Annual Report 2010 - St. James's Hospital

Corporate Reports I Report from the Chief Executive
• Day Care
All patients waiting for elective attendance < 6 months
@ 31.12.10 (National Target)
– SJH performance 100% compliant
All patients waiting for elective attendance < 4 months
@ 31.12.10 (Local Target)
– SJH performance 100% compliant
• ED attendances
– increasing presenting acuity/complexity with 28% of new
attendances triaged category 1/2
• Admissions
– increase in number of patients requiring emergency
admission – refl ecting both presenting volume and
complexity value increases
• Outpatient
All patients waiting for appointment < 6 months booking -
31.12.10 (National Target)
– SJH performance 99% compliant
– increasing tertiary complex (predominantly) surgical
treatment demand particularly relating to cancer. A
recent internal study identifi ed for 2010 a 29% increase
in cancer diagnosis/treatments predominately surgical.
SJH has continued to expand range and volume of day
care treatments, and in 2010 79% of (day care/inpatient)
treatments were undertaken on a day care basis – particularly
specialties of Medical Oncology/Haematology, where 91%
of treatments were undertaken as day attendances.
Within Surgery, 75% of ’25 Surgical Basket of Procedures’ 1
was undertaken on a day attendance basis.
The Hospital has also signifi cantly advanced capability to
effect same day admission - treatment. This combined with
patient processing improvements within the Emergency
Department, continuing AMAU 2 high value capability in
relation to timely discharge (50% discharged within 5 days
of admission), successful collaboration with the NTPF,
the introduction of the Fair Deal initiative, increased OPD
clinics/initiatives to reduce non attendance and ongoing
appropriate pan-hospital control provisions, has enabled not
only treatment volume/range increases, but as well access
improvements to be secured.
The NTPF identifi ed a national median wait time of 2.5 months
for 2010, with SJH, having a median wait time of 1.3 months -
the lowest wait time for the Major Academic Hospital Group 3 ,
and nationally ranked 3rd – the other 2 hospitals ranked
higher, being either single specialty providers/not having an
emergency department or being less than 200 beds.
• Discharge
– curtailment of home support necessary to effect
timely discharge
– curtailment of community accommodation for frail
highly dependent patients.
• Outpatient Referral
– 6% increase in new referrals (09/10) including signifi cant
referrals from geographical areas where SJH is not the
responsible provider
Impact of these Factors
The impact of these external challenges are as follows:
• capability of ED directorate/AMAU4 to manage signifi cant
and increasing patient volume/acuity, has been challenged
in terms of ability to ensure full adherence to ED centred
clinical protocols/pathways and has resulted in less than
optimal patient processing
• capability of General Medicine consultant cohort/associated
interdisciplinary teams to manage within current construct,
presenting ED generated patient cohort/inpatient work
and outpatient demand in terms of timely response to ED,
securement of optimum inpatient pathway including prompt
discharge and necessary out patient access has been
signifi cantly challenged
Key Challenge Factors
Whilst overall clinical volume and access performance 2010
outcome values have generally been satisfactory, there
remain certain presenting external factors that present
signifi cant challenges for existing hospital capacity and
capability provisions:
• increasing emergency admission acuity/tertiary transfer
volume of patients requiring complex surgery has routinely
exceeded existing critical care capacity - leading to patient
treatment delay, particularly for those patients requiring post
operative critical care accommodation
Note 1 :
Note 2 :
Note 3 :
British Association of Day Surgery
Acute Medical Admissions Unit
MATH’s comprising: St. James’s Hospital, Beaumont Hospital, Tallaght Hospital, St. Vincent’s hospital, The Mater Hospital, University Hospital Galway,
Limerick Regional Hospital and Cork University Hospital
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