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 BEAUMONT HOSPITAL 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 BEAUMONT HOSPITAL 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.