Limerick 1970’s. Limerick 1950’s Limerick 2010 Our Lady of Lourdes.
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Transcript of Limerick 1970’s. Limerick 1950’s Limerick 2010 Our Lady of Lourdes.
Limerick 1970’s
Limerick 1950’s
Limerick 2010
Our Lady of Lourdes
South Tipperary General HospitalSouth Tipperary General Hospital
….. recent reports that the ongoing violence has moved off the streetsof Limerick, and spread elsewhere in the country, are apparently true….
RTE Newsflash:
Reconfiguration in South East
Reconfiguration in South East
Dept of General Surgery, STGH Dept of General Surgery, STGH
D.I.Y. 2010
National Surgical Reconfiguration Project
Reconfiguration of Acute Hospital Care:
just what is it all about anyway ? …
Reconfiguration:
Modernisation ?
Improvement of Services ?
Altering the Role ?
Gaining Control ?
Where is the evidence that the patient benefits ? …
or, is it just about downgrading… !
History of Successful Reconfiguration in Irish Health Services
- FEDERATED HOSPITALS
- MANCH
- JERVIS St / RICHMOND
- SOUTH DUBLIN
- CORK
- WRH
So what’s the common theme ?
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
Motorway & Major Road Network 2010
Has there been successful reconfiguration of acute Services in Smaller hospitals ? ….
What defines a ‘smaller’ Hospital ? ..
- Bed numbers
- Activity
- Complexity of work
- Budget
-Geography
-Hospitals now well flagged
Independently Resourced Hospitals
Blackrock Clinic
MPH
Beacon
Bons Secours Hospital Group
Hermitage Clinic
Whitfield
Mount Carmel Hospital Group
Galway Clinic
….. and others
-Kilkenny
-Portlaoise
-Portiuncula
-Tullamore
-South Tipperary ( Reconfiguration 2007)
-Kerry
-Wexford
-North Western group
-Naas
-Mullingar
The real question is can we or should we reconfigureAcute core services in the Intermediate-sized Hospitals
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’
‘Drivers’ of Reconfiguration
- Critical Mass Differs hugely in every western country
- Outcomes No Evidence for vast majority of acute conditions
- Safety Read the papers
- Specialism Recognized ceilings
- Working Time Restrictions Mostly being achieved
- Diminishing pool of Doctors / Professionals Fault is one of policy / manpower embargo
- Costs No Savings
- Training Ask the trainees
‘The Counter Claims’
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 :
Necessary Reconfiguration
vs
Unnecessary Reconfiguration
vs
Unsafe Reconfiguration
Getting the balance correct
Stranger things happen ! ...
So what have we done ? …..
South Tipperary General South Tipperary General HospitalHospital
S.T.G.H.S.T.G.H.
1940 Surgical Hospital Cashel1940 Surgical Hospital Cashel 1952 Medical/Maternity Hospital in Clonmel1952 Medical/Maternity Hospital in Clonmel 1969 Acute Psychiatric Unit integrated in 1969 Acute Psychiatric Unit integrated in
ClonmelClonmel 1996 High Court agreement to reconfigure all 1996 High Court agreement to reconfigure all
acute careacute care 2007 Reconfiguration finally happens2007 Reconfiguration finally happens 2008 May: Official opening STGH by Minister 2008 May: Official opening STGH by Minister
Mary Harney Mary Harney
Demographics STGHDemographics STGH
Population ServedPopulation Served
Med/surg/mat/gynae/paeds: 110,000Med/surg/mat/gynae/paeds: 110,000
Psychiatry: 150,000 (planned 88,000)Psychiatry: 150,000 (planned 88,000)
Pop.Profile: Mixed urban/rural (70% Pop.Profile: Mixed urban/rural (70% rural)rural)
Major manufacturing farming equine Major manufacturing farming equine centrecentre
Geographic Area: Approx 1,000 sq miles Geographic Area: Approx 1,000 sq miles
National Statistics National Statistics
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
Bantry
Monaghan
St. John's
Mallow
St.
Nenagh
Ennis G
eneral
Louth
Roscom
mon
Merlin Park
St. Michaels
Our L
ady's
Naas G
eneral
South
Connolly
Mercy
Midland
Midland
Portiuncula
South
Cavan
Kerry
St. Vincents
St. Luke's
Mater
Wexford
In-patient Discharges
Overview Statistics 2009 STGHOverview Statistics 2009 STGH
Discharges 12,794 + 3%Discharges 12,794 + 3% Day Cases 8,430 + 46%Day Cases 8,430 + 46% Radiology Procedures 74,557 + 20% Radiology Procedures 74,557 + 20%
E D Attendances 34,911 + 6%E D Attendances 34,911 + 6% Deliveries 1,365 + 15% (+36%/3 years)Deliveries 1,365 + 15% (+36%/3 years) OPD Attendances 47,045 + 6% OPD Attendances 47,045 + 6% G I Endoscopies 3,993 + 1% G I Endoscopies 3,993 + 1%
ServicesServices
Surgery GeneralSurgery General Surgery UrologySurgery Urology Obstetrics & GynaecologyObstetrics & Gynaecology Paediatrics & NeonatologyPaediatrics & Neonatology Acute PsychiatryAcute Psychiatry E.D.E.D. Imaging including 24 hour CTImaging including 24 hour CT Laboratory Laboratory
ServicesServices
General Medicine General Medicine
CardiologyCardiologyDiabetes/EndocrinologyDiabetes/EndocrinologyGerontologyGerontologyAcute Stroke UnitAcute Stroke UnitGastroenterologyGastroenterologyRheumatologyRheumatologyMAUMAU
E D WorkstationE D Workstation
ED Minor Injuries ED Minor Injuries Adult resus Adult resus
Emergency Department Emergency Department ActivityActivity
2007 2008 2009 % 2007 2008 2009 % changechange
New Atts 25,943 29,116 31,832 New Atts 25,943 29,116 31,832
Return 2,692 2,830 3,079Return 2,692 2,830 3,079
Total 28,185 31,946 34,911 +9 Total 28,185 31,946 34,911 +9
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Rosco
mm
on C
ounty
St. M
ichaels
Nen
agh G
eneral
Louth
County
St. Jo
hn's H
osp
ital,
Ennis G
eneral
Our L
ady's G
eneral
Portiu
ncu
la Hosp
ital,
South
Infirm
ary
St. C
olu
mcilles
Mercy
Hosp
ital,
Cav
an G
eneral
Naas G
eneral
South
Tip
perary
May
o G
eneral
Mid
land R
egio
nal
Letterk
enny G
eneral
Connolly
Hosp
ital
St. L
uke's H
osp
ital,
Kerry
Gen
eral
Slig
o G
eneral
Wex
ford
Gen
eral
Longfo
rd/W
estmeath
ED Attendances 2007
National Statistics National Statistics
1 of 4 New Theatres1 of 4 New Theatres
SurgerySurgery20072007 20082008 20092009 % Change% Change
AdmissionsAdmissions 2,7442,744 2,7322,732 3,0063,006 + 10+ 10
Average Length of StayAverage Length of Stay 4.584.58
Day Cases Day Cases 2,3412,341 2,4592,459 2,5272,527 + 5+ 5
OperationsOperations
MajorMajor 832832 792792 981981 + 23+ 23
MinorMinor 1,5381,538 1,3931,393 1,6941,694 + 21+ 21
EndoscopiesEndoscopies 1,7741,774 2,3362,336 2,2812,281 - 2- 2
Out-PatientsOut-Patients
New AttendancesNew Attendances 2,3632,363
ReturnReturn 4,1664,166
Surgical Department South East Surgical Department South East Comparative Statistics Jan-Nov 2008Comparative Statistics Jan-Nov 2008
WaterfordWaterford Wexford Wexford KilkennyKilkenny ClonmelClonmel
Inpatient Inpatient DischargesDischarges
25522552 29822982 34263426 30063006
DaycasesDaycases 23172317 19851985 23052305 23222322(2527:2009)(2527:2009)
A.L.O.S. A.L.O.S. (Days)(Days)
6.416.41 4.94.9 4.374.37 4.584.58
% Surgical % Surgical Daycases Daycases of Total of Total 20072007
31%31% 18%18% 30%30% 34%34%(45%:2009)(45%:2009)
% Surgical % Surgical AdmissionAdmissions with no s with no procedure procedure
31%31% 36%36% 38%38% 20%20%
Day Ward EndoscopyDay Ward Endoscopy
1 of five new inpatient 1 of five new inpatient wardswards
Medical DepartmentMedical Department20072007 20082008 20092009 % Change% Change
AdmissionsAdmissions 4,9964,996 5,3315,331 4,8644,864 - 10- 10
Average Length of StayAverage Length of Stay 6.296.29 6.256.25
Day Cases (inc MIC*)Day Cases (inc MIC*) 2,3482,348 2,6802,680 2,8612,861 + 7+ 7
Medical OncologyMedical Oncology NANA NANA 2,3362,336
Day Cases TotalDay Cases Total 5,1975,197
Out-PatientsOut-Patients
New AttendancesNew Attendances 2,2952,295
ReturnReturn 7,9007,900
TOTALTOTAL 10,19510,195
EndoscopiesEndoscopies 1,3321,332 1,6251,625 1,7121,712 + 5+ 5
Medical Departments S E Hospital ComparisonsMedical Departments S E Hospital ComparisonsGeneral Medical Jan-Nov ‘08General Medical Jan-Nov ‘08
WaterfordWaterford Wexford Wexford KilkennyKilkenny ClonmelClonmel
AdmissionsAdmissions 46864686 68566856 56675667 53315331
ALOS ALOS (Days)(Days)
9.09.0 6.456.45 5.815.81 6.296.29
DaycasesDaycases 25342534 14031403 14471447 24642464 (5197:2009)(5197:2009)
Casemix Casemix IndexIndex
.95.95 .86.86 .76.76 .96.96
New Intensive Care UnitNew Intensive Care Unit
ICU Activity SnapshotICU Activity Snapshot
PatientsPatients Bed Days UsedBed Days Used Occupancy (%)Occupancy (%)
20062006 4242 695695 4848
20082008 135135 16271627 8484
Anaesthetics Activity SnapshotAnaesthetics Activity Snapshot
SurgicalSurgicalAnaestheticsAnaesthetics % % ChangeChange
GynaecologyGynaecologyAnaestheticsAnaesthetics % % ChangeChange
ObstetricObstetricAnaestheticsAnaesthetics % Change% Change
20082008 21852185 13791379 226 (’06)226 (’06)
20092009 26752675 2222 15941594 1616 521521 130130
ObstetricsObstetrics
20082008 20092009 % change% change
AdmissionsAdmissions 1,9571,957 20522052 +5+5
Average Length Average Length of Stay Daysof Stay Days
3.173.17 3.163.16
BirthsBirths 1,1781,178 1,3651,365 +15+15
GynaecologyGynaecology
Activity
20082008 20092009% change% change
AdmissionsAdmissions 845845 783783 639639 -13-13
Average Length Average Length of Stayof Stay
2.72.7 2.642.64
Number of Number of Procedures Procedures
13791379 15941594 1616
Day CasesDay Cases 139139 259259 347347 +32+32
TotalTotal 984984 10321032 986986Outpatients
NewNew1,1411,141
ReturnReturn 2,0852,085
TotalTotal 3,2263,226
Paediatric PartyPaediatric Party
Paediatrics ActivityPaediatrics Activity
20072007 20082008 20092009 % % ChanChangege
AdmissionsAdmissions 1,3811,381 1,7421,742 1,4921,492 - 15- 15
Average Length of Average Length of StayStay
2.622.62 2.582.58
Day CasesDay Cases 1515 109109 109109 00
Psychiatry ActivityPsychiatry Activity
20072007 20082008 20092009
Acute Acute AdmissionsAdmissions
602602 663663 661661
Out-PatientsOut-Patients 845845
X – Ray DeptX – Ray Dept
Imaging ActivityImaging Activity
20082008 20092009 % Change% Change
X-RaysX-Rays 46,51746,517 53,54153,541 +15+15
CT ScansCT Scans 3,8463,846 5,9905,990 +59+59
UltrasoundsUltrasounds 10,75210,752 13,65113,651 +30+30
Dexa ScansDexa Scans 1,0031,003 1,3751,375 +37+37
TotalTotal 62,55062,550 74,55774,557 +20+20
New Oncology WardNew Oncology Ward
In Hospital Visiting Consultant In Hospital Visiting Consultant Led ServicesLed Services
OncologyOncology Palliative CarePalliative Care DermatologyDermatology HaematologyHaematology MicrobiologyMicrobiology Orthopaedics and Fracture ClinicsOrthopaedics and Fracture Clinics
New physio gymNew physio gym
In Hospital Associate In Hospital Associate Specialties:Specialties:
Cardiac InvestigationCardiac Investigation DieteticDietetic LaboratoryLaboratory PharmacyPharmacy PhysiotherapyPhysiotherapy Occupational TherapyOccupational Therapy Speech and Language TherapySpeech and Language Therapy
Library
Academic LinksAcademic Links
UCC UCC Integral Teaching HospitalIntegral Teaching Hospital
U.Lim U.Lim Integral Teaching Hospital 1 Integral Teaching Hospital 1stst Aug 2010 Aug 2010 UCD UCD Paediatrics Medical SchoolPaediatrics Medical School
U.Lim U.Lim Midwifery Training PlacementsMidwifery Training Placements
U.LimU.Lim Physiotherapy PlacementsPhysiotherapy Placements
WIT WIT General Nurse Training Placements General Nurse Training Placements
WIT WIT Strategy Development Strategy Development
WIT WIT Research/Service Evaluation TrainingResearch/Service Evaluation Training
DITDIT Cardiac Technician PlacementsCardiac Technician Placements
Medical Unit Medical Unit Morbidity/Mortality Morbidity/Mortality Conference 26/03/10Conference 26/03/10
Innovations STGHInnovations STGH
1969 One of the first acute mental health inpatient units 1969 One of the first acute mental health inpatient units integrated into general hospitalintegrated into general hospital 19851985 First County Hospital fully developed First County Hospital fully developed
diabetes/endocrine diabetes/endocrine service service 1986 First rheumatology service S. E. 19861986 First rheumatology service S. E. 1986 19871987 First dietetic service S. E. First dietetic service S. E. 19921992 First open access GI endoscopy service Ireland First open access GI endoscopy service Ireland 1992 First multi disciplinary infertility clinic outside 1992 First multi disciplinary infertility clinic outside
DublinDublin 1994 First colposcopy service S.E. 1994 First colposcopy service S.E. 20012001 First pulmonary rehab service outside Dublin First pulmonary rehab service outside Dublin 20022002 First joint inflammatory bowel disease clinic Ireland First joint inflammatory bowel disease clinic Ireland 2007 Syncope assessment service2007 Syncope assessment service 2009 Acute stroke unit with thrombolysis2009 Acute stroke unit with thrombolysis 2009 First fracture liaison service in non-orthopaedic 2009 First fracture liaison service in non-orthopaedic
centrecentre
S E Hospitals Comparison 2009S E Hospitals Comparison 2009
WaterfordWaterford WexfordWexford KilkennyKilkenny ClonmelClonmel
BedsBeds 572572 283283 330330 276276
Occupancy %Occupancy % 85.1685.16 93.4493.44 83.7383.73 94.5994.59
ALOSALOS 5.75.7 4.34.3 4.84.8 5.65.6
Inpatients Inpatients DischargedDischarged
21,28121,281 14,34714,347 15,78815,788 12,79412,794
Day casesDay casesDischargedDischarged
18,72118,721 6,5896,589 9,2819,281 6,6806,680
OPD OPD AttendanceAttendance
114,087114,087 52,36952,369 48,24148,241 45,24145,241
New OPD New OPD AttendanceAttendance
23,58023,580 12,20112,201 15,97215,972 12,59412,594
Return OPDReturn OPDAttendanceAttendance
90,50790,507 40,16840,168 32,26932,269 32,67732,677
Number of Number of Deliveries Deliveries (’08)(’08)
2,6082,608 2,4142,414 2,2012,201 1,365 (’09)1,365 (’09)
Projected Annual Activity of Projected Annual Activity of Regional Centre of Excellence South EastRegional Centre of Excellence South East
Elective Inpatients 12,290Elective Inpatients 12,290
Non- Elective 48,700Non- Elective 48,700
Total Inpatients 60,990Total Inpatients 60,990
Deliveries 8,900Deliveries 8,900
ED Attendance 127,000 ED Attendance 127,000 (Allowing for 50% reduction from peripheral hospitals)(Allowing for 50% reduction from peripheral hospitals)
Estimated Requirement for Acute Day & Estimated Requirement for Acute Day & Local Rehabilitation BedsLocal Rehabilitation Beds
Regional Centre of Excellence SERegional Centre of Excellence SE
Acute Inpatient Beds 900Acute Inpatient Beds 900
Day Beds 48Day Beds 48
Rehab Rehab 128128Total 1076Total 1076
Current Total 572Current Total 572
New Bed Requirement 496New Bed Requirement 496(Based on Horwath/Teamwork Report HSE Mid-West 2008)(Based on Horwath/Teamwork Report HSE Mid-West 2008)
Conditions for Conditions for Reconfiguration SE Reconfiguration SE
Hospitals Acute ServicesHospitals Acute Services 1 No acute service withdrawn until 1 No acute service withdrawn until
regional centre resourced & ready to regional centre resourced & ready to deliver servicedeliver service
2 The PCCC resourced, developed & 2 The PCCC resourced, developed & working to international best practice working to international best practice standards in & out of hours.standards in & out of hours.
3 Ambulance service has fully developed 3 Ambulance service has fully developed mobile response capabilities by training mobile response capabilities by training advanced paramedics and deploying them advanced paramedics and deploying them to all areas of SEto all areas of SE
Conditions for Conditions for Reconfiguration Reconfiguration
4 Helicopter medical emergency service is4 Helicopter medical emergency service is fully integrated into emergency care fully integrated into emergency care
system SE.system SE.5 Advanced nurse practitioner & clinical5 Advanced nurse practitioner & clinical nurse specialist workforce in place – nurse specialist workforce in place –
network of local nurse led urgent care network of local nurse led urgent care centres.centres.
6 Effective partnership across all elements 6 Effective partnership across all elements of pre-hospital & hospital systems. of pre-hospital & hospital systems.
ConclusionsConclusions
Thriving 3 year old hospital with Thriving 3 year old hospital with outstanding ethos of service & innovationoutstanding ethos of service & innovation
Ever expanding local & outreach workEver expanding local & outreach work Vital part of infrastructure of a major Vital part of infrastructure of a major
population & industrial centrepopulation & industrial centre Impossible to provide adequate Impossible to provide adequate
alternativealternative services without very major expenditureservices without very major expenditure
Thomond Park 2005
Teamwork
Leaders
Backup !
Catch …..
Turn….
Now , Do You want to be the player scoring the goal, or the one throwing the stick ? …..
Unnecessary Reconfiguration in Ireland 2010
Doomed