Recent Submissions

  • Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach.

    Flynn, Daniel; Joyce, Mary; Gillespie, Conall; Kells, Mary; Swales, Michaela; Spillane, Ailbhe; Hurley, Justina; Hayes, Aoife; Gallagher, Edel; Arensman, Ella; et al. (2020-05-14)
  • Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma.

    Mullally, W J; Cooke, F J; Crosbie, I M; Kumar, S; Abernethy, V E; Jordan, E J; O'Connor, M; Horgan, A M; Landers, R; Naidoo, J; et al. (2022-04-20)
    Case report: A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP.
  • Exploring the impact of over requesting of laboratory tests in biochemistry, MUH and devising a demand management strategy to reduce costs without compromising patient care and safety

    Yates, Stephanie; Barden, Eithne; White, Cáit; Stephanie Yates, Eithne Barden, Cáit White, Biochemistry Laboratory/Pathology IT, Mercy University Hospital, Grenville Place, Cork, Ireland (2020-07-07)
    Like many other areas of the health care sector, there is increasing pressure being put on medical laboratories to cut costs and eliminate wastefulness, while still maintaining and improving standards and expanding test repertoire. As a result many laboratories are turning to demand management as a way of cutting excess costs. It is estimated that up to 25% of pathology investigations are unnecessary indicating a significant potential waste. The aim of demand management is to control the appropriateness of tests that are requested. There are 3 main categories used when trying to achieve demand management; (1) Pre laboratory. This involves educating and engaging with requestors with regards to testing, examining the test repertoire available and also the withdrawal of obsolete tests. (2) Within laboratory. This is largely based around using minimum retest interval rules to prevent duplicate testing. (3) Post laboratory. This involves liaising with clinical teams to review the influence of test results on patient care.
  • Troponin testing in the emergency department in MUH

    Yates, Stephanie; Barden, Eithne; Healy, Anne; Dairiam, Samuel; Sharma, Abhishek; White, Cáit; Stephanie Yates, Eithne Barden, Cáit White, Biochemistry Laboratory/Pathology IT, Mercy University Hospital, Grenville Place, Cork, Ireland; Anne Healy, Samuel Dariam, Abhishek Sharma, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2021-09-30)
    Background / Problem Identified: Chest pain is one of the most common reasons for people attending the emergency department (ED). As there are many causes of chest pain, the physician has the responsibility of ruling out serious and potentially life threatening conditions such as acute myocardial infarction (MI), aortic dissection or pulmonary embolism (PE). Acute Coronary Syndrome (ACS) is one of the most common presentations in acute hospital settings. Cardiac troponin (TnI) is the preferred biomarker for the detection of myocardial injury. High sensitivity assays can detect elevated levels of TnI (above the 99th percentile of an apparently healthy reference population) within 3 hours after the onset of chest pain. It is particularly of value for the cohort of patients who have ACS, without typical features. For example diabetic patients, the very elderly or those with asymptomatic ACS. However if troponin is used incorrectly and without true clinical context then it can be elevated in a number of non cardiac conditions which can lead to a false clinical diagnosis, inappropriate workup and an increased patient stay in hospital. It was felt that an excessive amount of troponin tests were being requested especially in the ED so an audit was carried out to examine patterns of troponin requesting and to determine if troponin tests are requested appropriately from the ED in MUH and if the timings of the repeat requests were appropriate.
  • Comparison of sodium levels between GEM 5000 Blood Gas Analysers and Abbott c8000 Architect Analyser in patients admitted to ED in MUH

    Yates, Stephanie; Barden, Eithne; Louw, Michael; Lagali, Angeline; Stephanie Yates, Eithne Barden, Michael Louw, Angeline Lagali, Biochemistry, Mercy University Hospital, Grenville Place, Cork, Ireland. (2022-06-23)
    Background / Problem Identified: Sodium is the major cation of extracellular fluid; it plays an essential role in the normal distribution of water and in the maintenance of osmotic pressure in extracellular fluid compartments. Here in MUH, sodium levels are reported using the GEM 5000 Blood Gas Analyser, as a point of care test in the ED. They also form part of a renal panel and are reported in the Biochemistry lab using the c8000 Abbott Architect, using whole blood and serum/li-heparin samples respectively. The c8000 uses Integrated Chip Technology (ICT), Ion Selective Electrode, diluted (Indirect) to measure sodium, whereas the Gem 5000 uses potentiometric sensors to measure sodium (Direct). Hypo and Hypernatremia are the most common electrolyte disorders. Therefore precise and reliable sodium measurements are crucial for correct treatment of the patient. In recent years, several studies have showed a discrepancy in sodium levels between direct and indirect methods. In general, clinicians consider the two methods to be interchangeable and there is a lack of awareness of the associated discrepancy between methods.
  • S.A.F.E. huddle in the emergency department

    Fitzgerald, Shona; O'Donnell, Barbara; Healy, Anne; McLoughlin, Darren; Shona Fitzgerald, Barbara O'Donnell, Anne Healy, Darren McLoughlin, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland. (2022-06-23)
    Background / Problem Identified: A high volume of patients with undifferentiated diagnoses attend the Emergency Department complicated by high acuity and risk of deterioration. This risk increased during the pandemic when the department was divided into single rooms for isolation reducing the level of visual observation. The challenge was keeping these patients safe behind the closed doors. We needed to enhance communication within the multidisciplinary team to create a safer environment for both staff and patients. The issue of unrecognised deterioration or failure to escalate is identified as a risk to patient safety.
  • Multidisciplinary quality improvement plan: Introduction of use of Passy Muir speaking valve in line with mechanical ventilation in patients with tracheostomy in ICU setting in MUH

    Ferris, Finola; O'Sullivan, Keith; Murphy, Dervla; Marshall, Teresa; O'Mahony, Michellle; O'Croinin, Donall; Hanna, Elaine; Friel, Tara; Finola Ferris, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Keith O'Sullivan, Physiotherapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Dervla Murphy, Physiotherapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Teresa Marshall, Department of Nursing, Mercy University Hospital, Grenville Place, Cork, Ireland; Michelle O'Mahony, Anaesthesia Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Donal Ó CróinÍn, Anaesthesia Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Elaine Hanna, Department of Nursing, Mercy University Hospital, Grenville Place, Cork, Ireland; Tara Friel, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2022-06-23)
    Background / Problem Identified: What is a tracheostomy tube? A tracheostomy tube is an artificial airway inserted through the neck into the trachea to allow a more direct access for ventilation. What is a Passy Muir speaking valve? A Passy Muir speaking valve is a one-way valve which can be placed over the end of tracheostomy hub to redirect airflow into the upper airways when the tracheostomy cuff is deflated, allowing air to flow through vocal folds and facilitating verbal communication in patients with tracheostomy. What is mechanical ventilation? Mechanical ventilation is the technique through which gas is moved towards and from the lungs through an external device connected directly to a patient. What is involved in using a speaking valve in line with mechanical ventilation? Speaking valves can be used in line with ventilators but requires deflation of tracheostomy cuff to allow leaked expiratory air to travel through the vocal folds to facilitate speech. This has implications in measuring expired tidal volume and potential loss of lung volume. Project Background: Increased numbers of patients requiring tracheostomy in last 2 years in MUH. More complex cohort of patients requiring tracheostomy with prolonged length of weaning from mechanical ventilation and protracted ICU stay. Implications of protracted ICU admission: - significant impact to patient with increased risk of ICU delirium - psychological impacts to patient including frustration, anxiety, low mood, poor engagement with rehabilitation. - increased morbidity. - impacts negatively on patient flow and bed management. - high financial cost to MUH - impacts on staff morale. Current practice in MUH: Speaking valves are utilised in patients with tracheostomy who have weaned from mechanical ventilation but have not yet been decannulated (tracheostomy tube removal). This results in a period when patients are conscious, alert and unable to communicate verbally. Practices in larger critical care facilities have progressed to use of speaking valves in line with ventilators (SVILV). Benefits of speaking valve: Benefits of speaking valve (on ventilated/non-ventilated patients) are well recognised. These include restoration of speech, improved swallow function and reduced aspiration risk. Benefits of SVILV: Benefits include primarily earlier restoration of verbal communication. In addition, it can expedite weaning from mechanical ventilation by re-establishing physiological PEEP (Positive End Expiratory Pressure) which improves arterial oxygenation, improved secretion management by enabling a stronger, more effective cough and increased end expiratory lung impedance.
  • Compliance with venous thromboembolism protocol in surgical patients in Mercy University Hospital quality improvement project

    Shehata, Danny; Cagney, David; McGreal, Gerald; Danny Shehata, David Cagney, Gerald McGreal, Vascular Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland. (2021-09-30)
    Background / Problem Identified : 63% of all venous thromboembolic (VTE) events occur in the hospital setting, of which 70% may be preventable with appropriate VTE prophylaxis. Local and national quality improvement initiatives have led to development of a generic VTE prophylaxis protocol for hospital inpatients which can be found on page 3 of the hospital drug kardex. This quality improvement project aims to assess and improve the compliance amongst Non-Consultant Hospital Doctors (NCHDs) with completion of the VTE Protocol and as well as the appropriate prescription of VTE prophylaxis amongst surgical patients in Mercy University Hospital.
  • A large upper abdominal mass in an adolescent with high Ca 19.9: a case report.

    O'Connell, Robert M; O'Sullivan, Adrian (2022-04-27)
    Mucinous cystic neoplasms of the liver are uncommon cystic lesions of the liver, most commonly seen in women in the fifth decade of life. We present a case of a 16-year-old girl with an incidentally discovered abdominal mass while undergoing a tonsillectomy. Investigation revealed a multiloculated, septated 17 × 17 × 11 cm cystic lesion arising from the left lobe of the liver, with displacement of the remaining upper abdominal viscera. Serum Ca19.9 was significantly elevated at 2256 U/ml (range 0–37), but other bloods including liver function tests, alphafoetoprotein and carcinoembryonic antigen were within normal limits. We proceeded to open formal left hemi-hepatectomy. Histology was consistent with a diagnosis of mucinous cystic neoplasm with low-grade intra-epithelial neoplasia.
  • Ageing well at home: advice to help you age well in your community [updated September 2022]

    Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09)
    The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.
  • Patient empowerment: a key enabler to improve patients experience of hospital discharge

    O'Keeffe, Anne; Hayes, Eileen; Anne O'Keeffe, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Eileen Hayes, St. John's Hospital Limerick, Ireland. (2019)
    The National Patient Experience Survey (2017) found lower levels of satisfaction with hospital discharge. Poor communication was the primary cause for this finding. A thorough review of the survey resulted in the identification of four key areas pertaining to discharge that patients had a knowledge deficit namely Diagnosis, Drugs, Aftercare and ‘Your’ Follow-up. This resulted in the development of the D-day mnemonic/concept. Communication is a two way process between the healthcare provider (HCP) and the patient. This facilitates shared decision making and an equal partnership that is truly person centered. Patient empowerment is prerequisite to this as proposed by the mantra ‘no decision about me, without me’ (Kings Fund, 2011). Enabling patients to participate as equal partners is a challenge for HCP’s as it conflicts with paternalism, the dominant decision making healthcare model (Coulter et al, 2008). The National Healthcare Charter (HSE, 2012) ‘its safer to ask’ encourages patients to ask questions about their care. Patient utilisation of the charter was not evident in the findings of the national patient experience survey. To this end we developed a ‘D-day patient information leaflet’ containing cue questions targeting the d-day knowledge deficits. Due to the time constraints of this project we focused on two of the four D-day knowledge deficits namely Aftercare and ‘Your’ follow-up.
  • Ageing well at home: advice to help you age well in your community [Updated version Sept 2022]

    Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09-22)
    The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.
  • Oncology/haematology patients use of an acute oncology specialist nursing service to avoid emergency department admission

    Creedon, Stephanie; O'Mahony, Valerie; Stephanie Creedon, Valerie O'Mahony, St Therese’s Oncology Day Unit & St Bernadette’s Ward, Mercy University Hospital, Grenville Place, Cork, Ireland (2022-06-23)
    Background / Problem Identified: In 2021 347 new patients were referred to St Therese’s Oncology Day Unit and St Bernadette’s Ward for systemic anti-cancer treatment (SACT). Most of these patients will experience side effects which can be mild, moderate, or severe. In 2020 the National Cancer Control Program (NCCP) funded a 1.0 WTE Acute Oncology Service (AOS) CNS with the primary role of being the first point of contact for patients experiencing SACT side effects. The overall aim of the AOS CNS role is: Provide Telephone Triage to assess and advise Oncology Haematology patients experiencing SACT side effects using the UKONS 24-hour triage tool (a symptom-based oncology assessment tool using NCI-CTTAE (see diagram). Provide a rapid access pathway for Oncology/Haematology patients to address acute side effects from SACT. Ensure patients receive appropriate nursing and medical interventions to avoid Emergency Department attendance and reduce Hospital admissions and length of inpatient stay. An evaluation of the Acute Oncology Service in April 2021 highlighted our patients experiencing side effects from SACT continued to contact St Therese’s Ward, their GP or attend the Emergency Department for advice and management. The advice they received was impromptu and not consistent. Patients continued attending the Emergency Department for medical assessment. The AOS CNS didn’t have a dedicated space to admit patients for review. There was no clear AOS patient pathway. Combined these factors contributed to the underutilization of the Acute Oncology Service from its introduction in August 2020 until review in April 2021.
  • Acute stroke unit booklet: Bridging the information gap between patients, relatives and providers

    Saramago, Inês; Inês Saramago, Acute Stroke Unit, Mercy University Hospital, Cork, Ireland (2019-07-07)
    Background / Problem Identified: Following a stroke, patients are often confronted with many impairments, which can trigger many questions from their relatives. Establishing clear and regular communication with the relatives can be challenging when using a multidisciplinary team approach. Also, the ability to retain all the information and new medical terminology by both patients and their relatives can be limited during this stressful time. The aim of the acute stroke unit booklet is to provide medical and practical information relevant to the acute stroke patients, and their relatives, admitted to the acute stroke unit in St. Finbarr’s Ward, Mercy University Hospital. Measurement Methods / Design / Strategy: The development of the Acute Stroke Unit Booklet was carried out in two phases. Phase I, a review of the published Stroke unit Booklets from UK and Irish Hospitals/Organizations was conducted. MDT opinions and suggestions were also sought. In phase II, the booklet was formally validated by inviting the MDT to assess each relevant section of the booklet for adequacy, coverage and readability of the content. Results / Lessons learned / Limitations: The 44 page booklet was organized into 13 sections. The MDT section incorporates 7 departments and every department provided feedback. The booklet was primarily distributed and explained to acute stroke patients. Where the patient’s cognitive status was significantly impacted, the booklet was then assigned to the patients’ relatives. Conclusions / Reflections: A simple, illustrated information booklet designed for acute stroke patients and their relatives using clear and plain language is an effective mean to maintain communication between patients, relatives and providers. A similar approach focusing on aphasic stroke patients and cognitively impaired stroke patients could be adopted for the development of other accessible information booklets.
  • Using the AMAU pathway as an alternative to the “admission-to-investigate” pathway

    José María Martínez Ávila, James Ryan, Hannah O’Sullivan, Síofra Bennett, Abbey Murphy, Conor Martin, Acute Medical Assessment Unit, Mercy University Hospital, Grenville Place, Cork, Ireland (2021-09-30)
    Background / Problem Identified: Acute Medical Assessment Units (AMAU) were created with the main goal of providing medical patients with prompt, consultant-led decision making. According to the 2010 HSE National Acute Medicine Programme, a decision should be made regarding admission or discharge for AMAU patients (time to decision) in less than 6 hours. The aim of our Acute Medical Assessment Unit is to provide a service that enables early patient assessment and prioritisation of investigations leading to a reduced patient experience time (PET) on the emergency department floor. The AMAU will also provide an alternative pathway for follow-up in patients not requiring acute admission – with scheduled follow up of planned investigations in the AMAU clinic or Virtual Ward. Complementary investigations play a key role in decision making. Prioritisation of urgent investigations to determine acute management (Priority 2 e.g. CTPA for a suspected PE with a high Wells’ score) and less urgent investigations (Priority 3 e.g. endoscopy for gastritis) can be decided and followed-up via the AMAU. Lack of timely access to these investigations can lead to an undue delay in patient flow and obstruct potentially safe patient discharges. The Mercy AMAU was restructured in July 2020. This resulted in the addition of a fixed medical SHO, CNM2, and clerical officer; along with 2 Consultants who supervise the unit. There is additional support provided with an SHO and Medical Registrar from another team. A GP referral pathway was introduced to further expedite patient assessment in November 2020. This AMAU Audit aims to ascertain to what extent the AMAU activity reduces the number of hospital admissions that are required to facilitate access to timely investigations.
  • A novel education programme to improve confidence and knowledge levels regarding medications in an inpatient population

    Ryan, Joseph; Balfour, Timothy; Joseph Ryan, Timothy Balfour, Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland. (2019-06-06)
    Background / Problem Identified: HIQA report Feb 2018: One in five patients has an adverse event after discharge from hospital, with the majority of these relating to medicines. HIQA report on Medication safety Sept 2017: 58% reported the purpose of a new medication was explained in a way that they could understand. Personal experience of admitting patients (particularly in out of hours setting). Aims of this project were: To increase confidence and knowledge with regards regular medications. To assess patient confidence levels regarding current medications. To assess patient knowledge with regards to purpose and frequency of medications. To identify sources of information used by patients with regards medications
  • Non invasive ventilation BiPAP pathway

    Farrell, Aisling; O'Keeffe, Michelle; Curran, David; O'Connor, Terry; Aisling Farrell, Michelle O’Keeffe, David Curran, Terry O’Connor, Respiratory Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2019-06-06)
    Background / Problem Identified: Respiratory failure is a syndrome in which the respiratory system fails in one of both of its gas exchange functions. Type 2 failure is defined by a PaO2 of <8 kPa and a PaCO2 of >6 kPa. The use of Bi Level Positive Airway Pressure (BiPAP) has been shown to be an effective treatment option for people with Type 2 respiratory Failure. The aim of this audit was determine if patients with T2RF were correctly diagnosed and appropriately treated with BiPAP as per hospital protocol.
  • Electronic referrals to speech & language therapy (SLT): Design and implementation of an electronic referral system in MUH

    Galvin, Sheena; Curtis, Ross; Friel, Tara; Sheena Galvin, Tara Friel, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Ross Curtis, ICT Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2020-07-07)
    Background / Problem Identified: Since the establishment of the Speech & Language Therapy (SLT) service in MUH in 2005, internal inpatient referrals to the service have been made using paper referral forms. The paper-based referral system was audited for quality, safety and efficiency in 2018, in the context of increasing referral rates to SLT. A number of issues of concern were identified within this audit, across the domains of quality and safety, economic costs and data use/security. 1. Quality and safety issues: Delayed receipt of referrals E.g. 25% of referrals were delayed in reaching the SLT service in 2017 and this increased to 36% (267 patients) in 2018. Paper referrals often lacked essential information. These issues resulted in inaccurate and inequitable triage of referrals and provision of services, leading to delayed hospital discharge in some cases. 2. Economic costs: Opportunity costs in terms of staff time: NCHDs, SLTs, nursing staff and clerical staff time was lost in generating referrals, collecting referrals from wards, checking the status of referrals, duplicating referrals and restocking referral forms on wards. The paper referral system workflow encompassed 15 steps, from the SLT viewpoint alone. 3. Data use & security issues: Incomplete referral information limited the scope for data analysis which impacted on service audit, planning and development (Harman and Cornelius, 2017). Manual data analysis of paper forms led to inefficiency and human errors in data analysis. Hardcopy referral waiting lists were kept in storage in the SLT department, representing a data protection risk associated with storage of confidential information (Data Protection Commissioner, 2017, Health Service Executive, 2013, Burke and Weill, 2013, Harman and Cornelius, 2017, Hoyt et al., 2012). Measurement Methods / Design / Strategy: In order to address the above quality and risk issues, a health information technology solution was implemented in March 2019 in the form of an Electronic Referral system. The design and implementation of the E-referral system encompassed a number of phases, all based on the HSE change management approach; 1. Stakeholders were identified: A change in referral processes was found to affect the SLT department, ICT department, NCHDs and Consultants, ward clerks, ward CNMs, patient flow service and the hospital stores department. 2. In-house technology solutions were explored: The existing Social work E-referral system was reviewed. The Social work manager shared learning from the design and implementation phases involved in rolling out the social work E-referral system. 3. Literature review: Current literature on the implementation of internal referral systems in acute care settings was reviewed. 4. System design & end-user consultation: The NCHD committee 2017-2018 was consulted on system design in order to design a user-friendly system and to promote end user buy-in the change initiative. A member of NCHD committee with background qualifications in IT provided support to SLT and ICT department in the design of the system. The ICT department redesigned the existing social work referral system in order to capture the data required by the SLT service. 5. Education & training: Stakeholders were informed in January 2019 regarding the new system via emails to Consultants, NCHDs, CNMs and patient flow, presentations at intern education session, information handouts on wards and communication to ward clerks. 6. System testing: The E-referral system was tested on St. Finbarr’s ward for a seven day period in February 2019. Changes to the system were made by the ICT department in response to feedback from stakeholders. 7. Implementation: The E-referral system was rolled out to all clinical areas March 2019. 8. Gathering of feedback and audit. Results / Lessons learned / Limitations: A number of beneficial results were noted in practice, which echo the findings in current literature on the subject. These benefits can be described across the three areas of quality and safety improvements, economic benefits and data security and data use improvements. 1. Improvements in service quality & patient safety - Completeness and legibility of referral information enables accurate triage and equitable prioritisation of referrals, ensuring that patients are seen for SLT assessments in order of most urgent clinical need (for example, a dysphagia assessment in the case of a patient who is nil by mouth) (Kim-Hwang et al., 2010, Adaba and Kebebew, 2018, Bates and Gawande, 2003, Ash et al., 2004). - Delayed referral rates have dropped to 0%. Referrals are received immediately by the system, in chronological order and can be triaged as such (Shaw and de Berker, 2007). - Delayed hospital discharges no longer occur as a result from delays in the receipt of referrals (Bates and Gawande, 2003). - Increased numbers of patients can be seen by the SLT service as a result of the time saved by the new system. 2. Economic Benefits –hospital costs, staff time & productivity - NCHDs do not have to search for hardcopy forms on each ward. - Automated completion of demographic information and tick box options ensures that each referral takes less than 2 minutes to complete and submit. - Feedback from NCHDs on the wards is that the system is an improvement on the paper-based one, in terms of ease of use and time efficiency. - The system confirms when referrals have been submitted- NCHDs and nurses do not have to contact SLTs to check if referral was received, or submit multiple referrals. - Stores department do not have to order or deliver paper referral cards. - Ward clerks do not need to monitor and reorder stocks of referral cards for wards. - The E-referral system workflow reduces the steps required for an SLT to process a new referral to 7 steps (down from 15). - SLT time saved over the course of a year on referral processing is 65 hours, which can now be used to see 130 extra patients. This represents a cost saving of 2,340.32EU. - The system automates the process of calculating SLT response times to referrals. Time saved over the course of a year on such data analysis is 24 hours, which can now be used to see 48 extra patients. It also represents a cost saving of 864.16EU. 3. Data use & data security improvements - Complete referral information has resulted in improved scope for SLT service analysis, planning and development. - Efficiency and accuracy of data analysis has been achieved (Adaba and Kebebew, 2018, Bates and Gawande, 2003). - The system can be used as an activity management tool, as SLT response-times to referrals can be analysed automatically. - Referral data is now computerised and therefore stored on the hospital’s server, ensuring maximum security of digital information. - There is no longer a need for duplication of referral information into spreadsheets to calculate referral delay times and SLT response times to referrals, as this is automated within the new system. Conclusions / Reflections This project showcases the internal resources and skills available in MUH with which a health information technology solution can be implemented to address organisational inefficiencies, quality and safety issues (Burke, 2013). However, as a ‘frontline ownership’ model was adopted for the most part, the project developed across a two-year time period, which is a lengthy timeframe for a project of this nature. If carrying out a similar initiative, top-down project sponsorship and championing by senior management may be beneficial in securing protected resources with which to complete a similar project in a shorter timeframe. Based on the positive results on service efficiency and patient safety outlined above, there is a strong case to be made for rolling this system out across other clinical services, such as HSCP services, medical/surgical consults for inpatients and MDT referrals. Indeed, it could be used to streamline processes and collect data on operational services also, such as catering requests or requests for continuous supervision on wards. Reflection and stakeholder consultation upon completion of the project revealed a number of additional features that could be incorporated into practice, in order to maximise efficiency. For example, the E-referral system generates unique referral ID numbers. These could be quoted in the healthcare record, instead of printing and filing copies of referrals. It would also maximise transparency and accountability re the processing of referrals.
  • Healthcare workers use of psychological support resources during COVID-19; a mixed methods approach utilising Pillar Integration Analysis.

    Richards, Helen L; Eustace, Joseph; O' Dwyer, Amanda; Wormald, Andrew; Curtin, Yvonne; Fortune, Dónal G (2022-04-27)
    Objectives We sought to examine healthcare workers (HCWs) utilisation of formal and informal psychological support resources in the workplace during the first and third waves of the COVID-19 pandemic in Ireland. Methods A convergent mixed methods approach was undertaken. Four hundred and thirty HCWs in the Mid West and South of Ireland responded to an online survey in terms of their use of psychological support resources during Wave 1 (April/May 2020) of COVID-19. Thirty-nine HCWs undertook in depth interviews at Wave 3 (January/February 2021), and a further quantitative survey was distributed and completed by 278 HCWs at this time. Quantitative data arising at Wave 1 and Wave 3, were synthesised with Qualitative data collected at Wave 3. A Pillar Integration Process (PIP) was utilised in the analysis of the quantitative and qualitative data. Results Five pillars were identified from the integration of results. These were: a) the primacy of peer support, b) the importance of psychologically informed management, c) a need to develop the organisational well-being ethos, d) support for all HCWs, and e) HCWs ideas for developing the well-being path. These pillars encapsulated a strong emphasis on collegial support, an emphasis on the need to support managers, a questioning of the current supports provided within the healthcare organisations and critical reflections on what HCWs viewed as most helpful for their future support needs. Conclusions HCWs who utilised supportive resources indicated ‘in house’ supports, primarily collegial resources, were the most frequently used and perceived as most helpful. While formal psychological supports were important, the mechanism by which such psychological support is made available, through utilising peer support structures and moving towards psychologically informed supervisors and workplaces is likely to be more sustainable and perceived more positively by HCWs.

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