Anaesthesia, Intensive Care and Pain Medicine - St Vincent's ...

Department of Anaesthesia, Intensive Care and Pain Medicine
St.Vincent’s Healthcare Group
157 staff trained as ACLS Providers.
538 staff trained as Basic Life Support Providers.
An Intern orientation programme presented for the first time
proved very popular.
Other courses include Basic Rhythm Recognition Workshop,
Cardiac Arrest Management Workshop. Numerous lectures and
in-services were presented on a variety of topics associated
with resuscitation.Ward-based training proved most popular and
it is hoped to increase the number of sessions provided in 2004.
At the end of 2003 an election was held to select a new
Chairman of SEDDA. Dr.Alan McShane was elected to the
post of Chairman of SEDDA for a term.
I wish to express my thanks to the secretary of SEDDA, Ms
Louise McNicholas and to the secretary of the Department of
Anaesthesia,St.Vincent’s University Hospital,Ms Róisin Crowe,
for all their help throughout my term as Chairman of SEDDA.
Dr. Edward Gallagher
Outgoing Co-ordinator
South East Dublin Department of Anaesthesia
ICU ACTIVITY
2003 2002 2001 2000 1999 1998 1997
Admissions 450 471 421 469 556 551 537
Average length of stay (days) 6 6 5 5 3.4 3.9 4.8
Average occupancy 90% 85% 89% 85% 64% 75% 92%
Elective surgical 27% 30% 32% 35% 36% 43% 43%
Emergency surgical 39% 31% 31% 35% 31% 30% 30%
Medical 34% 39% 37% 30% 33% 27% 28%
Mechanical ventilation 70% 75% 68% 67% 58% 57% 69%
In addition
Central venous access 73% 81% 69% 78% 75% 65% 74%
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• SVUH maintained its status as a training site with the Irish
Heart Foundation.
• A database to record those trained was maintained.
• Separate ‘Cardiac Arrest’ bleeps were obtained for the
cardiology team.
• Obsolete defibrillators continue to be replaced.
• Contents of the cardiac arrest trollies were reviewed and
s i g n i ficant improvements made relating to equipment and dru g s .
• Additional Laerdal pocket masks were placed in strategic
locations around the hospital.
• Emergency resuscitation equipment was obtained for St Ritas
and the ERC.
• SVUH collaborated with St Michael’s Hospital to provide
ACLS training.
• Training equipment was purchased through the ACLS A c c o u n t .
• Resuscitation guidelines were reviewed and are currently
being updated.
• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
draft guidelines are in the final stages of review.
Appointments
Drs Ingrid Browne, Michael Moore and Rachel O’Farrell were
Research Registrars attached to the SVUH Liver Transplant
anaesthesia programme in 2003.Drs Ita Brady and Berni Egan
were the Educational Co-ordinators.
South East Dublin Department of
Anaesthesia Review
Co-Ordinator Dr. Edward Gallagher
South East Dublin Department of Anaesthesia was relatively
inactive in the area of new and replacement posts by virtue of
the fact that St.Vincent’s University Hospital was undertaken as
an ongoing pilot project through Hanly.
The outcome of the project was awaited and it was felt that it
would be of no advantage to hold any meeting pending the
outcome of the publishing of the Hanly Report.
SEDDA continued to be involved in the training and rotation of
d o c t o rs appointed by Section 7.6 of the College of Anaesthetists
in Ireland.
Intensive Care Unit
Medial Director
Consultant
Clinical Nurse Manager 2
Service workload
Dr Kieran Crowley
Dr Pat Benson
Ms Geraldine Carey
450 patients were admitted to the ICU in 2003, similar to
recent years.43% of patients stayed 1 day, while 38% stayed 3
days or more:this represents a decrease in the proportion of
patients in the shorter length of stay category. Average length
of stay unchanged from 2002,at 6 days.Bed occupancy remains
above internationally recommended levels.
Severity of illness seems to have plateaued over recent years:
average APACHE II score was 20, similar to last year. Similarly
organ failure rates and organ support rates seem to have
plateaued: for example 70% of patients received mechanical
ventilation and 16% received continuous renal replacement
therapy. Overall ICU survival was increased at 82%,with
hospital survival of 78%.
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.
Staffing
N u rsing staffing remained at or near to its full complement duri n g
2003,allowing utilization of all beds for almost all of the year.
There are two attendants,one shared orderly, one shared
technician and a shared ICU secretary. The ICU is staffed by a
registrar or senior registrar rotating from the department of
anaesthesia, available 24 hours a day.
Developments
Planning for the new ICU in the development project is well
advanced and is at the phase of preparing tenders for equipment.
Design of the layout and fixed equipment is completed.There
will be 16 beds in the new development.
Vasoactive infusions 18% 25% 33% 33% 26% 22% 27%
Acute renal failure 17% 25% 23% 24% 14% 13% 16%
Contin.renal replacement therapy 16% 21% 16% 14% 10% 8% 12%
Tracheostomy 13% 11% 13% 6% 6% 9% 9%
Unplanned discharges from ICU 25% 1.5% 11.4% 6% 5% 4% 5%
Readmissions 2.9% 0.9% 6.3% 9.6%
APACHE II score (mean) 20 19 20 18 14 15 16
ICU survival 82% 75% 73% 75% 81% 82% 83%
Hospital survival 78% 70% 68% 70% 71% 75% 73%
During 2003 the ICU team formed teams and began work for
the hospital accreditation survey in 2004.
The ICU introduced routine "tight" glycaemic control in 2003, a
major innovation in practice, requiring increased input by the
nursing staff at the bedside.
Vascular Access
Director
Dr Alan McShane
The vascular access service is provided primarily by Dr Alan
McShane and Dr Neil McDonald. It grew again during 2003,
with 362 procedures being carried out. The service is primarily
availed of by Oncology, Haematology, Nephrology and Cystic
Fibrosis units.
Demand for the educational video we prepared in 2002 with a
grant from the Irish Cancer Society, "Learning your lines: a guide
to tunnelled central venous catheter care" continued from
around the country.
In an effort to provide the service each day and in an orderly
manner it is the ambition of the Department of Anaesthesia to
have a dedicated vascular access theatre slot each day. This will
allow for a Consultant led and provided service. It will facilitate
better planning of patients’treatment.It should go a long
way towards eliminating the prolonged fasting and anxiety of
patients who often have to wait until long into the night to have
their lines sited and treatment commenced. It will also allow for
more structured modular training of anaesthesia trainees.
During the year, Dr McShane was asked to present at the
Annual Scientific Conference of the College of Anaesthetists.
He spoke on "Vascular Access Procedures". In June he also
attended a workshop on the use of Ultrasound for Vascular
Access Procedures,at Guy’s Hospital,London.
Risk Management
Dr Richard Assaf has been appointed for an initial period
as Clinical Risk Facilitator. He was invo l ved in liasing with
the Medical Board and Hospital Management on
Medical Risk Management issues,and teaching
the NCDH staff.His role includes
reviewing all adverse drug reactions
submitted to the Ethics
Committee.
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