Annual Report 2010 - St. James's Hospital

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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. 64
Clinical Directorates I Emergency Audit of Reperfusion for ST segment Myocardial Infarcts In conjunction with the cardiology department we have an ongoing audit of ‘time critical’ interventions for ST segment elevation MIs. In 2010, a total of 107 patients presented to the ED with acute STEMI. This represents a 52% increase on 2009. The majority of patients were male (74%). The age range was 27yrs to 90yrs with a mean age of 60yrs. Over half (52%) of patients presented out of normal working hours. The time to fi rst ECG was within international practice guidelines of 9 minutes. Despite the prevalence of out of hour’s presentations, the time to transfer to the Cath Lab was within international best practice guidelines in 96% of patients (
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2010 St. James’s Hospital Annual
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contents st james’s hospital Gove
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Governance and Executive I Corporat
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Governance and Executive I Consulta
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Governance and Executive I Consulta
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introduction from the chairman Prof
Page 15 and 16: Corporate Reports I Introduction fr
Page 17 and 18: Corporate Reports I Report from the
Page 19 and 20: Corporate Reports I Report from the
Page 21 and 22: Performance Highlights I Key Activi
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Page 29 and 30: Corporate Division Reports I Materi
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Page 37 and 38: Corporate Division Reports I Intern
Page 39 and 40: Corporate Division Reports I Inform
Page 41: Services Division Reports
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Page 54 and 55: Clinical Directorates I SaMS Staff
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Page 68 and 69: Omega Ms. Patricia Eadie Clinical D
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Page 72 and 73: Non Directorate Specialities I Depa
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Page 98 and 99: Clinical Support Services I Pharmac
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Page 102 and 103: Clinical Support Services I Medical
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Page 106 and 107: Clinical Support Services I General
Page 108 and 109: Programmes Division Reports I Techn
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Page 112 and 113: General Support Services I Nursing
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General Support Services I Educatio
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Programmes Division Reports I Quali
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The PAC produced two ‘Welcome’
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Programmes Division Reports I Plann
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St. James’s Hospital Foundation I
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Publications Publications MedEL Bor
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Publications Fitzgerald K, Steen G,
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Publications Walsh JB, Lawlor BA. (
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Publications transcription in perip
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Publications White HE, Matejtschuk
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Publications chronic myeloid leukem
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Publications compliance with curren
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Publications P, Morris JC, Mayo K,
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The Hospital’s fundamental purpos
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Annual Report 2010 - St. James's Hospital

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