Annual Report Department of Anaesthesia, Intensive Care & Pain Medicine

Transcription

1 Annual Report 2007 Department of Anaesthesia, Intensive Care & Pain Medicine 2007 was characterised by ongoing shortages of Consultant Staff which was particularly evident in the area of Intensive Care Medicine and the Liver On-call rosters. Although the number of Consultant Anaesthetists working in the hospital had dropped slightly from 27 to 26, the number of full time permanent staff had increased slightly from 8 to 9 with the appointment of Dr Paul Murphy. The complement of staff at this time therefore consists of 9 permanent, fulltime consultants and 2 fulltime locum consultants. There are 15 part-time consultants. Of the 15 part-time consultants, 5 posts are currently filled by locums. The difficulty in advancing the respective consultant posts has been exacerbated by two main problems. Firstly, the ongoing negotiations for new contracts with consultants has resulted in an embargo on all posts, both new or replacement. The situation is likely to continue until the end of Secondly, the Department has undergone an external review. Throughout this time we have been unable to advance any new permanent posts. The external review has brought about a number of changes. Articles of Association were formulated. An internal Implementation Body has been set up which oversees the day to day running of the Department and answers directly to the full Department. In time we will see the appointment of Clinical Directors who will have special responsibility and expertise in their particular area. Teaching and training has improved significantly and we had good success in recent exams. I would like to acknowledge the input of a number of individuals for their hard work in improving the teaching programme in the Department. Dr Dara Breslin, our Senior Lecturer, was appointed in Dr John Boylan, Dr Ingrid Brown, Dr Juliette McAleese and Dr Kieran Crowley in the Intensive Care Unit. The external review has also resulted in the production of a new schedule and this will take into consideration additional areas of activity such as in the X-Ray Department. A pre-assessment clinic is due to begin in April In addition to this an Acute Pain Service for post operative pain is also to be put in place by June The number of operating theatres has remained as in previous years. Namely there are 15 theatres in all but this does not take into consideration the additional areas of activity outside of the operating theatre which have to be covered, namely acute pain, radiology, pre-assessment and ECT. I would like to welcome Dr Paul Murphy, Consultant Anaesthetist with a special interest in Pain Medicine, as a permanent member of staff. Dr Murphy is a replacement for Dr Vincent Hannon who retired. I would like to congratulate Dr Paul Murphy and extend to him our heartiest congratulations and welcome him into our Department and wish him a successful and fulfilling career in St Vincent s University Hospital. Service Development /Activities

2 Activity Report Operating Statistics 2007 Category SVUH St. Michael s Annexe St. Michael s Public St. Vincent s Private Dental 29 1 Dermatology 7 0 E.N.T Eswl (Lithotripsy) General G.U. Endo G.U. Open Gynaecology Local 316 Nerve Block + 15 Sedation Ophthalmology Orthopaedic Pain Plastic Thoracic Vascular TOTALS Outstanding / Significant Achievements Our congratulations are extended to Dr Juliette McAleese, Dr Mohd Attia, Dr Tom Owens, Dr Hugh Gallagher and Dr Pat Benson who presented a paper at the Association of Anaesthetists of Great Britain and Ireland which was held in Dublin in The paper won a medal which was well deserved. Resident Merit Awards The following residents received medals as follows: Dr Catherine Nix - Dr. Gerry Dorrian Award for best SpR in Anaesthesia Dr Caroline Larkin Dr. Dick Nolan Award for best BST in Anaesthesia Dr Denise McCarthy - Dr Seamus O Donnell Award for best SpR in ICU Intensive Care Unit Medial Director Consultants Dr. Kieran Crowley Dr. Pat Benson Dr. Caroline Hickey

3 Clinical Nurse Manager III Ms Geraldine Carey Service workload 628 patients were admitted to the ICU in 2007, a record number. 39% of patients stayed 1 day, while 45% stayed 3 days or more, similar to recent years. Average length of stay was 4 days. Average occupancy for the year was 91%. The ICU continued to provide the critical care component of the liver transplant programme. The year saw another equal record with 65 transplants. Organ failure rates and organ support rates were similar to recent years: 71% of patients received mechanical ventilation. Overall ICU survival was 77%, with hospital survival of 76%. There is a continuing trend of increasing post-icu discharge hospital survival. St. Vincent s supplied an ICU nurse and registrar to staff the transfer of critically ill patients by MICAS (mobile intensive care ambulance service) on a 1:4 roster. The ICU is contributing to a national HSE study on organ procurement (the link nurse for organ donation is Mary Galligan). Staff The ICU ran two Foundation Courses, 8 nurses having completed the first course (all remaining on staff) with 11 on the current course. This course promises to greatly assist in providing adequate numbers of suitably trained nursing staff, which remains an issue. Maureen Flynn left her post as DNM to work with the HSE, Maureen Darcy filling the DNM position. Anne Donegan and Mark Jeffrey were appointed CNM2; Aisling Vickers was appointed Acting CNM2. There are two attendants, one shared orderly, one shared technician and a three secretaries. The ICU is staffed by a registrar or specialist registrar rotating from the department of anaesthesia. The aim of achieving out-of-hours cover by consultant intensivist staff has not yet been met: this is now achieved for 2/4 of weekends. Service developments Of the total of 16 beds in the new ICU initially 8 were opened, increasing to 10 in July, with overflows to 13 beds at times. Efforts are being made to open further beds. Edwina Beirne was appointed to oversee the introduction of a Clinical Information System, with a planned go-live date mid Edwina previously oversaw such a project in Amsterdam. After a successful application to the National Council for the Professional Development of Nurses, Dennis Wedgeworth took up a post studying the feasibility of an Outreach Service for patients after ICU discharge. Thanks to the work of Liam McGann and Joey Gormly, the Purchasing Department took over stock management in ICU, freeing up ICU staff time for patient care and saving money. As part of the commitment to continuing education, the ICU Nursing Staff hosted their annual educational conference in February 2007 with an attendance of over 100. Intermittent Haemodialysis is now available to patients in the ICU with the support of the Renal Service. The ICU marked its first year in the new premises with an international lunch. Significant achievements

4 At the SVUH poster competition on Quality in Healthcare Dr. Hani and Dennis Wedgeworth won 1 st and 2 nd prizes respectively. ICU ACTIVITY Admissions Average length of stay (days) Average occupancy 91%91% 92% 93% 90% 85% 89% 85% 64% Elective surgical 29%34% 38% 36% 27% 30% 32% 35% 36% Emergency surgical 25%25% 30% 30% 39% 31% 31% 35% 31% Medical 46% 43% 32% 34% 34% 39% 37% 30% 33% Mechanical ventilation 71% 80% 82% 69% 70% 75% 68% 67% 58% Central venous access 77% 73% 77% 64% 73% 81% 69% 78% 75% Vasoactive infusions 31%19% 24% 20% 18% 25% 33% 33% 26% Acute renal failure 18%14% 10% 10% 17% 25% 23% 24% 14% Continuous renal replacement therapy 18%14% 10% 10% 16% 21% 16% 14% 10% Tracheostomy 10% 7% 6% 6% 13% 11% 13% 6% 6% Unplanned ICU discharge - 17% 21% 21% 25% 1.5% 11.4% 6% 5% Readmissions 9.7% 8.1% 12% 8.3% 2.9% 0.9% 6.3% ICU survival 77% 78% 80% 79% 82% 75% 73% 75% 81% Hospital survival 78% 76% 78% 75% 78% 70% 68% 70% 71% LIVER TRANSPLANTATION 2007 was a very busy year for the Liver Transplantation Group. 59 Orthotopic Liver transplants took place. The results for 2007 were very good. Transplantation is demanding work for all concerned. All credit to the Anaesthesia Team: Consultant Anaesthetists Liver Fellows Anaesthetic Nurses Dr Neil McDonald Dr Mohammad Zafruddin Sr. Jean McCarthy Dr. John Boylan Dr. Shaikh Subani Billie Stafford Dr. Aly Karim Aly Karl Perocillo Karen Ann Keating The transplant anaesthesia group provided coverage for 59 liver transplants, including 52 primary elective transplants, during The 60-day survival for primary isolated elective transplants was 96%, with median ICU stay and hospital stay of 1 and 21 days, respectively. Outcome for primary elective liver transplantation at SVUH continues to be one of the best in the UK and Ireland.

5 Peer-reviewed papers J.J. Magner, K.J. Crowley, J.F. Boylan. Fatal fibrinolysis during orthotopic liver transplantation in patients receiving solvent/detergent-treated plasma (Octaplas ). Journal of Cardiothoracic & Vascular Anesthesia 2007; 21: Abstracts A.D. Nichol, F. Naughton, D. Ó Cróinín, J.F. Boylan, P. McLoughlin. Buffered hypercapnia worsens lung injury in endotoxin induced pneumonia. American Journal of Respiratory & Critical Care Medicine 2007 A785 A.D. Nichol, D. Ó Cróinín, F. Naughton, J.F. Boylan, P. McLoughlin. Hypercapnic acidosis attenuates oxidative reactions in endotoxin induced acute lung Injury. American Journal of Respiratory & Critical Care Medicine 2007 A785 Three former Conway research fellows, Dr. Finola Naughton, Dr. Ahtsham Niazi and Dr. Alistair Nichol, took up posts as staff anaesthesiologists at the University Hospital Network, Toronto, Canada (Drs. Naughton and Niazi), and as Senior Lecturer at Monash University, Australia (Dr. Nichol). Dr. John Boylan was a contributing author for the Irish Critical Care Trials Group (ICCTG), and a manuscript reviewer for Chest. VASCULAR ACCESS Director: Consultant: Dr. Alan McShane Dr. Neil McDonald The Vascular Access service continues to meet the constants demands from a variety of healthcare groups. The requests include placement of a variety of vascular access devices, and increasingly, the provision of a consultation service. While the oncology and haematology services continue to be frequent users of the service, the number of referrals of patients with cystic fibrosis for portacath placement also continued to rise. Training in the use of ultrasound devices to aid the placement of central venous access devices has continued, and there is increasing willingness of all to embrace this technology. Formal training in central vascular access is now a training requirement of the College of Anaesthetists. Drs McShane and McDonald again organized the Vascular Access Study Day in the College. This course continues to be popular and oversubscribed. It provides didactic lectures, live and cadaveric demonstrations and tuition in the use of ultrasound. SOUTH EAST DUBLIN DEPARTMENT OF ANAESTHESIA Again in 2007 consultant recruitment to the SEDDA hospitals was severely curtailed. This was due to a combination of reasons but mainly to uncertainty about the new consultant contract and uncertainty about what hospitals were to be built up. Consequently, we again relied, heavily on locum consultant services. These enabled the comprehensive anaesthesia services in the group to be maintained. We are again grateful to the contribution made by these doctors. We were happy to welcome one new Consultant to the SEDDA group, Dr. Paul Murphy, who will be joining the liver

6 transplantation anaesthesia team and will also work with the Pain Service. We wish him well in his career here. The SEDDA training scheme retains its popularity, with a constantly increasing number of applications. This reflects on the individual teaching done by consultants and the facilities and varied clinical experience available in the constituent hospitals. PAIN MEDICINE 2007 was another year of immense development in the Pain Service in St. Vincent's University Hospital with the appointment of a new Consultant in Pain Medicine, Dr Paul Murphy. Dr Murphy did his Pain Fellowship training in the world famous North Shore Hospital in Sydney, Australia, under the guidance of Prof Michael Cousins. We also had the project of planning a new pain suite, and the commencement of the transfer of our clinical activities from St Anthony s Rehabilitation Centre to the main SVUH building. Outpatient Activity Number Of Sessions New Patients Return Patients Total Tues ,244 2,494 Dr O'Keefe Tues Dr Victory Wed Dr O'Keefe Pain Unit Total ,764 4,152 The Wednesday Clinic has been taken over by Dr Paul Murphy as his basic OPD assessment access for new patients, this commences at 3 p.m and finishes at 6 p.m. We have continuted with the initiative which was introduced in 2006, of the Wound Clinic and the Walk In OPD Service for emergencies and urgent referrals. This had a huge impact in accident & emergency admission avoidance and prolonged stay at St. Vincent's University Hospital. Publications and Presentations Presentations National 5 International 4 Publications 2 2 Papers were presented by Dr Zuberi and Dr Hannsman. INSUKI Meeting in York in October There were 5 poster presentations at the Irish Pain Society Meeting in UCD in October 2007, which were jointly authored by Dr O Keeffe and Dr Murphy. With presentations from Dr Zuberi, Dr Hannsman, Dr Idrees, Dr Kamraj on a variety of topics, including Audits of Electronic Neuromodulation Practice, and the use of Pharmacologic Neuromodulation using a novel new drug, Ziconatide. There were also 2 presentations from the Unit at the North American Neuromodulation Society in Acapulco, Mexico, in December 2007, given by Dr Zuberi. One of which was a case report and the second was an audit of our Electronic Neuromodulation Practice.

7 Dr Philip Hu commenced and successfully completed a year in the Dept of Functional MRI and the University of Oxford, under the guidance of Prof Eileen Tracey, where he is investigating the Impact of Subcutaneous Electrical Stimulation on Brain psychophysics. The Pain Programme, under the joint Clinical Directorship of Dr. Rosemary Walsh and Dr Declan O Keeffe, continued with its cognitive behavioural therapy programme, 3 week programme for patients with chronic pain and new innovations including tailored programmes for patients with special needs. Publications: Subcutaneous Electrical Nerve Stimulation for Luterscapular Neuropathic Pain Najede MP, Allajade A, O Keeffe D. Pain Medicine, Volume 9, Issue 1, Page (AAPM Abstracts) January / February Audit of Neuromodulation: Our Experience of 83 Implanted Systems. Hu P, Majedi Max P, Illynski O, Al Majedi A, O Keeffe D. Neuromodulation Vol 10 Issue 2. Page April Finally the total patient interaction in the department was over 5,200 for 2007 Director: Dr. Declan O Keeffe 11 sessions Consultants: Dr. Paul Murphy 7 sessions Dr. Ray Victory 2 sessions Dr Oleg Illynski 4 sessions Pain Fellows Dr. Michael Hannsman Dr. Aamir Zuberi Dr Kamraj Senior Clinical Psychologist: Dr. Rosemary Walsh 0.5 WTE Physiotherapist: Miss Aoife Caffrey 1.0 wte Occ Therapist Miss Shannon Barr Pain Management Co-ordinator/ PA to Director Niamh Clohessy Neuromodulation Co-ordinator Locum

8 Activity OUTPATIENT CLINICS Day Consultant Total No. of Patients to visit OPD Pain Clinic Tuesday Dr. O Keeffe 2492 Wednesday Dr. Victory 287 Tuesday Dr. O Keeffe 998 St. Clare s Pain Unit Procedure Room Wound Clinic 1319 Extramural Theatre Bone&Joint Unit Pain Management Programmes Type Programme No. of Courses in 2007 Total Number of Patients on Course 3 week Day 2 8 Distinguished Guests

9 Dept was honoured by the presence of the world famous Pain Physician / Scientist, Prof Michael Cousins, of the University of Sydney, in October Prof Cousins visited the unit, and delivered the Anaesthesia grand round lecture on Chemotherapy Analgesia. Given Prof Cousins background, this was a view into the future of pain medicine, and he explained to us the new goal of attempting to achieve periods of remission from pain of patients with unrelenting chronic pain. Prof Cousins was also accompanied by Dr Damian Finess, (Chairman of the IASP Group on Placebo), who is attached as a Physiotherapist / Neuroscientist to the famed North Shore Hospital facility in Sydney, Australia. Prof Cousins also gave an address on Pain Relief as a Human Right at the Royal College of Physicians, as part of the Irish Pain Society s Annual Scientific Meeting. It was a great pleasure to have Prof Cousins visit our unit, and I on behalf of the MDT in St Vincents Pain Clinic would like to thank our new colleague Dr Paul Murphy for facilitating this wonderful experience for our group.