Surgery
The aim of the National Clinical Programme for Surgery (NCPS) is to provide a framework for the delivery of safer, more timely, accessible, more cost-effective and efficient care for all surgical patients.
The NCPS works closely with the other clinical programmes, notably the National Clinical Programme for Anesthesia but also the Acute and Emergency Medicine, and Critical Care programmes.
NCPS also works with other clinical programmes, hospitals, hospital groups, specialty bodies, patient advocacy groups and all relevant stakeholders across the health system.
NCPS core principles
- Improvement should be designed to give patient improved access to surgical services.
- Targeted at having the greatest impact on waiting lists through focused capacity creation.
- A partnership with the hospitals and hospital groups to develop and implement the capacity to positively impact on waiting lists.
- Specialty focused so improvements will be data-driven and evidence-based.
- Ensure that all programmes are in line with Sláintecare in ensuring that care pathways are integrated between primary care and acute hospital care.
- Co-Leads: Prof. Deborah McNamara and Mr Ken Mealy
- Clinical Advisor for ENT: Prof. Michael Walsh
- Clinical Advisor for General Surgery: Prof. Paul Ridgway
- Clinical Advisor for OMFS Surgery: Mr Dermot Pearse
- Clinical Advisor for Plastic Surgery: Mr Padraic Regan
- Clinical Advisor for Urology: Prof. Eamonn Rogers
- Programme Manager: Ciara Hughes
- Nurse Lead: Patricia Delaney
- Administrator: Sharon Casey
- Data Technician: Laura Hammond
- Business Intelligence Lead: Gerry Kelliher
- NQAIS Clinical Deployment Project Manager: Eilish Croke
The NCPS is based in RCSI in 2 Proud's Lane, Dublin 2 and can be contacted at surgeryprogramme@rcsi.ie.
General surgery
- See and Treat: This model of streamlining patients who require minor surgical procedures from three clinic visits down to just one. The model is currently in the pilot phase and being validated on a second site. The aim of this model is to reduce the burden on acute hospitals, improve patient experience and provide GPs with the direct booking to procedures. This also allows latent capacity to be utilised more effectively.
- State of Emergency Surgery 2018 review: This is a document currently in a draft format that is reviewing the current service provision and workforce delivering emergency surgery throughout the country. It is envisaged that this work will be a prerequisite for a further document mapping the future of emergency surgery.
Otorhinolaryngology
- Model of Care (MOC) Implementation Group: Following the successful launch of the Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) Model of Care for Ireland in February 2019, the NCPS are moving the MOC to the implementation planning phase. Membership of this group will be multidisciplinary ensuring all key stakeholders are represented.
- Direct booking tonsillectomy, patients presenting to general practice: Following review of a questionnaire for symptom validation are then booked directly onto a tonsillectomy waiting list. This reduces the amount of OPD visits and facilitates patients timely access to the services required.
Urology
- Model of care: Urology, a Model of Care for Ireland has been completed and will launch prior to the Annual RCSI Freyer meeting in September 2019. Next steps will be the implementation of the recommendations of this MOC from policy to practice.
- Rapid Access Hematuria Pathway: The NCPS in collaboration with the National Clinical Programme in Radiology and National Cancer Control programme have been piloting the rapid access, diagnosis and treatment of frank hematuria in line with OSPIS 28-day referral to treatment target. The final report has identified positive feedback from service users. The NCPS will bring to this proven initiative to the Scheduled Care Commissioning Group to implement in other hospital groups.
- The treatment and intervention of males with lower urinary tract symptoms (LUTS) has been redesigned, shifting the diagnosis to a nurse in an advanced role with a treatment algorithm for primary care practitioners to know where to send patients for optimal treatment.
Vascular surgery
- A model of care for vascular surgery in Ireland is currently being drafted.
Surgical nursing
- The NCPS has developed, and continues to develop, specialty models of care, all of which advocate the role of advanced and specialist nursing practice.
- An education and needs analysis is currently being piloted in hospital groups the aim of this survey is to scope the educational requirements of nurses in practice.
Plastic, reconstructive and aesthetic surgery
- The NCPS is in the process of defining the current state and developing the future state which includes resource requirements based on national gap analysis, and on international best practice
- Develop standardised care pathways which are quality assured to support primary care and acute hospitals which are patient-centric for the patient journey in line with Sláintecare
- Be part of an all-Ireland ‘Burns Partnership’ to include adults and paediatric patients
- Develop standardised care pathways which are quality assured to support trauma centres and waiting list initiatives.
- Identify key risk and mitigation plans to stabilise the service and training and education needs for succession planning in support and collaboration with the RCSI Dean and training director.
Oral and maxillofacial surgery
- The NCPS is in the process of defining the current state and developing the future state which includes resource requirements based on national gap analysis, engagement with oral surgeons and dentists and on international best practice.
- Develop standardised care pathways which are quality assured to support primary care, the community and acute hospitals which are patient-centric for the patient journey in line with Sláintecare
- Identify key risk and mitigation plans to stabilise the service and training and education needs for succession planning in supporting and collaborating with the RCSI OMFS Dean and training director.
Acute Surgical Assessment Units
Acute Surgical Assessment Units (ASAUs) are dedicated surgical units were acutely ill surgical patients can be assessed and monitored prior to being admitted to hospital, or being treated and discharged. They form an integral part of the National Clinical Programme (NCPS) 2013 'Model of Care for Acute Surgery'. Their main aim is to improve patient flow and provide better access to assessment, investigation and senior decision-makers. Assessing, prioritising and treating patients in a rapid streamlined fashion through the ASAU has the potential to result in a shorter length of stay, a more positive experience for the patient, fewer complications and a lower mortality rate.
The NCPS along with collaboration from the Healthcare Pricing Office and the Office of the NCAGL for Acute Operations have now successfully accredited six sites nationally where the ASAU fulfils the minimum standards for ASAUs in Ireland. Current accredited sites are:
- Mater Misericordiae University Hospital
- University Hospital Galway
- St Luke's University Hospital Kilkenny
- Our Lady of Lourdes Hospital, Drogheda
- University Hospital Limerick
- University Hospital Cork
Acute Floor Information System
The Acute Floor Information System (AFIS) is currently being developed to record information for core components of the acute floor, namely; EDs, AMAUs and ASAUs across the country. The NCPS is contributing to the development and procurement of this system. AFIS will provide access to similar information to that available through HIPE in relation to inpatient care provided. It will provide information on access, quality and cost of unscheduled care services.
The key areas it will cover are triage, patient tracking and data reporting; clinical documentation and discharge communication and diagnostic coding.
National Quality Assurance and Improvement System
The National Quality Assurance and Improvement System (NQAIS) Clinical is an online interactive application that analyses hospitals’ own HIPE data to provide detailed feedback to clinicians and managers. The primary focus of NQAIS Clinical is to optimise the length of stay (LOS) for safe patient care in all publicly funded Irish hospitals. NQAIS surgery and medicine have been integrated into a single system called NQAIS Clinical. Maternity, new-born, non-operative surgical cases and medical elective day cases are also included.
The evolution of NQAIS Clinical was led by Health Intelligence (Health and Wellbeing HSE) in partnership with the NCPS, National Acute Medicine Programme, National Obstetrics and Gynaecology Programme, National Clinical Programme in Trauma and Orthopaedics, Integrated Care Programme for Older Persons, Emergency Medicine Programme, the Children’s Hospital Group, hospital group representatives and the Acute Hospitals Directorate. The application was developed by OpenApp, Dublin. The overall aim of NQAIS Clinical is to provide interquartile (IQR) comparisons of the average length of stay (AvLOS) for teams providing similar care. In addition, the metrics can be used by clinical and management leads to re-engineering the delivery of care based on interdisciplinary co-operation using their own data.
National Quality Assurance and Improvement System (NQAIS) Clinical is a web-enabled online reporting system that analyses Hospital In-Patient Enquiry (HIPE) data supplied by HSE-funded acute hospitals to the Healthcare Pricing Office (HPO). The system is designed to provide a complete and integrated picture of HIPE records for surgery, medicine, maternity and newborn discharges from acute hospitals.
There is an abundance of metrics displayed in the system which allows clinical teams and hospital management to monitor, review and improve care, including in-patient average length of stay (AvLOS), percentage day case rates and day of surgery admissions (DOSA). The system can assist with re-engineering the delivery of care based on interdisciplinary cooperation and also provides a rich source of data for research purposes.
The evolution of NQAIS Clinical was led by HSE Health Intelligence in partnership with the National Clinical Programme for Surgery, National Acute Medicine Programme, National Obstetrics and Gynaecology Programme, Clinical Programme in Trauma and Orthopaedics, Integrated Care Programme for Older Persons, Emergency Medicine Programme, Children’s Hospital Group, hospital group representatives and the Acute Hospitals Operations Division.
Developed by OpenApp, HIPE coding was updated effective from 1 January 2020 to ICD-10-AM/ACHI/ACS (10th edition). As some codes are no longer in use, new codes were identified and a detailed guideline for classifying COVID-19 scenarios was provided by the Independent Hospital Pricing Authority (IHPA).
The NQAIS Clinical system compares activity patterns to nationally derived targets for AvLOS from all HSE-funded Irish hospitals. These targets were updated and other improvements made to the system and, in line with changes to the system, an updated training programme was developed.
The Transforming Theatre Programme is a ‘Quality Improvement Theatre Management System’ with the following objectives:
- Embed a system of standardised theatre metrics enabling both locally-led (tactical and strategic) improvements and high-level hospital group development opportunities.
- Align a process for routine review and action of these metrics locally by theatre staff and hospital theatre governance group, and collectively by a hospital group theatre governance group.
- Provide a structured quality improvement (QI) methodology to achieve tangible improvements through a multidisciplinary teams (MDT) approach.
- Advance QI capability for all by providing training, facilitation and coaching at all stages of the programme.
The Transforming Theatre Programme pilot is a collaboration between the HSE (funder), RCSI National Clinical Programme in Surgery, National Clinical Programme in Anaesthesia and the South South West Hospital Group (SSWHG).
The RCSI National Clinical Programme in Surgery is the technical partner for the programme providing the programme design, development and implementation including training, coaching and facilitation at all levels across the HG. The 18-month implementation phase is ending at the end of Q1 2022, with all implementation stages currently on track for completion.
To support the SSWHG in the next phase of executing the high-level opportunities identified through the programme design implementation, additional funding is required to acquire continued involvement from the RCSI National Clinical Programme in Surgery. This support will build on the structures already developed in order to realise the benefits of increased surgical patient throughput through the theatre resource, linked with waiting list initiatives and care pathways and embed a sustained culture of theatre management and leadership across the HG.
You can get more details on the current programme through the following presentation:
If you would like to get more details or are interested in your hospital or hospital group to get involved please contact the Transforming Theatre Programme Manager, Charlie Dineen.