Annual Report 2010 - St. James's Hospital

Clinical Directorates I Emergency
importantly, the duration to fi rst diagnosis and therapy. This
is due to the inability to access space to deal with patients
effi ciently and in privacy. Strenuous personal effort by many
individual members of our team has kept this negative burden
moderately under control.
Total time for all patients in ED
49% 0 – 6 hours
33% 6 – 12 hours
18% 12 – 24 hours
With the “Flu” epidemic, we instituted a policy of restricting
visitors within the clinical area of the ED. Whilst we appreciate
that this is a stressful time for families, the burden of visitors
had become so great that they outnumbered patients and
destroyed any semblance of privacy for ill people. After some
initial teething problems of communication, we have found
this has improved patient comfort. We have fi ne-tuned our
process and have now implemented the use of a colourcoded
“visitor pass” for critically-ill and less-ill patients.
We were delighted to welcome Dr. Una Kennedy as our
fourth Consultant in Emergency Medicine in January 2010.
Unfortunately, shortly before that, we lost our long-standing
Associate Emergency Physician, Mr. Linus Offi ah, as he was,
happily, appointed to a Consultant post in Cavan. This means
we have had four “senior clinical decision makers” since
2001, with no sign of expansion, despite the ED Taskforce
report and the HSE 100+ Initiative, both of which had
advocated increases.
Emergency Patients Attendance
Year Attendances Discharges Admissions New Return
2010 45230 43648 12746 43655 1575
Total Time for Patients Discharged from ED
60% 0 – 6 hours
28% 6 – 12 hours
12% 12 – 24 hours
Total time for patients admitted through ED 2010
22% 0 – 6 hours
45% 6 – 12 hours
33% 12 – 24 hours
Chest Pain Assessment Unit 2010
556 patients were admitted to the chest pain assesment unit
(CPAU) in 2010. 59% of these were assessed and discharged
within 24hours. Less than 5% were admitted for over 72
hours. 60% of patients had a negative assessement of acute
coronary syndrome. The remainder required further diagnostic
assesment with diagnostic angiography or CT coronary
angiography. 167 patients required diagnostic angiography
of which 59% were abnormal, requiring percutaneous
coronary artery intervention and/or medical management.
CT coronary angiography was undertaken in 94 patients,
to determine the need for further diagnostic angiography or
medical management.
Following discharge from CPAU, all patients are reviewed in
a nurse led CPAU review clinic, where the primary focus is
risk factor assessment and modifi cation. There was a 96%
attendance rate.
The CNS’s and ANP in Emergency Cardiology
role in the ED:
In 2010 they were responsible for reviewing 1770 patients
in the ED. Additional responsibilities include training in ECG
interpretation and BLS for both nursing and medical staff.
Running the CPAU review clinic, organisation of patients
undergoing CTCA and audit.
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