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Limerick 1970’s. Limerick 1950’s Limerick 2010 Our Lady of Lourdes.

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Presentation on theme: "Limerick 1970’s. Limerick 1950’s Limerick 2010 Our Lady of Lourdes."— Presentation transcript:

1 Limerick 1970’s

2 Limerick 1950’s

3 Limerick 2010

4 Our Lady of Lourdes

5 South Tipperary General Hospital

6 ….. recent reports that the ongoing violence has moved off the streets of Limerick, and spread elsewhere in the country, are apparently true…. RTE Newsflash:

7 Reconfiguration in South East

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9 Dept of General Surgery, STGH Dept of General Surgery, STGH

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11 D.I.Y National Surgical Reconfiguration Project

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14 Reconfiguration of Acute Hospital Care: just what is it all about anyway ? …

15 Reconfiguration: Modernisation ? Improvement of Services ? Altering the Role ? Gaining Control ?

16 W here is the evidence that the patient benefits ? …

17 or, is it just about downgrading… !

18 History of Successful Reconfiguration in Irish Health Services - FEDERATED HOSPITALS - MANCH - JERVIS St / RICHMOND - SOUTH DUBLIN - CORK - WRH So what’s the common theme ?

19 Reconfiguration of Acute Services Urban vs Rural Road Network 2000 vs Motorway Network 2010 Celtic Tiger 2000 era vs Anglo world 2010 Evidence of benefit

20 Motorway & Major Road Network 2010

21 Has there been successful reconfiguration of acute Services in Smaller hospitals ? ….

22 What defines a ‘smaller’ Hospital ?.. - Bed numbers - Activity - Complexity of work - Budget -Geography -Hospitals now well flagged

23 Independently Resourced Hospitals Blackrock Clinic MPH Beacon Bons Secours Hospital Group Hermitage Clinic Whitfield Mount Carmel Hospital Group Galway Clinic ….. and others

24 -Kilkenny -Portlaoise -Portiuncula -Tullamore -South Tipperary ( Reconfiguration 2007) -Kerry -Wexford -North Western group -Naas -Mullingar The real question is can we or should we reconfigure Acute core services in the Intermediate-sized Hospitals

25 Drivers of Reconfiguration Critical Mass Outcomes Government Policy / Transformation Programme Safety / Licensing Specialism Working Time Restrictions Diminishing pool of Doctors / Professionals Costs Training ‘The Claims’

26 ‘Drivers’ of Reconfiguration - Critical MassDiffers hugely in every western country - OutcomesNo Evidence for vast majority of acute conditions - SafetyRead the papers - SpecialismRecognized ceilings - Working Time Restrictions Mostly being achieved - Diminishing pool of Doctors / ProfessionalsFault is one of policy / manpower embargo - CostsNo Savings - TrainingAsk the trainees ‘The Counter Claims’

27 What services are working well vs What services would work better in central located hopsital vs What financial benefits are accrued from reconfiguration Reconfiguration should be about :

28 Necessary Reconfiguration vs Unnecessary Reconfiguration vs Unsafe Reconfiguration Getting the balance correct

29 Stranger things happen !...

30 So what have we done ? …..

31 South Tipperary General Hospital

32 S.T.G.H Surgical Hospital Cashel 1940 Surgical Hospital Cashel 1952 Medical/Maternity Hospital in Clonmel 1952 Medical/Maternity Hospital in Clonmel 1969 Acute Psychiatric Unit integrated in Clonmel 1969 Acute Psychiatric Unit integrated in Clonmel 1996 High Court agreement to reconfigure all acute care 1996 High Court agreement to reconfigure all acute care 2007 Reconfiguration finally happens 2007 Reconfiguration finally happens 2008 May: Official opening STGH by Minister Mary Harney 2008 May: Official opening STGH by Minister Mary Harney

33 Demographics STGH Population Served Population Served Med/surg/mat/gynae/paeds: 110,000 Med/surg/mat/gynae/paeds: 110,000 Psychiatry: 150,000 (planned 88,000) Psychiatry: 150,000 (planned 88,000) Pop.Profile: Mixed urban/rural (70% rural) Pop.Profile: Mixed urban/rural (70% rural) Major manufacturing farming equine centre Major manufacturing farming equine centre Geographic Area: Approx 1,000 sq miles Geographic Area: Approx 1,000 sq miles

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35 National Statistics In-patient Discharges

36 Overview Statistics 2009 STGH Discharges 12, % Discharges 12, % Day Cases 8, % Day Cases 8, % Radiology Procedures 74, % Radiology Procedures 74, % E D Attendances 34, % E D Attendances 34, % Deliveries 1, % (+36%/3 years) Deliveries 1, % (+36%/3 years) OPD Attendances 47, % OPD Attendances 47, % G I Endoscopies 3, % G I Endoscopies 3, %

37 Services Surgery General Surgery General Surgery Urology Surgery Urology Obstetrics & Gynaecology Obstetrics & Gynaecology Paediatrics & Neonatology Paediatrics & Neonatology Acute Psychiatry Acute Psychiatry E.D. E.D. Imaging including 24 hour CT Imaging including 24 hour CT Laboratory Laboratory

38 Services General Medicine General MedicineCardiologyDiabetes/EndocrinologyGerontology Acute Stroke Unit GastroenterologyRheumatologyMAU

39 E D Workstation

40 ED Minor Injuries Adult resus

41 Emergency Department Activity % change % change New Atts 25,943 29,116 31,832 Return 2,692 2,830 3,079 Total 28,185 31,946 34,911 +9

42 National Statistics

43 1 of 4 New Theatres

44 Surgery % Change Admissions2,7442,7323, Average Length of Stay 4.58 Day Cases 2,3412,4592, Operations Major Minor1,5381,3931, Endoscopies1,7742,3362, Out-Patients New Attendances 2,363 Return4,166

45 Surgical Department South East Comparative Statistics Jan-Nov 2008 WaterfordWexfordKilkennyClonmel InpatientDischarges Daycases (2527:2009) A.L.O.S. (Days) % Surgical Daycases of Total %18%30%34%(45%:2009) % Surgical Admission s with no procedure 31%36%38%20%

46 Day Ward Endoscopy

47 1 of five new inpatient wards

48 Medical Department % Change Admissions4,9965,3314, Average Length of Stay Day Cases (inc MIC*) 2,3482,6802, Medical Oncology NANA2,336 Day Cases Total 5,197 Out-Patients New Attendances 2,295 Return7,900 TOTAL10,195 Endoscopies1,3321,6251,

49 Medical Departments S E Hospital Comparisons General Medical Jan-Nov ‘08 WaterfordWexfordKilkennyClonmel Admissions ALOS (Days) Daycases (5197:2009) (5197:2009) Casemix Index

50 New Intensive Care Unit

51 ICU Activity Snapshot Patients Bed Days Used Occupancy (%)

52 Anaesthetics Activity Snapshot SurgicalAnaesthetics % Change GynaecologyAnaesthetics ObstetricAnaesthetics (’06)

53 Obstetrics % change Admissions1, Average Length of Stay Days Births1,1781,365+15

54 Gynaecology Activity % change Admissions Average Length of Stay Number of Procedures Day Cases Total OutpatientsNew1,141Return2,085 Total3,226

55 Paediatric Party

56 Paediatrics Activity % Chan ge Admissions1,3811,7421, Average Length of Stay Day Cases

57 Psychiatry Activity Acute Admissions Out-Patients845

58 X – Ray Dept

59 Imaging Activity % Change X-Rays46,51753, CT Scans 3,8465, Ultrasounds10,75213, Dexa Scans 1,0031, Total62,55074,557+20

60 New Oncology Ward

61 In Hospital Visiting Consultant Led Services  Oncology  Palliative Care  Dermatology  Haematology  Microbiology  Orthopaedics and Fracture Clinics

62 New physio gym New physio gym

63 In Hospital Associate Specialties: Cardiac Investigation Cardiac Investigation Dietetic Dietetic Laboratory Laboratory Pharmacy Pharmacy Physiotherapy Physiotherapy Occupational Therapy Occupational Therapy Speech and Language Therapy Speech and Language Therapy

64 Library

65 Academic Links UCC Integral Teaching Hospital UCC Integral Teaching Hospital U.Lim Integral Teaching Hospital 1 st Aug 2010 U.Lim Integral Teaching Hospital 1 st Aug 2010 UCD Paediatrics Medical School UCD Paediatrics Medical School U.Lim Midwifery Training Placements U.Lim Midwifery Training Placements U.LimPhysiotherapy Placements U.LimPhysiotherapy Placements WIT General Nurse Training Placements WIT General Nurse Training Placements WIT Strategy Development WIT Strategy Development WIT Research/Service Evaluation Training WIT Research/Service Evaluation Training DITCardiac Technician Placements DITCardiac Technician Placements

66 Medical Unit Morbidity/Mortality Conference 26/03/10

67 Innovations STGH 1969 One of the first acute mental health inpatient units 1969 One of the first acute mental health inpatient units integrated into general hospital integrated into general hospital 1985 First County Hospital fully developed diabetes/endocrine 1985 First County Hospital fully developed diabetes/endocrine service service 1986 First rheumatology service S. E First rheumatology service S. E First dietetic service S. E First dietetic service S. E First open access GI endoscopy service Ireland 1992 First open access GI endoscopy service Ireland 1992 First multi disciplinary infertility clinic outside Dublin 1992 First multi disciplinary infertility clinic outside Dublin 1994 First colposcopy service S.E First colposcopy service S.E First pulmonary rehab service outside Dublin 2001 First pulmonary rehab service outside Dublin 2002 First joint inflammatory bowel disease clinic Ireland 2002 First joint inflammatory bowel disease clinic Ireland 2007 Syncope assessment service 2007 Syncope assessment service 2009 Acute stroke unit with thrombolysis 2009 Acute stroke unit with thrombolysis 2009 First fracture liaison service in non-orthopaedic centre 2009 First fracture liaison service in non-orthopaedic centre

68 S E Hospitals Comparison 2009 WaterfordWexfordKilkennyClonmel Beds Occupancy % ALOS InpatientsDischarged21,28114,34715,78812,794 Day cases Discharged18,7216,5899,2816,680 OPD Attendance 114,08752,36948,24145,241 New OPD Attendance 23,58012,20115,97212,594 Return OPD Attendance90,50740,16832,26932,677 Number of Deliveries (’08) 2,6082,4142,201 1,365 (’09)

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70 Projected Annual Activity of Regional Centre of Excellence South East Elective Inpatients 12,290 Non- Elective 48,700 Total Inpatients 60,990 Deliveries 8,900 ED Attendance 127,000 ED Attendance 127,000 (Allowing for 50% reduction from peripheral hospitals) (Allowing for 50% reduction from peripheral hospitals)

71 Estimated Requirement for Acute Day & Local Rehabilitation Beds Regional Centre of Excellence SE Acute Inpatient Beds 900 Day Beds 48 Rehab 128 Rehab 128 Total 1076 Current Total 572 New Bed Requirement 496 (Based on Horwath/Teamwork Report HSE Mid-West 2008)

72 Conditions for Reconfiguration SE Hospitals Acute Services 1 No acute service withdrawn until regional centre resourced & ready to deliver service 1 No acute service withdrawn until regional centre resourced & ready to deliver service 2 The PCCC resourced, developed & working to international best practice standards in & out of hours. 2 The PCCC resourced, developed & working to international best practice standards in & out of hours. 3 Ambulance service has fully developed mobile response capabilities by training advanced paramedics and deploying them to all areas of SE 3 Ambulance service has fully developed mobile response capabilities by training advanced paramedics and deploying them to all areas of SE

73 Conditions for Reconfiguration 4 Helicopter medical emergency service is fully integrated into emergency care system SE. fully integrated into emergency care system SE. 5 Advanced nurse practitioner & clinical nurse specialist workforce in place – network of local nurse led urgent care centres. nurse specialist workforce in place – network of local nurse led urgent care centres. 6 Effective partnership across all elements of pre- hospital & hospital systems.

74 Conclusions Thriving 3 year old hospital with outstanding ethos of service & innovation Thriving 3 year old hospital with outstanding ethos of service & innovation Ever expanding local & outreach work Ever expanding local & outreach work Vital part of infrastructure of a major population & industrial centre Vital part of infrastructure of a major population & industrial centre Impossible to provide adequate alternative Impossible to provide adequate alternative services without very major expenditure services without very major expenditure

75 Thomond Park 2005

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80 Teamwork

81 Leaders

82 Backup !

83 Catch …..

84 Turn….

85 Now, Do You want to be the player scoring the goal, or the one throwing the stick ? …..

86 Unnecessary Reconfiguration in Ireland 2010 Doomed


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