led to a for the next 20 years and capable of Occupational Health Department formalisation of many of the excellent being expanded as service needs on Head of department: Dr Blanaid Hayes. structures which previously existed in the site grow with the increase in building stock. The Occupational Health Department is Beaumont Hospital. concerned with the two way relationship between work and health. The department is responsible for pre- employment health assessments, staff
98 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Functional/Support Departments
The Hospital has become of an age The maintenance team continues to where plant and equipment is ready for provide high levels of service, with the replacement, and the capital volume of daily works requests programme identified a programme of increasing from 12,424 in 2002 when upgrades for roofs around the Hospital. we started tracking work loads to The first priority for this work was 15,789 during 2006. This shows that carried out with the total roof the workload has increased over time replacement of the high level ward by 27% with the same staff levels, block, ensuring the in-patient areas are demonstrating increased efficiencies in weather tight. the management of the service. The The Hospital was asked to look at computerised help desk effectively options for helping the Emergency manages this with accurate tracking of Department winter initiative, and the work loads and history files of what projects team built a new 10-bed work has been done in each location. admissions lounge as an extension to The need to expand the service to other the existing Emergency Department. sectors is planned with the roll-out of This project was turned around in a very the service to cover some of the short time scale and in a very cost general services sectors, with the aim efficient manner, therefore changing of giving staff a single contact number, the existing situation of trolley-based whatever their need is. The planned patients to that of patients in beds maintenance works for the engineering waiting for transfer to the wards. service are being reviewed as a result of the plant room replacement A new waste transfer station was built, programme which has taken place over to meet the Hospital’s obligations in the last two years. effective management of waste streams. Planning permission was gained for developments that are being developed, for services including a new haemodialysis unit with 44 patient areas, an interim cancer unit with 2 linear accelerators and a hepatology unit. The department’s commitment to electronic archiving has proven its worth with now approx 1 million documents and 10,000 drawings being held on a web-based system. The integrated service has led to external agencies accessing the site drawing register when planning new developments for the site. Energy management is always a prime issue for the estates team and the Hospital overall. This has been supported through the use of specialist expertise and the Hospital has tendered and contracted its energy usage to ensure most cost efficient procurement. We still continue to be one of the few hospitals or major businesses that are committed to carbon trading, as demonstration of our commitment to the environment and emissions control.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 99 + positive developments
The integration of St. Joseph’s Hospital in Raheny with Beaumont was completed in 2006 and provides a range of valuable additional service, including rehabilitation for the elderly.
100 BEAUMONTHOSPITAL ANNUAL REPORT 2006 St. Joseph’s Hospital, Raheny, Report
The year 2006 represented a period of The hospital completed the transition consolidation and achievement for St from private to public services with the Joseph’s Hospital. The major upgrade loss of some consultants and the of the Hospital’s heating system was introduction of seven new consultants completed by September. In addition and their services. replacement of the Hospital’s emergency lighting system and an Activity electrical upgrade ensured compliance Bed Utilisation: with health and safety requirements. Bed utilisation was affected by ward The x ray machine was replaced and closures as part of the utilities upgrade Helen Shortt, included a room upgrade. A CT scanner and theatre activity was affected by the Interim Hospital Manager was also purchased. changeover of consultant staff.
In-Patient Activity (exclusive of Rehab Unit) Specialty Disch Bed Days Used ALOS GENERAL SURGICAL 332 1412 4.25 E.N.T. 129 142 1.1 The year 2006 VASCULAR SURGERY 124 468 3.77 represented a CARDIOLOGY 76 602 7.92 period of UROLOGY 68 135 1.99 consolidation and GERIATRICS 59 1211 20.53 PLASTIC SURGERY 37 58 1.57 achievement for ORTHOPAEDICS 22 76 3.45 St Joseph’s GASTROENTEROLOGY 20 224 11.2 Hospital. RESPIRATORY MEDICINE 18 240 13.33 GENERAL MEDICAL 17 277 16.29 PAIN RELIEF 14 16 1.14 ENDOCRINOLOGY 14 140 10 RHEUMATOLOGY 13 286 22 DERMATOLOGY 11 148 13.45 ONCOLOGY MEDICAL 8 19 2.38 INFECTIOUS DISEASES 5 74 14.8 GYNAECOLOGY 4 21 5.25 HAEMATOLOGY 12 2 NEPHROLOGY 1 17 17 NEUROSURGERY 01 0 TOTAL 973 5,569 5.72
Day Case Activity St. Josephs Rehab Unit - In-Patient Activity Specialty Disch Specialty Disch Bed Days Used ALOS GENERAL SURGICAL 581 Geriatrics 84 4229 49.19 GASTROENTEROLOGY 568 VASCULAR SURGERY 294 UROLOGY 252 St. Josephs Theatre Activity Total Activity 2,707 PAIN RELIEF 146 E.N.T. 96 DERMATOLOGY 96 GYNAECOLOGY 51 PLASTIC SURGERY 37 ORTHOPAEDICS 18 CARDIOLOGY 3 ONCOLOGY MEDICAL 2 GERIATRICS 2 Totals 2,146
BEAUMONTHOSPITAL ANNUAL REPORT 2006 101 St. Joseph’s Hospital, Raheny, Report
Reports fromWards & Departments prepare for the transition to the main hygiene, waste management and Nursing hospital’s pharmacy system. environmental standards setting and monitoring, and the setting up and Ms Moira Hazlett, Nurse Manager. Bed Management- Ms Catherine monitoring of a target driven sub-admis- McDonnell 2006 was a very challenging year for sions process for surgical procedures. Nursing in St. Joseph’s Hospital. Liaison between Bed Management at Work continued on projects begun in The impact of staff shortages due to sick the two hospitals increased significantly the previous year such as Accreditation leave and other leave, as well as difficul- during 2005 leading to 183 patients being including collecting, collating and ties recruiting nurses for the Hospital, transferred from Beaumont Hospital. presenting evidence of compliance and was managed through the use of At times it was a challenge to match completion of Phase II of the DRM overtime and agency staff. The appoint- transferring patients dependency needs Offsite Storage plan for patient records. ment of ward managers was delayed as with facilities available on Unit 2A. The discussions continued regarding the development of a transfer protocol led to Ms Keane developed and held local appropriate use of Unit 2A. However, improvements in the transfer process. training and development including Nursing continued to contribute signifi- There were 4,095 surgical procedures Team Based Performance Management cantly to the Hospital through the performed in St. Joseph's Hospital in to heads of department and she accreditation process, hygiene audits 2005, 281 elective medical admissions developed a programme for Interview and attendance at workshops and and 104 patients were transferred and Techniques specific to St. Joseph’s courses such as Dignity & Respect at admitted to the Rehabilitation Unit. administrative staff needs. Work, Health Promotion and Hygiene training. Professional development Rehabilitation Unit Physiotherapy continued through in-house courses Ms Liz McArdle CNM 2, Ms Thelma Murphy, arranged by Ms Marie Hennegan, CPDN, Ms Emma Bartlett, Physiotherapy Manager Senior Physiotherapist and through courses provided in The Physiotherapy Department at St. Ms Sinead Duddy, Beaumont Hospital. Five candidate Joseph’s Hospital is an integral part of Senior Occupational Therapist. nurses completed their adaptation period the physiotherapy service available to in St. Joseph’s Hospital. 84 patients were treated in the patients referred by their GP from Ms Louise Dillon and Ms Karen Gorman Rehabilitation Unit during 2006. within Beaumont Hospital’s catchment ably managed staff and the nursing The average length-of-stay in the Unit area. However, as a consequence of service to patients on Unit 2A although was 49.19 days. the changing profile of patients admitted to St Joseph’s during 2006, they had to assist staff in adjusting to Staff in the Unit undertook a number of some rationalisation of this service took high patient dependency and a longer service developments including a place in order to ensure that in-patients length-of-stay. Ms Verette Stringer Balance Re-introduction booklet and in St Joseph’s Hospital received a managed a highly efficient surgical programme, and the continuation of service appropriate to their needs. nursing service to patients on Unit 1; patient goal setting. The team were theatre services were managed by also involved in a satisfaction survey of There were a total of 2,989 patient Ms Nessa Murphy, who assisted in patients and their relatives. treatments in 2006, of which 2,063 arrangements for accommodating new were out-patient treatments and 926 and additional consultant theatre Presentations and conferences: were in-patient treatments. sessions. Ms Liz McArdle, Clinical Nurse Presentations were given to hospital staff Staff continued to engage in personal Manager for the Rehabilitation ward, and members of the multi-disciplinary and professional development activities encouraged staff and rehabilitation Rehabilitation team on the following: during the year and in improvements to service development. Ms Eleanor * Position and manual handling of the service offered to patients. McNamara provided out of hours patients with stroke, nursing support along with a number of Radiography senior nursing staff. Ms Catherine * Cognitive assessments and seating, Ms Noreen Maguire McDonnell provided Bed Management Staff attended a Stroke and Aphasia In September 2006 the general x-ray services throughout a period of conference and an IGS conference. room was refurbished and new equip- considerable change and upheaval. Liaison and Administrative Officer ment installed. This made a considerable Pharmacy activity increased with bed Ms Gillian O'Kane. difference to patient comfort. utilisation but continued to be provided St. Joseph’s Hospital commenced an through a private pharmacy service. The role of Liaison and Administrative out-patient service to rheumatology A Senior Pharmacist was appointed to Officer expanded during 2006 to include patients of Dr Paul O’Connell and Dr St. Joseph’s in November in order to specific projects such as time and atten- dance management for non-officers, Grainne Kearns in October 2006.
102 BEAUMONTHOSPITAL ANNUAL REPORT 2006 St. Joseph’s Hospital, Raheny, Report
A 6 slice CT scanner was installed and Vacancies were filled following September 2006. A new 6 slice CT commissioned in October 2006. Staff competitions across both sites thus scanner was also installed. for this service have been requested improving co-operation and experience. A programme of replacement of flat under the Winter Initiative programme. The filling of nursing vacancies was a roof covering was undertaken towards challenge during the year. Accounts and Administrative Staff the end of 2006. Ms Phyllis O'Carroll Staff returns continue to be managed A programme of refurbishment of locally with support from Salaries in Many initiatives have been introduced to bathrooms on Unit 2A has begun and Beaumont Hospital. Training in the administrative functions in St. Joseph's will continue into 2007. Payroll function has been given to Hospital. These include the introduction another staff member in St. Joseph's in While acknowledging that 2006 was a of Standard Operating Procedures and order to provide cover as required. considerable challenge in a number of the introduction of inter-department ways, I am very happy to say that all training, thus ensuring cover during Refurbishment Project staff rose to the challenge. Physical annual and other leave. This training was A new boiler house and electrical plant improvements in infrastructure reduced achieved through team work. room was completed in the early part of patient and staff exposure to these as The introduction of Team Based 2006. Additionally old boilers, radiators risks, but more work needs to be done Performance Management identified and piping were removed and replaced in in 2007 to ensure continued improve- training needs and goals for the phases throughout the year. Simultane- ments in facilities. St Joseph’s Hospital department for 2006. Courses attended ously wiring and electrical boards was re- staff have assimilated much of the during 2006 include basic computer placed, as was emergency lighting. systems and processes inherent in the training, and ECDL courses, Customer These works concluded in October 2006. working of Beaumont Hospital; Care, Staff Development, Presentation Replacement of oil tanks and oil deconta- however, they have maintained their Skills and Interview Techniques. mination of relevant areas was under- identity and ethos of good patient care. taken as part of the heating upgrade. The heads of departments and services A Sub-admissions Office was set up in at St. Joseph’s have provided good St. Joseph’s in July 2006. The aim of Additional office space, including a leadership to their staff and have helped this service was to ensure that patients meeting room, was added to the them in coming to terms with the who are considered suitable for elective Hospital as a portacabin building. changes of the past two-and-a-half surgery in St. Joseph’s Hospital receive Areas for male and female staff years. their date for surgery at least six weeks changing were also provided during the in advance. The service was introduced year. An office for the Sub-admissions It has been my pleasure to work with on a limited basis during the set- up service, on the second floor, was St. Joseph’s Hospital staff through a phase. It will be available for all surgical created from an old laboratory room. period of significant change. I look lists in 2007. forward to guiding their continuing Work was undertaken to re-cable for progress from Beaumont Hospital Human Resources and Payroll CAD 5 for computers and telephones, through the appointment of a hospital Ms Anne Kelly and the intruder alarm was upgraded. manager in 2007. Sr Francis Bean A ‘turn-key’ project for refurbishment of Helen Shortt Staff in St. Joseph’s Hospital increased the general X Ray room, and replace- Interim Hospital Manager their familiarity with Human Resources ment of the x-ray was completed in policies and procedures through involvement on interview boards, managing absences and understanding contracts. Managing cross-site processes continued to offer challenges, however, and opportunities for further integration.
Flexi-time was introduced for administration staff through a ‘Clocking- in’ project undertaken by the Liaison and Administration Officer. The project was extended to include clocking-in of other relevant staff in the Hospital.
A number of staff retired from St. Joseph’s after long and happy careers.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 103 + positive developments
Excellence in patient care begins with patient research, which in turn leads to clinical research and in time becomes clinical practice in the treatment of patients.
104 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Royal College of Surgeons in Ireland, Report
Introduction Department of Surgery programme in St. Michael’s Hospital each As the main teaching hospital of the The Department of Surgery continued its Wednesday afternoon. It was a great Royal College of Surgeons in Ireland traditional enthusiastic approach to pleasure to welcome back Professor (RCSI), the relationship between teaching and research within the RCSI David Bouchier-Hayes. He specifically Beaumont Hospital and RCSI is a and Beaumont Hospital. There was undertook a leadership role in delivering dynamic, evolving, collaborative significant change introduced in the clinical teaching to the GEP students. He partnership between a tertiary level undergraduate teaching programme for was joined in this programme by Mr. Hy hospital and an academic institution, the final medical students in which there Browne to whom we are extremely with excellence in patient care being was case based teaching for two hours grateful for his ongoing support of the the focus for both. each morning. This is delivered by the teaching programme at RCSI. Excellence in patient care begins with Consultants followed by ward based In research, the department continued basic research, which in turn leads to teaching in the afternoons. This under the leadership of Dr. Leonie Young, clinical research and in time becomes programme has proven to be highly to develop its focused interest in breast clinical practice in the treatment of successful. It was well received by the cancer. The programme for research in patients. This is what is now described final medical students. Another signifi- breast cancer made significant progress as translational research and cant development in the teaching during the year. In fundraising, the race translational medicine. All of RCSI programme was the increased utilization day for breast cancer was particularly clinical academic departments at of e-learning and the virtual learning successful in November raising over € Beaumont play a major part in the environment “Moodle”. In 2006, over 600,000. We were very fortunate to be provision of clinical services within the 200 students graduated with over 50% able to attract Dr. Anne Hopkins from the Hospital, as well as leading research achieving honours standard. Conway Institute, UCD, to join the programmes and the training and In the intermediate cycle semester three research team as a lecturer in surgery. education of our undergraduate and teaching programme, Professor John The collaborative efforts of the entire postgraduate students. O’Byrne introduced a very innovative 2006 research team is greatly appreciated programme in Cappagh National – notably Fiona Baine, Jane O’Hara, Marie RCSI is anxious to help Beaumont McIlroy, Aisling Redmond, Tony Stafford, Hospital deliver and implement the Orthopaedic Hospital for Orthopaedic Surgery. This was warmly welcomed by Aoife Quinn, Dearbhaile Collins, Sarah seven key priorities as identified in the Early, Sinead Cocchiglia and Paul Tibbits. Beaumont Hospital Strategy 2006- the students. Professor Ciaran Bolger introduced a teaching programme in 2010. To this end, we see ourselves as Department of Medicine Neurosurgery for the entire class which strategic partners and look forward to The Department of Medicine continues was well received in intermediate cycle working together in promoting its pivotal role in undergraduate and semester one. A notable development Beaumont Hospital as a Centre of postgraduate medical education. was the utilization of senior clinical Excellence for research, teaching and The major undergraduate curricular teachers to deliver bedside teaching. professional development. changes envisioned in RCSI over the We warmly welcome the valuable next number of years have been initiated We are always mindful of the fact that contribution from Mr. James Murphy, by the department in conjunction with our partnership can only truly flourish Mr. Seamus Smith, Mr. Vincent Keavney the other academic teaching depart- with the continuing generosity and and Mr. Paul Farrell to the clinical ments. This revision exercise has been understanding of the patients of teaching programme. Beaumont Hospital, and on behalf of very successful and will ultimately lead to the academic staff and students, I wish The “Graduate Entry Programme” (GEP) a more fulfilling, modern, modular course to convey our heartfelt appreciation for began this year. The class participated in comparable to that of any of the major the role that patients play, on a daily the weekly surgical grand rounds by teaching institutions around the world. basis, in the education and training of video-conference. This was a very The department is greatly indebted to its young doctors and surgeons. successful venture. In the second members for their help in this endeavour. semester the GEP programme first year The status of teaching hospital confers students attended Beaumont Hospital for special recognition on Beaumont Michael Horgan a thirteen week programme on Hospital. This is appreciated by patients Wednesday afternoons. This was a very Chief Executive and medical staff alike and facilitates innovative introduction to clinical May 2007 Beaumont in continuing to attract staff of teaching which was led and coordinated the highest calibre. In recognition of this by Dr. Deirdre Seoighe. We are also the Department has appointed three new extremely grateful to Mr. Joe Duignan honorary professors; Professor Frank who facilitated a very unique teaching Murray, Professor Chris Thompson and
BEAUMONTHOSPITAL ANNUAL REPORT 2006 105 Royal College of Surgeons in Ireland, Report
Professor Peter Conlon from the patients. The ease of DBS sample In April 2005, Prof McElvaney was Beaumont consultant body. In the area of collection and storage has allowed self- asked to chair 2 sessions at the postgraduate education Professor testing in the home and has already American Thoracic Society annual McElvaney was appointed “Censor of helped increase the numbers screened. meeting in San Diego and continues to the Royal College of Physicians of The Sheppard Prize was held in February act as External Reviewer for the United Ireland” and Professor Costello has been 2006. The adjudicators were Dr. Steven Kingdom Cystic Fibrosis Gene Therapy appointed “Specialty Director for Higher Smith, Dr. Seamus Sreenan, Dr. Peter Project. Prof McElvaney has also been Medical Training in Pulmonary Medicine” Conlon, Dr. Richard Costello, Dr. Liam asked to serve on the UK Cystic Fibrosis and continues his role as “Dean of Grogan, Dr. Chris Thompson and Dr. Gene Therapy Vector Assessment Postgraduate Examinations” in Ciaran Donegan. The winner of the Committee. Prof McElvaney was an Beaumont Hospital. Sheppard Prize was Dr. James Paul invited speaker at the European Cystic The Department of Medicine continues O’Neill for the best MD oral presentation. Fibrosis Meeting in Copenhagen in its work in the area of diagnosis and Second prize went to Dr Marcus Butler. 2006. In October 2006 Prof McElvaney treatment of Alpha 1 Antitrypsin The department would like to congratulate was invited speaker at the Queens Deficiency. In 2004 the Department of Dr. Deirdre Kelly and Dr. Siobhan Griffin Medical Research Institute Edinburgh. Medicine in conjunction with the Alpha-1 who obtained their PhD awards and Professor Richard Costello is Chairperson Foundation secured funding from the Dr Alan Mulgrew and Mark Rogan who of the Irish Sleep Apnoea Association Department of Health & Children for a obtained their MD this year. and has established a non-invasive targeted detection programme for Alpha- The Department of Medicine organised a ventilation sleep service that is now fully 1 Antitrypsin Deficiency. This is the first Workshop in Cystic Fibrosis (CF) in 2006. operational. In addition Professor Costello programme of its kind in Europe and was This workshop was held at RCSI, Dublin has standardised the application of non followed by the opening of the Alpha-1 in June 2006 and was jointly chaired by invasive ventilation throughout the Centre by the Minister for Health & Professor McElvaney and Professor Rick Hospital. To this end the Department of Children in the Clinical Research Centre at Boucher (UNC Chapel Hill). This meeting Medicine has initiated a number of Beaumont Hospital in April 2004. To date, was opened by the US Ambassador to seminars on this topic for NCHDs and 1500 individuals have been screened for Ireland - the Honorable James Kenny. also to the nursing staff. Alpha-1 Antitrypsin Deficiency through The invited speakers were from Ireland, Professor Costello was asked to be a this programme. A total of 56 AAT- Northern Ireland and the US. These member of the Health Research Board deficient individuals have been identified, speakers represented the highest level of Pharmacology and Physiology Grant including 30 ZZ, 24 SZ and 3 SS, while research in the areas of infection and Review Board. He was also asked to join 272 AATD carriers were detected, of inflammation in CF. The support for this the EU Cost B29 expert panel on which 138 were MZ and 134 MS. meeting reflected the enthusiasm and Exacerbations of COPD and the American Several other rarer phenotypes were also diversity of the groups in the various Thoracic Society’s Allergy and identified. Further analysis will reveal jurisdictions and included the National Immunology Assembly. whether these phenotypes predispose Heart, Lung and Blood Institute (NIH,US), individuals to lung disease. Ms Catherine the National Institute of Diabetes and RCSI Clinical Research Centre O’Connor, Research Nurse and Dr Tomás Digestive and Kidney Disease (NIH,US), Research is key in the development of Carroll, Post-Doctoral Scientist have been the Research and Development Office science and clinical research is essential employed to work in this unit. In addition (Northern Ireland), the Health Research to advance medicine. We are proud to be to the work at Beaumont, they have also Board and Science Foundation (Ireland) the first dedicated academic clinical taken their screening programme to and Inter-Trade Ireland. The purpose of research centre in Ireland. Pioneering Mullingar, Drogheda, Cavan, and St. the meeting was to develop recommen- advances in health care in the Irish James’s and will further expand the dations for new research directions in context has unique challenges. In 2006 programme in the coming year to the common areas of basic and clinical the volume of our investigator and other Dublin teaching hospitals. research in CF with particular focus on pharmaceutical led studies increased A national registry of patients has also infection / inflation, genetic modifiers of significantly in the wake of the EU clinical been set up and a website launched disease, animal models of disease, novel trials directive. The centre made (www.alpha1.ie) providing a resource for therapeutics and neonatal screening. significant advances in investigator led doctors and patients alike. Recently, a research with patents filed in biomarker In addition in 2006 Beaumont Hospital dried blood spot (DBS) system of sample discovery and a key publication in lung was designated as a specialty centre for collection has been adopted, where cancer screening that was the subject of the treatment of adults with cystic blood is collected via a finger prick onto an editorial review. specially treated filter paper. Genotyping fibrosis. This has resulted in an increased Consistent with our growth in research of these DBS samples by PCR and melt staffing level in the CF unit in projects has been an increase in clinical curve analysis identifies alpha-1 deficient Beaumont Hospital.
106 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Royal College of Surgeons in Ireland, Report
research nurses and research associates. Department of Clinical Microbiology programme and in particular the modulari- In 2006 we were part of the Wellcome- The Department of Clinical Microbiology sation and semesterisation of the course. Health Research Board award for a is based at the RCSI Education and The Department delivers teaching in Dublin wide consortium in clinical Research Centre on the Beaumont microbiology and infection during the research. The Clinical Research Centre Hospital campus. This location facilitates intermediate cycle through a combination has undergone several audits from integration and liaison between the of lectures, demonstrations and problem- regulatory agencies, pharmaceutical Hospital, including the diagnostic based material. A review of the pharmacy companies and grant funding bodies. laboratory, and the RCSI Department, course was also undertaken with the The exceptional standards of the Clinical which greatly strengthens teaching and arrival of Dr. Deirdre Fitzgerald-Hughes. Research Centre have been noted in all research, both basic and translational. This course has been very successful and of these reviews. well received by students since the start The major research interests of the of the Pharmacy degree. Finally, the The Clinical Research Centre will Department are in the area of healthcare- continue to work with several agencies in Department organises a module for the associated infection (HCAI), including that training of infection control and preven- promoting the value of clinical research, caused by methicillin-resistant but most importantly will strive to tion nurses and participates in other Staphylococcus aureus (MRSA). There is modules that combine to deliver a higher enhance the care of our patients through increasing recognition of the need to carry advancing medical science. diploma. This course is pivotal in the out research that explains the high national strategy to tackle the problems Dermot Kenny, MD prevalence of antibiotic resistance in many of HCAI and MRSA and RCSI is to the Director, Clinical Research Centre Irish hospitals and to find the solutions to forefront in education in this area. improving the situation. During 2006, The year 2006 saw an increase in a major prevalence survey of HCAI was Members of the Department have research nurse personnel in the Clinical conducted in the UK and Ireland and the significant profiles nationally in the sphere Research Centre. Our policy of Department was involved in the Steering of HCAI and are involved in a number of supporting research nurses in their Group that organised this throughout both national and other committees and professional development has resulted in countries. This revealed a prevalence rate groups. These include those under the a cohort of highly skilled research nurses, for HCAI of 4.9% in Ireland, of which auspices of the Department of Health and many of whom are educated to master’s about 10% was due to MRSA. Children, the Health Services Executive level. The Clinical Research Centre is at (e.g. the Strategy for the control of During 2006, the Department was the core of developing research nurse Antimicrobial Resistance in Ireland), and successful in obtaining a major award education for research nurses throughout international professional groups such as from the Health Research Board to carry Ireland. This has been recognized by the the Hospital Infection Society. out translational research on HCAI and recent Wellcome Trust award. MRSA, in collaboration with the Dublin Department of Academic The first Clinical Research Centre nursing Dental School and Hospital (TCD), the Radiology grant was obtained in September 2005. Health Protection Surveillance Centre The Department of Radiology has This study has been completed ahead of (HPSC) and St. James’s Hospital. It is responsibility for undergraduate teaching schedule and is a major step in our plans hoped that this project, which is multi- in radiology and is also involved in to develop nursing research as a disciplinary in its origin and in its postgraduate radiology teaching, for the specialty within the Clinical Research implementation, will address the major Membership in Medicine, Nursing Centre. In addition, 2006 saw the issues as they pertain to the Irish Health Courses and the Faculty of Radiology continuing development of the Clinical Service, which are different to those of Training Programme, in Radiology. Research Centre’s expertise in other health services, such as the Dr. Deirdre Duke has commenced as a conducting clinical trials in a variety of Netherlands, where infections caused by Consultant in Breast Imaging and the therapeutic areas. We have proven our MRSA are much lower. Breast Imaging Department is now excellence in a number of Irish The appointment of Dr. Deirdre operational. The Department continues Medicines Board audits. Fitzgerald-Hughes to the post of Lecturer its research in interventional radiology As we continue to build on our nursing in Molecular Microbiology in the final techniques, chest imaging, abdominal expertise in clinical research we deliver quarter of 2006 greatly strengthens the imaging and neuroradiology. the highest standard to our investigators Department’s research and teaching The Department of Radiology is currently and, most importantly, assist in providing remit. She has particular strengths in the putting the teaching programme in evidence based care to our patients. application of Molecular Biology to radiology for final meds on the Web. Ailbhe Murray, RGN bacterial pathogenesis. It is aimed to complete this exercise Director of Nursing, The Department was closely involved in before the final medical exam in May Clinical Research Centre the review of the undergraduate medical 2006. Modules in chest radiology, neuro- radiology, abdominal radiology and
BEAUMONTHOSPITAL ANNUAL REPORT 2006 107 Royal College of Surgeons in Ireland, Report
musculoskeletal / trauma Radiology will Department of Anaesthesia Education and Research Centre, Smurfit be available. Dr Rory Dwyer, Senior Lecturer in Building. These programmes included The Department has embraced e- Anaesthesia, RCSI succeeded Dr Charles Advanced Cardiac Life Support courses, learning, putting much of its intermediate O’Hagan as Chairman of the Department Obstetric Anaesthesia Orientation teaching files and lectures on Moodle for of Anaesthesia. Dr Dwyer also chairs the programmes, Emergencies in Dental RCSI undergraduate students. Dr. Aoife College of Anaesthetists’ Credentials Practice, Crisis Management, SpR Keeling is the current Lecturer in Committee and he is a member of the Evaluation and Difficult Airway Interventional Radiology. Medical Council’s Registration Committee. Workshops. The College of Anaesthetists RCSI Department of Psychiatry Pathology Department appointed Dr Irene Leonard, former RCSI Our Mission Statement The RCSI Academic Department of Lecturer, as the inaugural Beaumont Psychiatry continues to contribute to “The Pathology Department of the RCSI Hospital College Tutor. Beaumont Hospital by providing a high is committed to providing the highest quality clinical service and active Dr David Hourihan succeeded Dr Miriam quality teaching and diagnostic service in undergraduate and postgraduate Langdon as RCSI Lecturer in Anaesthesia a safe and professional work environment educational programmes. in July 2006. Dr Hourihan is undertaking for its staff. The department also seeks to collaborative research project, in support the educational needs of its staff There is close integration with the association with Professor Brian Harvey, and to promote an environment Clinical Department of Psychiatry at entitled “The effects of noradrenaline on conducive to high quality research.” Beaumont Hospital with Professors the hypoxic proximal renal tubule cells” Murphy, Cannon and Cotter and Dr The RCSI Pathology Department has very as part of a MD thesis. Dr Miriam Cosgrave all holding joint RCSI / Beaumont close links with the Beaumont Langdon, recent RCSI lecturer in Hospital appointments. In addition, Histopathology department as the Anaesthesia, is currently Locum the Department has a number of clinical Consultant Pathologists have joint Consultant Anaesthetist in Our Lady’s research fellows completing their MD appointments with Beaumont Hospital. Hospital Cappagh. and PhD degrees who contribute to Consequently there is integration specialised clinical services in Professor Anthony Cunningham between Beaumont Hospital and RCSI in neuropsychiatry, psycho-oncology and completed two four-year terms as Clinical the provision of a diagnostic psycho-hepatology in Beaumont Hospital. Vice-Dean and Intern Co-ordinator in histopathology and cytology service, Dr Brian Hallahan, RCSI Lecturer RCSI. He co-ordinated the Third Annual teaching at undergraduate and obtained his MD during the year and College of Anaesthetists Overseas postgraduate level and clinical research. Development programme in Malawi achieved first place in the National Senior The RCSI Pathology Department January 2006. He co-ordinated the Registrar Scheme interviews. Dr Anita provides a clinically based undergraduate Critical Events module in the inaugural Ambikapathy returned from the Institute curriculum for medical students and MSc (Anaesthesia) degree programme of Psychiatry, King’s College London to physiotherapy students. The department with Dr Deirdre McCoy, former RCSI RCSI / Beaumont Hospital for the second pioneered a computer assisted learning Lecturer and Consultant Anaesthetist in year of her RCSI / KCL rotating Lecturer programme which is case based and St James’s Hospital. in Psychiatry post. which also has interactive learning and The Department of Psychiatry has a very Professor Cunningham was elected Irish self assessment based programmes. active research programme and specific representative on the Council of the The teaching programme includes research themes include the genetics of European Society of Anaesthesiology in lectures, clinicopathological case neuropsychiatric disorders, behavioural April 2006. He was elected Chairman of scenarios and discussion, tutorials, phenotypes of genetic disorders, cellular the Medical Council’s Education and specimen assisted teaching, wet tissue cytoarchitectural and protein signature of Training Committee in September 2006 (operative specimens) teaching and major psychiatric disorders, and also sits on the Council’s Fitness to autopsy teaching and learning. Students the developmental epidemiology of Practice and Ethics Committees. He co- are challenged throughout the course to psychosis and structural and functional ordinated the College of Anaesthetists continuously ask the question “why”. Workshop on Ethics and Legal Medicine neuroimaging of psychosis and autism. An undergraduate pathology programme November 2006 and was the keynote (www.rcsi.ie/Academic_Departments/ is also taught to physiotherapy students. speaker at the Scottish Society of Psychiatry). The Department generated The Pathology Department is deeply Anesthesiologists Congress in April 2006. many peer reviewed publications indebted to all the teachers / lecturers including publications in PNAS (USA), The academic department hosted a from Beaumont Hospital and Connolly Brain and the American Journal of number of postgraduate training Hospital who contribute to our teaching. Psychiatry and contributed to numerous programmes using the METI full Human The department has not had to cancel a national and international meetings. Physiological Simulator in the RCSI single lecture or teaching session in
108 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Royal College of Surgeons in Ireland, Report
2006. The latter is due to the dedication Medical Education, Research and Training Institute of Functional Genomics at and commitment of the teaching staff and is a member of a number of editorial Montpellier University. and to the organisational skills of Ms. boards of international journals. She is an Presentation of the Chevalier de l‘Ordre Dorothy Benson. external examiner for Trinity College, National du Merite by the French Pathology staff examine in the surgical University College Dublin, University Ambassador to Ireland, M. Federic pathology component of the Membership College Cork. She has published in Grasset to Prof Harvey in December Examination in Surgery (MRCS) in Dublin, excess of 200 publications. 2006. L-R Mr. Michael Horgan Chief Bahrain, Penang and Jordan. Professor Elaine Kay is a member of the Executive RCSI, Prof Harvey, HE In addition to teaching undergraduate following Committees / Boards: The Ambassador Grasset. students the department has a very Histopathology Committee of the Faculty The Associate Director of Molecular active postgraduate training programme of Pathology, The public liaison committee Medicine, Dr Stephen Keely was for histopathology trainees. of the Faculty of Pathology, The Council awarded the New Investigator Award of the Irish Association of Cancer from the American Physiology Society in In recognition of the crucial role of Research, The All Ireland NCI Scientific diagnostic histopathology in patient 2005 and obtained a Principle Advisory Board, ICORG, Translational Investigator Award from the SFI in 2006. diagnosis, prognosis and treatment the Research Sub-group, The Postgraduate Pathology Department will invite Dr Keely’s research focus is the study of Medical and Dental Board, The Board of molecular mechanisms of epithelial students in 2007 to experience the role Cancer Research Ireland, The Molecular of a clinical pathologist in clinical care by transport. His team is made up of 5 Subcommittee of the HRB. She is researchers and have an active spending designated time in the external examiner for Cambridge laboratory as part of a clinical elective. collaboration with Prof. Frank Murray in University, for the Biomedical Science, Beaumont Hospital. The RCSI Cytology Laboratory is the only Medical and Dental examination in accredited cytology laboratory under the Queen’s University Belfast and for the The laboratory’s main focus of research new CPA guidelines. Its future was in UK based MRCPath examination. continues to be in the molecular doubt in 2006 until a commitment was biology and physiology of rapid Dr. Tony Dorman is chairman of the responses to steroid hormones (RRSH). received by the HSE that it would take division of Laboratory Medicine in over the laboratory. The Department of Molecular Medicine Beaumont hospital and secretary of the will host the 5th International RRSH The research within the Pathology Irish Branch of the Association of meeting in September 2007. Department is translational focussed and Clinical Pathologists. He is the sole investigates telomere up-regulation, Consultant Renal Pathologist in The international research team includes modulators of invasion in bladder Beaumont hospital and provides an on 17 scientists and students from Italy, carcinoma, molecular biology of soft call service for renal pathology. Scotland, China, UK, France, Chile and tissue sarcomas, and molecular Ireland coming from a variety of Dr. Antoinette Grace is the lead disciplines. Molecular Medicine staff mechanisms of invasion in colorectal histopathologist in audit and in cytology. carcinoma. Skin cancer is also being represented the RCSI and Beaumont extensively studied. A number of staff of Charitable Infirmary Trust Hospital with distinction at both national the department are carrying out theses Molecular Medicine Laboratories and international level. Fiona O’Mahony for MDs, PhDs and MScs. The The Director of Molecular Medicine, was awarded best oral presentation at department generated many peer Professor Brian Harvey was awarded a the Annual DMMC Science Day in reviewed publications and contributed to knighthood by the President of France for October 2006 and Darina Hynes won numerous national and international his 25 years service to Ireland-France runner-up for the DMMC best poster scientific meetings in the last years. scientific collaborations. The laboratories presentation. Rodrigo Alzamora and have close collaborative links with Fiona O’Mahony were joint winners for The department has collaborative INSERM, Montpellier Hospital, France best poster at the FASEB Summer research links with external institutions and work from this collaboration on novel Research Conference in Tucson, USA, including the Conway Institute, Queens actions of glucocorticoids in human lung July 2006 while Fergal Donnellan won University Belfast, Trinity College and the was recognised by the award of the the Sheppard prize at the Beaumont National Cancer Institute in Washington. Laureat Prix Servier to Prof Harvey last Hospital Annual Research day. It was The RCSI research laboratory is year. The laboratories are currently also our honour to have Dr. Kim Barrett, accredited by CPA UK. sponsoring a collaborative research Professor of Medicine, University of Professor Mary Leader is a member of programme in pituitary gland dysfunction California at San Diego give the Prize the Faculty of Pathologists RCPI, following traumatic brain injury between CICT Lecture in Molecular Medicine at Beaumont Foundation, the Board of the Prof. Christopher Thompson, Beaumont the Annual RCSI Research day. British Division of the International Hospital and Dr. Patrice Mollard, CNRS Academy of Pathology, the Board of
BEAUMONTHOSPITAL ANNUAL REPORT 2006 109 Royal College of Surgeons in Ireland, Report
The department would like to The Department of Molecular Medicine Academic Activities congratulate Dr Ruth Muchekehu on sees its major role in the ERC to promote There have been significant academic obtaining her PhD award this year. Ruth clinician-scientist interaction and offers achievements throughout the course of has joined the cystic fibrosis research its facilities to RCSI and Beaumont staff the year, all of which merit team of Dr. Paul Quinton at the on a collaborative basis to further acknowledgement. University of San Diego Hospital. translational research. The Molecular Medicine laboratories For more information and contact points European Academy of Facial have continued their support for in Molecular Medicine visit our website Plastic Surgery translational medical research between www.rcsi.ie/molmed Professor Walsh hosted the annual clinicians and scientists with a new meeting of the European Academy of research programme into acute renal DEPARTMENT OF OTOLARYN- Facial Plastic Surgery (EAFPS) in injury in collaboration with Prof Anthony GOLOGY HEAD & NECK SURGERY September 2006 at the RCSI. Professor Cunningham and an HRB sponsored PhD The RCSI, Department of Otolaryngology, Walsh is the Vice President of the programme in cancer cell biology with Head & Neck Surgery continues to run Academy. This was the first time the Profs Arnold Hill (Dept of Surgery) and under the Chairmanship of Professor meeting had taken place in Ireland. Elaine Kay (Dept of Pathology). Michael A. Walsh. This meeting was attended by leading Irish and world renowned facial plastic The laboratories have developed a The primary mission of the department surgeons, including a member of the strategic plan to support translational is to provide teaching in the specialty of French team that successfully performed research through promoting targeted Otolaryngology, Head & Neck Surgery the worlds first human face transplant – senior appointments and closer at undergraduate and postgraduate Dr. Benoit Lengelé. collaboration between clinicians and level, promote research in the field and provide educational services for scientists at Beaumont Hospital and the Courses theoretical and practical training Education and Research Centre and the The department continues to run a courses run under the auspices of the RCSI research institute in York Street. series of practical and theoretical skills College. A team of academic and The Department of Molecular Medicine courses in association with the Irish clinical staff are dedicated to delivering has been instrumental in the Higher Surgical Training Committee in this mission. appointment of three new Chairs in Otolaryngolgoy Head & Neck Surgery: Translational Medicine, Cancer genetics Temporal Bone Course – and Neurodegeneration. Clinical Update The academic unit at Beaumont Hospital Directed by Mr. Rory McConn Walsh New clinician-scientist collaborations in is the largest regional Ear Nose and General Practice Study Day – Translational Research have been Throat (ENT) specialty unit in the Republic Directed by Professor M Walsh fostered over the past years. of Ireland. It has acquired national A collaboration between endocrinology responsibility for the provision of cochlear Structured Teaching Week – researchers has resulted in the implantation, and has a tertiary referral Directed by Mr. Rory McConn Walsh establishment of the RCSI-Beaumont base for head and neck surgical oncology, Prizes Hospital Endocrine Alliance which held skull base surgery and neuro-otology. its first meeting on 26th October, 2006. The Sheppard Prize for Scientific The aim of the Endocrine Alliance is to Patients referred for hearing assessment Research: foster collaboration and knowledge are now fast tracked directly to the 'Tamoxifen induces tumour cell apoptosis transfer between clinicians and scientists Department of Audiology. This initiative has and blocks metastasis invasion in in the field of endocrinology. In addition, greatly reduced the waiting time for Anaplastic Thyroid Cancer' the laboratories organised a Research patients. An additional initiative is being Dr. James P O’Neill - Feb 2006 introduced this year. Patients referred for Interaction Workshop in the Guinness RAMI prize for best research paper: tonsillectomy are now sent a questionnaire Hopstore to promote awareness of Dr Tara Mackle, April 2006 research and collaborative opportunities and information sheet on the procedure. If they satisfy specific criteria they are for clinicians. The laboratories also ran a Royal Academy of Medicine in Ireland, booked directly for a tonsillectomy. This will hands-on training workshop into siRNA Otorhinolaryngology section. and gene silencing techniques and cut the waiting time for this procedure by IOS 2006: applications. Given the huge interest in approximately six months. The case mix for Dr. Emer Lang this workshop from clinical and scientist complex operative procedures is increasing researchers, further workshops in this each year. Last year over 100 major Temporal Bone Course Medal and First area and in advanced molecular imaging complex operations were performed. Prize awarded jointly: techniques will be run over the Mr. Latif Kadhim, Mr. Munish Shandilya. coming year.
110 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Royal College of Surgeons in Ireland, Report
Head and Neck Course Medal awarded jointly: Ms. Mona Thornton, Dr. Orla Young. MCQ for Structured Teaching Course, First Prize: Dr. Michael Harney. Otolaryngology Section of Academy of Medicine Prize: Dr. Orla Young, Mr. Patrick Sheahan. Registrars Prize: Ms. Mona Thornton.
Clinical Governance in the Department of Otolaryngology Head & Neck Surgery: Professor M. Walsh is a member of the following bodies: • President Irish Society of Otolaryngology. • Secretary Irish Institute of Otolaryngology. • Vice President of European Academy of Facial Plastic Surgery. • Speciality Representative UEMS. • Member of British Academy in Otolaryngology Scientific Committee. Mr. R. McConn Walsh is a member of the following bodies: • Secretary, Royal Academy of Medicine in Ireland, Section of Otolaryngology /Head & Neck Surgery. • Course organiser, annual Postgraduate Teaching Course in Otolaryngology for Specialist Registrars in Otolaryngology. • Regional (national) Research Advisor to the Specialist Advisory Committee (SAC) in Otolaryngology. • Member of the National CJD Advisory Committee. • Tutor on the Manchester Temporal Bone Dissection Course for Specialist Registrars. Mr Peter Lacy was recently appointed to the Department of Otolaryngology. Peter has specific expertise in Rhinology and Anterior Skull Base Surgery. His appointment has greatly enhanced the academic profile of the Department.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 111 Beaumont Hospital Organisation Chart
MINISTER FOR HEALTH & CHILDREN
COMMITTEES BEAUMONT Audit HOSPITAL Finance BOARD Governance Planning
CHIEF INTERNAL EXECUTIVE AUDITOR
MEDICAL BOARD
REPRESENT- CONSULTANT MEDICAL DIRECTOR OF CLINICAL GENERAL DEPUTY HUMAN INFORMATION BUSINESS HEAD OF FINANCIAL PLANNING & ATIVE MEDICAL ADMINISTRATOR NURSING SERVICES MANAGER CHIEF RESOURCES TECHNOLOGY ORG. CONTROLLER EXECUTIVE PERFORMANCE DEVELOP SYSTEM STAFF CO- MANAGER MANAGER MANAGER ORDINATOR
DIVISIONAL HEADS OF HEADS OF NCHD’S NURSE PROFESSIONS/ NON-CLINICAL MANAGERS CLINICAL DEPTS DEPTS HEAD OF QUALITY & SAFETY
HEAD OF PROJECTS & FACILITIES MANAGEMENT MANAGEMENT STATISTICS
RADIOLOGY MEDICINE (2) PHYSIO – – PUL FUNCTION SURGERY PHARMACY – – AUDIOLOGY NEUROSURGERY EEG – – DIETETICS NEPHROLOGY ECG PATIENT SERVICES – – TRANSPLANT CO-ORD THEATRES/X-RAY/CSSD MED SOCIAL WORK GENERAL SERVICES – – ORTHOPTIST A&E/OPD/UROLOGY CHIROPODY MATERIALS MGMT – – PATHOLOGY HUMAN RESOURCES SPEECH THERAPY CATERING (NURSING) – MPCE – OCC THERAPY NURSE EDUCATION – NON-INVASIVE VASCULAR LAB – CLINICAL NURSING PRACTICE PSYCHOLOGY POISONS INFO DEVELOPMENT – COPD All Consultant Staff are members of the Medical Board. Representative System consists of Medical Executive on which a representative of each Cogwheel and Division has a seat
112 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Beaumont Hospital Research Report 2006
Publications European Academy of Dermatovenere- Ridge CA, Moktar A, Barry J, Murphy ology symposium Rhodes October 2006 GM. Photochemotherapy and COLORECTAL SURGERY Photoprotection methotrexate used to treat generalized Al-Hilli Z, Pritchard R, Roche Nagle G, cutaneous scleroderma. J Eur Acad Deasy J, McNamara DA, Nicorandil Skin cancer in transplant patients Dermatol Venereol. 2007 related anal ulcer. The European Society of Photoderma- May;21(5):692-3. Ir J Med Sci. 2006 Jul-Sep;175(3):62-3. tology Dusseldorf Nov 2006 Ultraviolet radiation and immunosup- Perrem K, Lynch A, Conneely M, Chica M, Parc Y, Tiret E, Dehni N, pression Wahlberg H, Murphy G, Leader M, McNamara D, Parc R. Coloanal sleeve Kay E. anastomosis (Soave procedure): the The Consultants Course London The higher incidence of squamous cell ultimate treatment option for complex October 2006 carcinoma in renal transplant recipients rectourinary fistulas. Skin complications in Transplant is associated with increased telomere Dis Colon Rectum. 2006 recipients lengths. Sep;49(9):1379-83. The Copenhagan Psoriasis working Hum Pathol. 2007 Feb;38(2):351-8. Healy CF, Branigan AE, Connolly EM, group Copenhagen June 2006 Epub 2006 Nov 28. Eng M, O’Sullivan MJ, McNamara DA , Psoriasis in sensitive sites including Laing ME, Moloney FJ, Comber H, Cusack C, Deasy J. The effects of low- photosensitive psoriasis Conlon P, Murphy GM. Malignant frequency endo-anal electrical Photobiology Course for SpRs London melanoma in renal transplant recipients. stimulation on faecal incontinence: a October 2006 Br J Dermatol. 2006 Oct;155(4):857. prospective study. Suncreen use in dermatology Int J Colorectal Dis. 2006 Laing ME, Barry J, Buckley AM, Murphy Festschrift for Professor JLM Hawk Dec;21(8):802-6. Epub 2006 Mar 17. GM. Immediate and delayed hypersen- London October 2006 sitivity reactions to food and latex in a Hanly AM, Redmond M, Winter DC, Research in Photobiology chef. Brophy S, Deasy J, Bouchier Hayes DJ, Contact Dermatitis. 2006 Kay EW. Thrombomodulin expression in Publications for 2006 Sep;55(3):193-4. No abstract available. colorectal carcinoma is protective and Moloney FJ, Comber H, O'lorcain P, PMID: 16918621 [PubMed - indexed for correlates with survival. O'kelly P, Conlon PJ, Murphy GM. MEDLINE] Br J Cancer. 2006 May 8;94(9):1320-5. A population-based study of skin cancer incidence and prevalence in renal trans- Murphy GM, Hawk JL. DERMATOLOGY plant recipients. Br J Dermatol. 2006 Erythropoietic protoporphyria advances Research Presented and Published Mar;154(3):498-504. today, with a special tribute to the late 2006 Professor Ian Magnus. Otley CC, Berg D, Ulrich C, Stasko T, Br J Dermatol. 2006 Sep;155(3):501-3. Dr GM Murphy: International Invited Murphy GM, Salasche SJ, Christenson Lectures LJ, Sengelmann R, Loss GE Jr, Garces Kovach BT, Murphy G, Otley CC, Invited Speaker American Academy of J;REDUCTIONOFIMMUNOSUPPRES- Shumack S, Ulrich C, Stasko T. Dermatology March 2006 SION TASK FORCE OF THE Oral retinoids for chemoprevention of San Francisco: INTERNATIONALTRANSPLANTSKIN skin cancers in organ transplant recipi- CANCER COLLABORATIVE and THE ents: results of a survey. AAD Photobiology Course SKINCAREINORGANTRANSPLANT Transplant Proc. 2006 Jun;38(5):1366-8. Acute effects of ultraviolet radiation PATIENTS EUROPE. Reduction of on the skin Laing ME, Moloney FJ, Kay EW, Conlon immunosuppression for transplant-asso- P, Murphy GM. AAD Forum on sunscreens ciated skin cancer: expert consensus Malignant melanoma in transplant What’s New in Sunscreens survey. Br J Dermatol. 2006 patients: review of five cases. AAD Symposium on Photodermatology Mar;154(3):395-400. Clin Exp Dermatol. 2006 Sep;31(5) The practical use of sunscreens Mahon MA, Wynne B, Murphy GM, :662-4. ITSCC Annual Meeting at AAD Kearns G. Recurrence of Kawasaki Moloney FJ, Dicker P, Conlon PJ, Malignant melanoma in transplant disease in an adult patient with chole- Shields DC, Murphy GM. patients cystitis. Ir Med J. 2007 The frequency and significance of thiop- Mar;100(3):400-1. The Brendan Society, Carmel, March urine S-methyltransferase gene 2006. polymorphisms in azathioprine-treated Ultraviolet radiation and Itch renal transplant recipients. Br J Dermatol. 2006 Jun;154(6):1199- 200. No abstract available.
BEAUMONTHOSPITAL ANNUAL REPORT 2006 113 Beaumont Hospital Research Report 2006
Van de Kerkhof PC, Kragballe K, Austad ENDOCRINOLOGYAND GYNAECOLOGY J, Berth-Jones J, Cambazard F, de la DIABETES (SAMPLE Uterine artery embolisation as an Brassinne M, Ljungberg A, Murphy G, PUBLICATIONS) interval adjunct to conservative Papp K, Wozel G. Agha A, Sherlock M, Brennan S, management of placenta praevia. Psoriasis: severity assessment in clin- O’Connor SA, O’Sullivan E, Rogers B, Breathnach F Tuite D J, McEniff N, ical practice. Conclusions from Faul C, Rawluk D, Tormey W, Byrne P, Geary M P workshop Thompson CJ. J Obstet Gynecol. 2007 27(2) 195 discussions and a prospective multi- Hypothalamic-pituitary dysfunction Is vaginal breech delivery outdated for centre survey of psoriasis severity. following irradiation of nonpituitary brain all singletons and twins? – The current Eur J Dermatol. 2006 Mar- tumours in adults. kaleidoscope of Irish Obstetric thinking. Apr;16(2):167-71. Journal of Clinical Endocrinology & Mc Millan H, Walsh T, O’Donovan M, Metabolism 90: 6355-6360 Moloney FJ, Comber H, Conlon PJ, Byrne P, Keane D. Murphy GM. Agha A, O’Kelly P, Tormey W, Phillips J, Irish Medical Journal. 2006. 4: 109-111 The role of immunosuppression in the Thompson CJ. The natural history of Recent developments in the manage- pathogenesis of basal cell carcinoma. post-traumatic hypopituitarism: implica- ment of stress incontinence. Br J Dermatol. 2006 Apr;154(4):790-1. tions for assessment and treatment Byrne P. No abstract available. American Journal of Medicine 118: Modern Medicine. 2006: 36: 45-48 Ring J, Barker J, Behrendt H, Braathen 1416.e1-1416.e7 Combination of vasa praevia, true L, Darsow U, Dubertret L, Giannetti A, Sherlock M, Agha A, Thompson CJ. umbilical cord knot and a subserosal Hawk J, Honigsmann H, Kemeny L, Aneurysmal subarachnoid hemorrhage. Millan H, Walsh T, Byrne Luger T, Meurer M, Murphy G, Peserico haemorrhage. New England Journal of P, Geary M. A, Ranki A, Reunala T, Saurat J, Sterry Medicine 354:1755-7 J. Perinat. Med. 2006. 34: 88 W, van de Kerkhof P. Sherlock M, Agha A, Smith D, Allcutt D, Review of the potential photo-cocar- Pregnancy Outcome in Immigrant Thompson CJ. Diabetes insipidus cinogenicity of topical calcineurin Women. Tracey A, Byrne P, Collins C, following pituitary surgery for a macro- inhibitors: position statement of the Geary M. prolactinoma. European Dermatology Forum. Irish medical Journal 2006. 99: 22-23 Pituitary 9:59-64 J Eur Acad Dermatol Venereol. 2005 Study of ovarian cancer management. Agha A, Thompson CJ. Anterior pitu- Nov;19(6):663-71 Gaughan E, Javaid T, Cooley S, Byrne P, itary dysfunction following traumatic Gaughan B. brain injury. Textbooks Irish Medical Journal. 2006 6: 279-280 Skin Complications in Transplant Clinical Endocrinology 64: 481-488 Patients Eds Salache,Otley, Stasko, Sherlock M, Mylotte D, Mac Mahon J, Murphy GM Mechanisms underlying Moore KB, Thompson CJ. Lipid skin cancer in transplant recipients In lowering targets are easier to attain Press Advances in Cutaneous Trans- than those for treatment of hyperten- plant Oncology Eds Stochfleth, sion in type 2 diabetes. Euvrarde Proby. Chapter: Photoprotec- Ir J Med Sci. 175:36-41. tion and sunscreens Gillian M Murphy In Press Acerini CL, Tasker RC, Bellone S, Bona G, Thompson CJ, Savage MO. Hypopi- Photodermatology Eds Honigsmann tuitarism in childhood and adolescence Lim & Hawk following traumatic brain injury: the The porphyries Gillian M Murphy K case for prospective endocrine investi- Anderson 2006 gation. Eur J Endocrinol. 155:663-9.
114 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Beaumont Hospital Research Report 2006
MICROBIOLOGY Humphreys H. Implementing guidelines Delanty N. Predicting drug-resistant E.O'Neill and E. Smyth. Colour Atlas of for the control and prevention of meti- patients who respond to add-on therapy Medical Bacteriology. cillin-resistant Staphylococcus aureus: with levetiracetam. Irish Medical Journal 2006;99: 93 comparisons of success. Seizure 2006; 15:387-392. Journal of Hospital Infection 2006; 62: F. Fitzpatrick, T McGaley, L Rajan, E. Kinirons P, Cavalleri GL, Singh R, 133-5. Smyth. Therapeutic drug monitoring of Shahwan A, Acheson JF, Wood NW, vancomycin in patients receiving Humphreys H. Overcrowding, under- Goldstein DB, Sisodiya SM, Doherty CP, haemodialysis: time for a change. staffing and infection in hospitals. Irish Delanty N. A pharmacogenomic explo- Journal of Clinical Pathology 2006; 59: Medical Journal 2006; 99:102. ration of vigabatrin-induced visual field 666-667 constriction. Epilepsy Res 2006; NEUROLOGY 70:144-152. O'Neill E. Humphreys H, Smyth EG. Greenway MJ, Andersen PM, Russ C, Impact of recommendations by clinical Ennis S, Cashman S, Donaghy C, Ronan L, Doherty CP, Delanty N, microbiologists on antimicrobial treat- Patterson V, Swingler R, Morrison KE, Thornton J, Fitzsimons M. Quantitative ment in the intensive care units of a Green A, Acharya KR, Brown RH, MRI: a reliable protocol for measure- Dublin teaching hospital. Hardiman O. Loss-of-function ANG ment of cerebral gyrification using Clinical Infectious Diseases mutations segregate with familial and stereology. Magn Res Imaging 2006; 2006;40:636. ‘sporadic’ amyotrophic lateral sclerosis. 24:265-272. Sexton T, Clarke P, O’Neill E, Dillane T, Nature Genetics. 2006; 4:411-3. Epub Kinirons P, Cavalleri GL, O’Rourke D, Humphreys H. Environmental reservoirs 2006 Feb 26. Doherty CP, Reid I, Logan P, Liggan B, of meticillin-resistant Staphylococcus O’Sullivan PJ, Gorman GM, Hardiman Delanty N. Vigabatrin retinopathy in an aureus in isolation rooms: Correlation O, Farrell MJ, Logan PM. Sonographi- Irish cohort: lack of correlation with with patient isolates and implications cally guided percutaneous muscle dose. Epilepsia 2006; 47:311-317. for hospital hygiene. biopsy in diagnosis of neuromuscular McKeon A, Vaughan C, Delanty N. Journal of Hospital Infection 2006; 62: disease: a useful alternative to open Seizure versus syncope. 187-94. surgical biopsy. J Ultrasound Med. Lancet Neurol 2006; 5:171-180. 2006; 1:1-6. O’Neill E, Humphreys H, Phillips J, Ronan L, Murphy K, Delanty N, Doherty Smyth EG. Third-generation Rathlev NK, Ulrich AS, Delanty N, C, Maguire S, Scanlon C, Fitzsimons M. cephalosporin resistance among Gram- D’Onofrio G. Alcohol-related seizures. Cerebral cortical gyrification: a prelimi- negative bacilli causing meningitis in J Emerg Med 2006; 31:157-163. nary investigation in temporal lobe neurosurgical patients: significant Jackson N, Ridge CA, Delanty N. epilepsy. challenges in ensuring effective Imaging in patients with a first seizure. Epilepsia. 2007 Feb;48(2):211-9. antibiotic therapy. Ir Med J 2006; 99:173-175. Lin F, Murphy R, White B, Kelly J, Journal of Antimicrobial Chemotherapy Feighery C, Doyle R, Pittock S, 2006; 57: 356-9. Chaila EC, McCabe DJ, Delanty N, Costello DJ, Murphy RP. Broadening the Moroney J, Smith O, Livingstone W, Humphreys H, Dillane T, O’Connell B, phenoptype of childhood-onset Keenan C, Jackson J. Circulating levels Luke LC. Survey of recent medical grad- dystonia. Arch Neurol 2006; 63:1185- of beta2-glycoprotein I in thrombotic uates knowledge and understanding of 1188. disorders and in inflammation. the treatment and prevention of infec- Lupus. 2006;15:87-93. tion. Irish Medical Journal 2006; 99: Ricotti V, Delanty N. Use of O’Sullivan SS, Hardiman O. Detection 58-59. complementary and alternative medi- cine in epilepsy. Curr Neurol Neurosci rates of sexual dysfunction amongst Cunney R, Humphreys H, Murphy N. Rep 2006; patients with multiple sclerosis in an Survey of acute hospital infection 6:347-353. out-patient setting--can this be resources and services in the Republic improved? Ir Med J. 2006 Nov- of Ireland. Kinirons P, Cavalleri GL, Shahwan A, Dec;100(9):304-6. Journal of Hospital Infection 2006; 64: Wood NW, Goldstein DB, Sisodiya SM, Ryan AM, Ryan J, Wan-Ahmed M, 63-8. Delanty N, Doherty CP. Examining the role of common genetic variation in the Hardiman O, Farrell MA, McNamara B, Humphreys H. Smyth ETM. Prevalence gamma2 subunit of the GABA A Sweeney BJ. Vacuolar leucoencephalo- surveys of healthcare-associated infec- receptor in epilepsy using tagging pathy and pulvinar sign in association tions: What do they tell us, if anything? SNPs. with coeliac disease. Clinical Microbiology and Infection Epilepsy Res 2006; 70:229-238. J Neurol Neurosurg Psychiatry. 2007 2006; 12:2-4. Jan;78(1):98-9. Kinirons P, McCarthy M, Doherty CP,
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Momeni P, Schymick J, Jain S, Cookson J Neurol Neurosurg Psych 2006 Hickey RCSI) MR, Cairns NJ, Greggio E, Greenway ;77:126-142. Quality of life in chronic neurologic MJ, Berger S, Pickering-Brown S, Chio disease (Funded by RCSI) Murphy S, O’Dwyer J, Murphy P, A, Fung HC, Holtzman DM, Huey ED, Awarded Jan 2006 Moroney, JT. Cerebral Ischaemia and Wassermann EM, Adamson J, Hutton Intracerebral Haemorrhage in the Dr.Stephen McNally (With Dr.Richard ML, Rogaeva E, St George-Hyslop P, Hypereosinophilic Syndrome (HES). Costello, RCSI) Rothstein JD, Hardiman O, Grafman J, BloodMed in association with the Respiratory Decline in ALS Singleton A, Hardy J, Traynor BJ. British journal of Haematology Awarded Nov 2006 Analysis of IFT74 as a candidate gene published online. June 15, 2007. for chromosome 9p-linked ALS-FTD. OCCUPATIONAL HEALTH BMC Neurol. 2006 Dec 13;6:44. Murphy S, Thornton J, Murphy P, Moroney, JT. A Novel Treatment for Publications: Cronin S, Greenway MJ, Ennis S, Kieran Intra-luminal Carotid Thrombus. Determinants of Influenza Vaccination D, Green A, Prehn JH, Hardiman O. BloodMed in association with the Uptake Among Hospital Healthcare Elevated serum angiogenin levels in British Journal of Haematology Workers, R Quigley & B Hayes – Irish ALS. Neurology. 2006 Nov published online. July 15, 2007. Medical Journal June 2006, Volume 99, 28;67(10):1833-6. No.6. Murphy S, Doherty C, Moroney JT. Beghi E, Logroscino G, Chio A, Investigation of apraxia of speech Benefits of a Sharps Awareness Hardiman O, Mitchell D, Swingler R, following acute hemispheral ischaemic Education Programme in a Dublin Traynor BJ; stroke. Cardiology Professional, 2007 Teaching Hospital (poster) presented on behalf of the EURALS Consortium. (1), 25-26. at National Conference for Health The epidemiology of ALS and the role Promoting Hospitals, November 2006 of population-based registries. Murphy S, Doherty C, Moroney JT. and International Conference for Health Biochim Biophys Acta. 2006 Nov- Infarct volume and apraxia of speech in Promoting Hospitals, May 2006. Dec;1762(11-12):1150-7. Epub 2006 acute ischaemic hemispheral stroke. Authors: M. Cagney, M. Donnelly, C. Sep 29. J Neurol 2007 (in press). McGowan, B. Hayes Ryan A, Mullins G, Scott J, Connolly S, Book Chapters Educational Intervention Promoting Hardiman O, Yilmaz E, Vincent A, Hardiman O. Multidisciplinary Care In Awareness of Pregnancy at Work Lynch T. ALS (poster)– National Conference for 45-year history of acquired autoimmune In The Motor Neurone Disease Hand- Health Promoting Hospitals, November neuromyotonia. book. M.Kiernan (ed) 2006 and International Conference for J Neurol. 2006 Sep;253(9):1243-5. Epub MJA books 2007 Health Promoting Hospitals, May 2006. 2006 Sep 22 Authors: E. Burke, M. Cagney, M Parkinson N, Ince PG, Smith MO, Patents Donnelly, B. Hayes Highley R, Skibinski G, Andersen PM, 1.UK 0425625.1 Treatment of Disease ‘Prevention of Transmission of Blood Morrison KE, Pall HS, Hardiman O, (use of angiogenin in neurodegenerative Borne Diseases in the Healthcare Collinge J, Shaw PJ, Fisher EM. ALS and axonal disease) (Dr.Hardiman & Setting’ Faculty of Occupational Medi- phenotypes with mutations in CHMP2B Dr.Greenway) cine (RCPI) Newsletter, Summer 2006 (charged multi-vesicular body protein 2. Preliminary application: Angiogenin (Dr B Hayes). 2B). as a treatment of neurovascular Injury Neurology. 2006 Jun 28; [Epub ahead (Prof.Prehn, Dr.Kieran, Dr.Hardiman, OTOLARYNGOLOGY of print]. Dr.Greenway) Publications Murphy S, Doherty C, Moroney JT. Lucey DJ, Walsh MA, Costello R Apraxia of speech, orofacial apraxia, and Higher Degrees Awarded Impostor cell lines Dr. Sarah Hosbeck linguistic dysprosody after acute LARYNGOSCOPE 116 (1): 161-162 IGF regulation in chronic neurologic ischaemic stroke: challenging traditional JAN 2006 disease (UL) (With Dr.Phil Jakeman UL)) thinking. Spontaneous CSF otorrhea from a Awarded Jan 2006 J Neurol. May 2006; 253 (Suppl 2):21. defect in the medial wall of the middle Dr. Maria Doyle (With Dr.Kay Nolan Murphy S, Doherty C, Moroney JT. ear. UCD) Prospective Study of Speech and Otolaryngol Head Neck Surg. 2006 IGF regulation in muscle Language Deficits in Acute Ischaemic Jan;134(1):166-7. Awarded Nov 2006 Stroke: Preliminary findings in 10 Sheahan P, McConn-Walsh R, Walsh patients. Dr.Lorna Doherty (With Dr.Anne MA, Costello RW
116 BEAUMONTHOSPITAL ANNUAL REPORT 2006 Beaumont Hospital Research Report 2006
European Archives of Oto-Rhino-Laryn- MA, Costello RW. Subjects with non- Sabah M, Cummins R, Leader M, Kay gology (in press, accepted July 19, allergic non-infectious perennial rhinitis E. Immunohistochemical detection of 2006) do not show nasal hyper-responsive- hTERT protein in soft tissue sarcomas: Sheahan P, Walsh RM, Walsh MA, et al. ness to bradykinin. correlation with tumor grade. Induction of nasal hyper-responsiveness European Archives of Oto-Rhino-Laryn- Appl Immunohistochem Mol morphol. by allergen challenge in allergic rhinitis: gology (in press). 2006;14(2):198-202. the role of afferent and efferent nerves Sheahan P, Thornton M, McConn-Walsh Sabah M, Cummins R, Leader M, Kay CLINICALANDEXPERIMENTAL R, Walsh MA, Costello RW. Role of the E. Altered expression of cell cycle regu- ALLERGY 35 (1): 45-51 JAN 2005 muscarinic M2 receptor in human nasal latory proteins in gastrointestinal T Mackle, J Hughes, J Fenton, R mucosa. stromal tumors: markers with potential McConnWalsh. Sheahan P, Walsh RM, Rhinology (in press). prognostic implications. Hum Pathol. 2006;37(6):648-55. Walsh MA, et al. Sheahan P, McConn-Walsh R, Walsh Hyperresponsiveness of congestive MA, Costello RW. The ARIA Sabah M, Cummins R, Leader M, Kay nasal reflexes in allergic rhinitis classification of allergic rhinitis and E. Loss of p16 (INK4A) expression is RHINOLOGY 44 (1): 68-73 MAR 2006 nasal hyper-responsiveness. associated with allelic imbalance/loss of “Subjects with non-allergic non-infec- Journal of Laryngology and Otology heterozygosity of chromosome 9p21 in tious perennial rhinitis do not show (in press). microdissected malignant peripheral nerve sheath tumours. nasal hyperresponsiveness to Senthilvel E, Walsh R McConn, Brett F, App Immunohistochem Mol Morphol. bradykinin” Thornton MA, Walshe P, Rawluk D. Facial nerve schwannoma of 2006;14(1):97-102. Costello RW, et McConnwalsh R,Walsh the internal auditory canal. MA. Irish Journal of Medical Science Bartlett JM, Ibrahim M, Jasani B, Rafferty M, McConn Walsh R, Walsh 2006;175(1):74-76. Morgan JM, Ellis IO, Kay E, Magee H, Burnett S, Miller K. External quality MA. A comparison of temporal bone Hafidh MA, Sheahan P, Keogh I, assurance of HER2 FISH testing: fracture classification systems. McConn Walsh R. Acute epigottitis in Results of a UK NEQAS pilot scheme. Clinical Otolaryngology 2006;31:287- adults: a recent experience with 10 J Clin Pathol. 2006; 291. cases. Sheahan P, McConn-Walsh R, Walsh M, Journal of Laryngology and Otology Levine RA, Sanderson SO, Ploutz- Costello RW. Hyper-responsiveness of 2006;120:310-313. Snyder R, Murray F, Kay E, Hegarty J, Nolan N, Kelleher D, McDonald G, congestive nasal reflexes in allergic Mackle T, Hughes J, Walsh R McConn, O’Keane JC, Crowe J. Assessment of rhinitis. Rawluk D. Spontaneous CSF otorrhoea fibrosis progression in untreated Irish Rhinology 2006;44:68-73. secondary to a defect in the medial wall women with chronic hepatitis C of the middle ear. Hafidh M, Keogh I, McConn Walsh R, contracted from immunoglobulin anti-D. Otolaryngology/Head and Neck Surgery Walsh M, Rawluk D. Otogenic intracra- Clin Gastroenterol Hepatol. (in press). nial complications. A 7-year 2006;4(10):1271-7. retrospective review. Safdar A, Hughes J, Walsh R McConn, Kamel MH, Daly PJ, Khan MF, Kay EW, American Journal of Otolaryngology Walsh M. Aberrant internal carotid O’Kelly P, Hickey DP. Survival and 2007;27:390-395. artery in the middle ear. progression in high grade tumour Ear Nose and Throat Journal (in press). Thornton M, Sheahan P, Smyth C, subset of G2 and G3 pT1 bladder transi- Costello R, McConn-Walsh R, Walsh M. PATHOLOGY tional cell carcinoma. Eosinophil recruitment to nasal nerves Sabah M, Cummins R, Leader M, Kay Eur J Surg Oncol. 2006;32(10):1139-43. and induced nasal reflex responses E. Abberrant expression of the Rb Laing ME, Moloney FJ, Kay EW, Conlon after antigen challenge in allergic pathway pproteins in soft tissue rhinitis. American Journal of Respira- P, Murphy GM. Malignant melanoma in sarcomas. strasplant patients: review of five tory and Critical Care Medicine (in Appl Immunohistochem Mol Morphol. press). cases. Clin Exp Dermatol. 2006;14(4):397-403 2006;31(5):662-4. Hafidh M, Sheahan P, Keogh I, Walsh Gray SE, Kay EW, Leader M, Mabruk Conway CM, O’Shea D, O’Brien S, MR. Epiglottitis in adults: a recent expe- MJ. Enhanced detection of microsatel- rience with 10 cases. Lawler DK, Dodrill CD, O’Grady A, lite instability and mismatch repair gene Barrett H, Gulmann C, O’Driscoll L, Journal of Laryngology and Otology (in expression in cutaneous squamous cell press). Gallagher WM, Kay EW, O’Shea DG. carcinomas. The development and validation of the Sheahan P, McConn-Walsh R, Walsh Mol Diagn Ther. 2006;10(5):327-34. virtual tissue matrix, a software applica-
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tion that facilitates the review of tissue Robertson D, Owen M, Murphy KC, RAIN gel matching technique. microarrays on line. Murphy DG. Proteomics. 2006 Aug 23. MBC Bioinformatics. 2006;17(7):256. Processing facial emotions in adults Focking M, Boersema PJ, O’Donoghue with velo-cardio-facial syndrome: func- Hanly AM, Redmond M, Winter DC, N, Lubec G, Pennington SR, Cotter DR, tional magnetic resonance imaging. Brophy S, Deasy JM, Bouchier-Hayes Dunn MJ. Br J Psychiatry. 2006 Dec; 189:560-1. DJ, Kay EW. Thrombomodulin expres- 2-D EIGE as a quantitative tool for sion in colorectal carcinoma is Glaser B, Moskvina V, Kirov G, Murphy investigating the HUPO Brain Proteome protective and correlates with survival. KC, Williams H, Williams N, Owen MJ, Project mouse series. Br J Cancer. 2006;94(9):1320-5. O’Donovan MC. Proteomics. 2006 Aug 23; Analysis of ProDH, COMT and ZDHHC8 O’Donnell JL, Henry FB, Kavanagh E, Gaughran F, Payne J, Sedgwick PM, risk variants does not support individual Brennan P, Kay E, Murphy P, Kelly CJ. Cotter D, Berry M. or interactive effects on schizophrenia Unicentric Castleman’s disease: a Hippocajpal FGF-2 and FGFR1 mRNA susceptibility. surprising neck mass. expression in major depression, schizo- Schizophr Res. 2006 Oct;87 (1-3):21-7 Ir J Med Sci. 2006;175(1):79-80. phrenia and bipolar disorder. Gulmann C, Sheehan KM, Kay EW, Paylor R, Glaser B, Mupo A, Ataliotis P, Brain Res Bu.. 2006 Jul; 70(3):221-7 Spencer C, Sobotka A, Sparks C, Choi Liotta LA, Petricoin EF 3rd. Array based Beasley CL, Pennington K, Behan A, CH, Oghalai J, Curran S, Murphy KC, proteomics: mapping of protein Wait R, Dunn MJ, Cotter D. Monks S, Williams N, O’Donovan MC, circuitries for diagnostics, prognostics, Proteomic analysis of the anterior Owen MJ, Scambler PJ, Lindsay E. and therapy guidance in cancer. cingulated cortex in the major Tbx1 haploinsufficiency is linked to J Pathol. 2006;208(5):595-606. psychiatric disorders: Evidence for behavioural disorders in mice and disease-associated changes Ryan JG, Dorman AM, O’Connell PG. humans: implications for 22q11 deletion Proteomics 2006 June; 6(11):3414-25 AA amyloidtosis in psoriatic arthritis. syndrome. Ir J Med Sci. 2006;175(2):81-2. Proc Natl Acad Sci USA. 2006 May 16; Behan AT, Cotter DR. Johnston O, O’Kelly P, Spencer S, 103(20):7729-34 Neuropathology of Mood Disorders Psychiatry 2006; 5:5 180-182 Cunningham P, Dorman A, Donohoe J, Murphy DG, Daly E, Schmitz N, Toal F, Walshe JJ, Hickey D, Little DM, Conlon Murphy K, Curran S, Erlandsson K, Professor Mary Cannon PJ. The impact of donor spontaneous Eersels J, Kerwin R, Ell P, Travis M. Cannon M, Moffitt TE, Caspi A, Murray intracranial haemorrhage vs. other Cortical serotonin 5-HT2A receptor RM, Harrington HL, Poulton R. donors on long-term renal graft and binding and social communication in Neuropsychological performance at age patient survival. adults with Asperger's syndrome: an in 13 and later schizophreniform disorder. Clin Transplant. 2006;20(1):91-5. vivo SPECT study. Am J Psychiatry. British Journal of Psychiatry (2006) Little MA, Dupont P, Campbell E, 2006 May;163(5):934-6. 189463-464 Dorman A, Walshe JJ. Severity of Murtagh A, Murphy KC. Trial of risperi- Clarke MC, Harley M, Cannon M. The primary MPGN, rather than MPGN type, done in India – concerns. role of obstetric events in determines renal survival and post- Br J Psychiatry 2006 May; 188:489. schizophrenia. transplantation recurrence risk. Schizophrenia Bulletin (2006) 32:3-8 Kidney Int. 2006;69(3):504-11. Campbell LE, Daly E, Toal F, Stevens A, Azuma R. Catani M, NgV, van Cannon M, Harley M, Clarke MC, Arse- PSYCHIATRY Amelsvoort T, Chitnis X, Cutter W, neault L, Caspi A. Professor Kieran Murphy Murphy DG. Murphy KC. Genes, cannabis and psychosis. Brian and behaviour in children with Page LA, Daly E. Schmitz N. Simmons Beyond Nature and Nurture: Genes, 22q11.2 deletion syndrome: a A, Toal F, Deeley Q, Ambery F, environment and their interaction in volumetric and voxel-based morphom- McAlonan GM, Murphy KC, Murphy Psychiatry. Chapter 16 (Eds: McCabe J, etry MRI study. DG. O’Daly O, McGuffin P, Murray R, Wright Brain. 2006 May;129(Pt 5): 1218-28 In vivo 1H-magnetic resonance spec- P). Informa Healthcare, UK, 2006: 141- troscopy study of Professor David Cotter 156 amygdale-hippocampal and parietal Dowsey AW, English J, Pennington K, Invited Presentations regions in autism. Cotter D, Stuehler K, Marcus K, Meyer Professor David Cotter Am J Psychiatry. 2006 Dec; HE, Dunn MJ, Yang GZ. HUPO Brain Proteome Project Schizo- 163(12):2189-92 Examination of 2-DE in the Human phrenia – A valid target of Proteomic Proteome Organisation Brain Proteome Van Amelsvoort T, Schmitz N, Daly E, Analysis February 2006. Deeley Q, Critchley H, Henry J, Project pilot students with the new
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The Finnish Psychiatric Association Pediatr Transplant. 2006 Nov;10(7):816- Conlon PJ. Spring Meeting Plenary Lecture, March 21 The impact of donor spontaneous 2006: What Proteomic Analysis tells us Johnston O, O'Kelly P, Spencer S, intracranial haemorrhage vs. other of Psychiatric Disorder. Helsinki, Finland Donohoe J, Walshe JJ, Little DM, donors on long-term renal graft and . March 2006. Hickey D, Conlon PJ. patient survival. Professor Mary Cannon Reduced graft function (with or without Clin Transplant. 2006 Jan-Feb;20(1): 91-5. Western European Regional CINP dialysis) vs immediate graft function--a Conference, Queen’s University Belfast. comparison of long-term renal allograft Little MA, Dupont P, Campbell E, April 2006 survival. Dorman A, Walshe JJ. Cannabis & Psychosis? – What is the Nephrol Dial Transplant. 2006 Severity of primary MPGN, rather than link? Aug;21(8):2270-4. MPGN type, determines renal survival and post-transplantation recurrence SWAHB Child Psychiatry Services Moloney FJ, Dicker P, Conlon PJ, Shields DC, Murphy GM risk. Academic Meeting, Cherry Orchard Kidney Int. 2006 Feb;69(3):504-11. Hospital. April 2006 The frequency and significance of thiop- Early risk factors for adult urine S-methyltransferase gene Giblin L, Hollander M, Little D, Hickey schizophrenia. polymorphisms in azathioprine-treated D, Donohoe J, Walshe JJ, Dorman A, renal transplant recipients. O'Kelly P, Conlon PJ. Academic Meeting, St. Ita’s Hospital, Br J Dermatol. 2006 Jun;154(6):1 Renal transplantation in the elderly--the Dublin 199-200 Irish experience. Guest Speaker: ‘Cannabis and Ir J Med Sci. 2005 Apr-Jun;174(2):9-13. Psychosis – what is the link?” Johnston O, O'Kelly P, Spencer S, November 2006 Cunningham P, Dorman A, Donohoe J, Johnston O, O'Kelly P, Donohue J, Walshe JJ, Hickey D, Little DM, Conlon Walshe JJ, Little DM, Hickey D, Northern Ireland Schizophrenia Forum. PJ. The impact of donor spontaneous Conlon PJ. Malone House, Belfast intracranial haemorrhage vs. other Favorable graft survival in renal trans- ‘Cannabis and Psychosis – what is the donors on long-term renal graft and plant recipients with polycystic kidney link?” November 2006 patient survival. disease. Professor Kieran Murphy Clin Transplant. 2006 Jan-Feb;20(1): Ren Fail. 2005;27(3):309-14. 91-5. ‘Mind Matters’ RTE Radio Science O'Kelly P, Giblin L, Spencer S, Donohoe Series Moloney FJ, Comber H, Conlon PJ, J, Walshe JJ, Little DM, Hickey D, Autism. March 2006 Murphy GM Cunningham P, Conlon PJ. The role of immunosuppression in the Outcomes of adult cadaveric renal 12th Annual International Scientific pathogenesis of basal cell carcinoma. transplantation in Ireland 1986 to 2001. Meeting of the VCFS Educational Br J Dermatol. 2006 Apr;154(4):790-1. Ir J Med Sci. 2005 Jan-Mar;174(1):42-8. Foundation. FISHing for the neurobiology of Moloney FJ, Comber H, O'Lorcain P, Giblin L, O'Kelly P, Little D, Hickey D, behaviour. Strasbourg July 2006. O'Kelly P, Conlon PJ, Murphy GM Donohue J, Walshe JJ, Spencer S, A population-based study of skin cancer Conlon PJ. 5th International 22q11.2 Deletion incidence and prevalence in renal A comparison of long-term graft survival Syndrome Conference. FISHing for the transplant recipients. rates between the first and second neurobiology of behaviour. Br J Dermatol. 2006 Mar;154(3): donor kidney transplanted--the effect of Marseilles, France July 2006 498-504. a longer cold ischaemic time for the National Conference on Child and Johnston O, O'kelly P, Spencer S, second kidney. Adolescent Psychiatry. The Syndrome Donohoe J, Walshe JJ, Little DM, Am J Transplant. 2005 May;5(5):1071-5. of Psychosis. Dublin June 2006 Hickey D, Conlon PJ. Papers Presented at Reduced graft function (with or without RENAL International/National Meetings dialysis) vs immediate graft function--a Congress of American Society of Published Papers comparison of long-term renal allograft Kamel MH, Mohan P, Conlon PJ, Little Nephrology survival. DM, O'Kelly P, Hickey, DP Rabbit November 14th -19th, 2006 – Nephrol Dial Transplant. 2006 Antithymocyte globulin related San Diego, CA, USA. Aug;21(8):2270-4. Epub 2006 May 23. decrease in platelet count reduced risk Plamapheresis as a Rescue Therapy in of paediatric renal transplant graft Johnston O, O'Kelly P, Spencer S, Acute Humoral Rejection (AHR) – A thrombosis. Cunningham P, Dorman A, Donohoe J, Long Term Follow-Up Study. Catherine Walshe JJ, Hickey D, Little DM, Brown, Gearoid McMahon, John
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Donohue, Peter Conlon, J. J. Walshe. Sanjay Haresh Chotirmal, Anthony A Longitudinal Study of Catecholamine Dept of Nephrology and Transplanta- Dorman, Joseph Walshe. Excretion in Pregnancy. G McMahon, tion, Beaumont Hospital, Dublin, Ireland Nephrology & Transplantation, K Abraham, M Little, R Fitzgerald, Co-Trimoxazole Induced Acute Beaumont Hospital, Dublin, Ireland. W Tormey and JJ Walshe. Interstitial Nephritis in the Early Post- BK Virus Nephropathy – A Single-Centre Dept of Nephrology, Beaumont 1 Hospital, Dublin, Ireland. Transplant Period. J. P. Garvey, H. Experience. G. McMahon1, S.P. Daniel1, 1 2 1 Chotirmall, T. Dorman, P. Conlon, J. S. Spencer2, T. Dorman2, P. Conlon1, Localised Argyria – An Unusual Compli- 1 Donohoe,1 J. Walshe. J. Donohoe1, J.J. Walshe1. cation of Prolonged Topical Silver 1 Dept of Nephrology & Transplantation, 1Dept of Nephrology, Beaumont Nitrate Use Around the Exit Site during Beaumont Hospital, Dublin, Ireland; Hospital, Dublin, Ireland; 2Rotunda Ambulatory Peritoneal Dialysis. Osman 2 Dept of Renal Pathology, Beaumont Maternity Hospital, Dublin, Ireland. G, Sultan N, McGrath M, Phelan E, Kelly Hospital, Dublin, Ireland. FJ, Leavey S, Walshe JJ, Walker JR. Urine Catecholamine Excretion during Irish Nephrology Society Renal Units – Waterford Regional Scientific Meeting/Annual General Pregnancy in Normotensive and Hyper- Hospital and Beaumont Hospital, Meeting, O’Reilly Hall, U.C.D., Belfield tensive Primigravidae. Gearoid Dublin. 1 1 Friday 5th May 2006 McMahon, Roly Fitzgerald, K.A. Switching Phosphate Binder to 1 1 Abraham, William Tormey, Mairead Haemodialysis and Peritonela Dialysis – Lanthanum Carbonate in Haemodialysis 2 1 Kennelly, J. J. Walshe, A Comparison of Outcomes after Renal Patients with Persistent 1 Dept of Nephrology, Beaumont Transplantation. G McMahon, S Hyperphosphataemia. P Phelan, 2 Hospital, Dublin, Ireland, National Spencer, C Browne, P O’Kelly, P J Donohoe, J Walshe, P Conlon. Maternity Hospital, Dublin, Ireland. Conlon, J Donohoe and JJ Walshe. Dept of Nephrology, Beaumont Dept of Nephrology & Transplantation, Haemodialysis and Peritoneal Dialysis – Hospital, Dublin, Ireland. Beaumont Hospital, Dublin, Ireland. A Comparison of Outcomes after Renal Use of Cinacalcet HCI in Beaumont Transplantation. Gearoid McMahon, Plasmapheresis as Rescue Therapy in Haemodialysis Patients. P Phelan, Susan Spencer, Catherine Brown, Accelerated Acute Humoral Rejection – C Brummell, J Donohoe, J Walshe, Patrick O’Kelly, Peter Conlon, John a follow up of long term graft survival. P Conlon. Donohoe, J. J. Walshe. C Brown, G McMahon, L Donohoe, Dept of Nephrology, Beaumont Dept of Nephrology, Beaumont P Conlon, and JJ Walshe. Hospital, Dublin, Ireland. Hospital, Dublin, Ireland. National Kidney Centre, Beaumont Hospital, Dublin 9. NDT – Nephrology Dialysis Transplantation Outcomes in Anti-GBM Disease; a XLIII Congress of the European Renal single centre experience. DG Cheriyan, Association, European dialysis and MA Azeez, P Lavin, D Gopinathan, T Transplant Association (ERA-EDTA) Dorman, M Keoghan, E Cambell, P July 15th -18th, 2006 O’Kelly, J Walshe, Jd Donohoe, Pj Glasgow, United Kingdom Conlon. Dept of Nephrology & Transplantation, Sirolimus in chronic Allograft Beaumont Hospital, Dublin, Ireland. Nephropathy. J.P. Garvey, Sanjay Haresh Chotirmall, Simon Curran, Peter Survival of Patients on Dialysis in Beau- Conlon, John Donohoe, Joseph Walshe. mont Hospital – 16 Year Experience. Nephrology & Transplantation, D Gopinathan, P Lavin, Patrick O’Kelly, Beaumont Hospital, Dublin, Ireland. JJ Walshe, J Donohoe, P Conlon. Dept of Nephrology & Transplantation, A Longitudinal Study of Catecholamine Beaumont Hospital, Dublin, Ireland. Production in Pregnancy. G. McMahon1, K. Abraham1, M. Little1, R. Fitzgerald1, BK Virus Nephropathy – A Single-Centre M. Kennelly2, J.J. Walshe1.2. Experience. G McMahon, SP Daniel, 1Dept of Nephrology, Beaumont S Spencer, T Dorman, P Conlon, Hospital, Dublin, Ireland; 2Rotunda J Donohoe and JJ Walshe. Maternity Hospital, Dublin, Ireland. Dept of Nephrology and Transplanta- tion, Beaumont Hosptial, Dublin, Co-Trimoxazole Induced Acute Intersti- Ireland. tial Nephritis in Renal Allografts: Clinical Course and Outcome. J.P. Garvey,
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