Minister for Health, Stephen Donnelly, Applauds St. Vincent’s University Hospital for Pioneering Modernised Care Pathways

26th January 2024

Today marked a pivotal moment as Minister for Health, Stephen Donnelly, toured St. Vincent’s University Hospital (SVUH) to acknowledge and commend the ground-breaking strides achieved in the realm of Modernised Care Pathways (MCPs). This visit underscores the Minister’s unwavering commitment to recognising and bolstering advancements in healthcare delivery nationwide. A substantial investment of €3.8 million has been allocated to the hospital, facilitating the recruitment of 26.92 Whole-Time Equivalents (WTEs) dedicated to implementing 17 modernised care pathways. In 2023 alone, a noteworthy €1,361,702 was expended. Presently, six pathways are in full operation, with an additional three poised to commence in the first half of 2024.

The day’s itinerary included a detailed presentation by Prof Michael Keane, Interim CEO at St. Vincent’s University Hospital, and an insightful tour of various clinical areas.

Prof Michael Keane, Interim CEO at St. Vincent’s University Hospital, expressed his enthusiasm for the transformative impact of Modernised Care Pathways, “St. Vincent’s University Hospital is proud to be at the forefront of healthcare innovation through our Modernised Care Pathways. These pathways not only enhance patient experiences but also significantly contribute to the efficiency and effectiveness of healthcare delivery. Our dedicated team is committed to providing the best care possible, and we are grateful for the support of Minister Donnelly in recognising our efforts.”

Minister for Health, Stephen Donnelly, acknowledged the dedication and hard work of the SVUH team, “I am truly impressed by the innovative approaches undertaken by St. Vincent’s University Hospital in modernising care pathways. The commitment to patient care and the efficiency demonstrated in the MCP Urology Pathway, Haematuria Pathway, Nephrology Pathway, Neurology Pathway, and Endocrine Pathway are commendable. The progress made in Phase 1 is a testament to the hard work and dedication of the SVUH team. These advancements align with our national healthcare goals, and I appreciate the hospital’s role in achieving them.”

Minister Donnelly further added, “I believe that the MCPs at St. Vincent’s University Hospital are setting a benchmark for healthcare facilities across the nation. The dedication of the hospital’s leadership and staff to improving patient outcomes and the overall healthcare experience is truly commendable. I look forward to seeing the continued success of these pathways as they positively impact the lives of patients and contribute to the broader healthcare landscape.”

Urology – MCP – Phase 1 Update:

The Haematuria Pathway at SVUH marks a significant leap in cancer diagnosis efficiency. Operating as a one-stop “See and Treat” service, patients undergo blood tests, imaging, and scope procedures on the same day, resulting in a rapid diagnosis, immediate treatment, or prompt referral for further management. This streamlined approach reduces patient visits from four to one and shortens the time to diagnosis by an average of three months. In the period from January to December 2023, the pathway attended to 485 patients, achieving an impressive 87% discharge rate, removing them from the Urology waiting list. Of those patients, 380 successfully completed the pathway, with 11% receiving a new diagnosis of bladder cancer and 1.9% diagnosed with other urological malignancies. The current wait time from referral stands at 32 days, and looking ahead to 2024, the pathway plans to scale up its services in alignment with the national key performance indicator of accommodating 700 patients annually.

Orthopaedic – MCP -Virtual Fracture Assessment Clinic (vFAC) – Phase 1 Update:

The vFAC Pathway at SVUH demonstrates a pioneering approach to patient care. This consultant-led service employs virtual assessments for low-acuity injuries presented at the Emergency Department, significantly reducing patient visits to fracture clinics and ensuring timely decisions for further management. The pathway faced challenges in recruiting a specialist Physiotherapist to support its operations. However, future service enablers are on the horizon, including direct referrals to physiotherapy, the utilisation of an e-Trauma platform, and formal expansion of the pathway to include St. Michael’s Hospital (SMH) and St. Columcille’s Hospital (SCH). Key Performance Indicators (KPIs) for the pathway in 2023 showcase remarkable achievements, including a 22% reduction in fracture clinic referrals at SVUH (42% at SMH), over 90% of patients assessed within 72 hours, and less than 2% progressing to surgery for both SVUH and SMH. These metrics underscore the pathway’s success in delivering efficient and effective orthopaedic care, setting the stage for further expansion and improvement in the coming years.

Nephrology – MCP – Phase 1 Update:

The Home Therapies Pathway at SVUH introduces Peritoneal Dialysis (PD) as a transformative form of dialysis that can be administered in the comfort of one’s home. This approach not only enhances the quality of life and independence for patients but also boasts similar survival rates to Hemodialysis (HD) while being more cost-effective. The pathway, active since 2023, has treated 22 patients, with an additional ten patients scheduled to enter the programme in the coming six months. Perhaps most strikingly, the Home Therapies Pathway significantly reduces hospital visits, reducing the average from 150 to just four/six visits per annum per patient, resulting in 2,800 fewer hospital visits and treatments at SVUH. The economic impact is notable, with an estimated cost saving of €30,000 per patient per annum in comparison to in-centre HD. This marks a considerable advancement in providing patient-centric, cost-effective, and accessible renal care through home-based therapies at SVUH.

Neurology – MCP – Phase 1 Update:

The Headache Pathway at SVUH represents a significant stride in enhancing patient access and care. This innovative approach ensures improved access for patients presenting with debilitating headaches and offers a viable alternative to presenting at the Emergency Department. Rather than being placed on the general neurology waiting list, they benefit from a dedicated pathway. The figures from the Headache Clinic Activity underscore the pathway’s impact, with monthly statistics correlating to the total figures for new, return, and virtual visits. Throughout the months of April to December 2023, the clinic saw a total of 123 new patients, 164 return patients, and 152 virtual consultations, contributing to an overall total of 439 clinic engagements.

Endocrine – MCP – Phase 1 Update:

The Diabetes pathway at SVUH highlights pivotal advancements in diabetes care. With a dedicated consultant in post since November 2023, the pathway has achieved a notable 47% redirection of diabetes referrals to community settings, demonstrating a commitment to more accessible and decentralised care. The pathway’s impact extends to 1062 patient contacts across community diabetes in CHO 6, with 142 patients receiving comprehensive care at SVUH since December 2023. A multidisciplinary team has played a crucial role, discussing 79 patients in meetings to prevent unnecessary GP referrals to outpatient departments (OPD) and emergency departments (ED). Looking ahead, the pathway anticipates enhanced services through future enablers, including the DIAMOND database, multisite access, the inauguration of a new patient clinic on February 21, 2024, at the Clonskeagh Hub, an urgent referral system for ED attendees, and virtual reviews to facilitate early discharge of inpatients, contingent upon access to continuous glucose monitoring (CGM) for insulin-treated type 2 diabetes mellitus (T2DM) patients. These initiatives collectively underscore SVUH’s commitment to advancing diabetes care, emphasising community engagement, and leveraging technological solutions for comprehensive and patient-centric services.

In the upcoming phase two of Modernised Care Pathways (MCPs) at SVUH, a strategic focus is placed on diverse medical specialties, each with its unique pathway designed to optimise patient care. In the Orthopaedic specialty, the Fracture Liaison Service is set to launch in the first quarter of 2024, with the recruitment of an Advanced Nurse Practitioner (ANP) in January 2024 and the establishment of clinical administration support. The Ear, Nose, and Throat (ENT) specialty introduce the Dystonia/Dysphagia pathway, bolstered by the recruitment of a Clinical Specialist in Speech and Language Therapy (SALT). Gastroenterology’s Inflammatory Bowel Disease (IBD) pathway aims to become operational in the second quarter of 2024, with the recent recruitment of two ANPs in January 2024. The Hepatology pathway focusing on abnormal Liver Function Tests (LFTs) is currently in the training phase, with an ANP enlisted in January 2024. Dermatology’s pathway covering Pigmented Skin Lesion, Acne, and Psoriasis, has seen progress with the appointment of a Clinical Advanced Nurse Practitioner (cANP) in September 2023. Lastly, in the Cystic Fibrosis specialty, recruitment efforts are underway for two Senior Clinical Psychologists, emphasising the holistic approach to patient well-being in this evolving phase of MCPs at SVUH.

The Acute Virtual Ward project at SVUH is making significant progress in its mission to develop a 25-bed facility, initially catering to Cardiology and Respiratory services. This innovative initiative aims to provide crucial support to patients who, under normal circumstances, would be hospitalised, enabling them to receive care and monitoring within the comfort of their homes. The development has seen key milestones achieved, starting with a workshop held on December 19, 2023, at SVUH. Subsequent advancements include a Steering Committee meeting in January 2024, a pathway mapping workshop conducted at Dr Steeven’s Hospital on January 23, 2024, and a Procurement Evaluation Group review on January 24, 2024. These steps underscore the hospital’s commitment to advancing healthcare services through cutting-edge initiatives, with the Acute Virtual Ward poised to revolutionise patient care by combining the benefits of hospital-level monitoring with the convenience of home-based support.

The Cardiology Integrated Care programme at SVUH is dedicated to managing Deteriorating Heart Failure cases with a comprehensive and patient-centric approach. Patients gain access to the programme through either GP referral or direct presentation to the Heart Failure Unit. Upon confirmation of deterioration in heart failure, a dedicated team involving consultants and senior house officers institutes a tailored management plan, which may include the escalation of therapy through intravenous or oral means. The process includes a thorough E-Health and face-to-face (F2F) review. Once patients stabilise, they seamlessly transition to community care, emphasising continuity and holistic support. The service has demonstrated substantial impact, with 242 patients admitted to the pathway. Notably, 82% of patients achieved stabilisation, 15% required admission, and 3% unfortunately did not respond to intervention (RIP). The programme’s success is further enhanced by robust patient and family support, reinforcing its integral role in providing effective and compassionate care for individuals experiencing deteriorating heart failure at SVUH.

The Respiratory Integrated Care programme at the hospital demonstrates a comprehensive and forward-thinking approach to respiratory health. A fully operational enhanced hub in Bray, along with a satellite clinic in Wicklow, is equipped with Advanced Nurse Practitioners (ANP) and physiotherapists, ensuring accessible and specialised care. The pulmonary function testing (PFT) lab in Bray, networked to SVUH, facilitates diagnostic processes, complemented by mobile spirometry clinics in Wicklow. With a focus on community engagement, the programme boasts five pulmonary rehabilitation sites in Wicklow and South-East Dublin.

In terms of activity, the virtual consultation service, introduced in Q4 2023, served over 520 clients in the same year. The integration with SVUH is evident through virtual multidisciplinary team (MDT) consultations, direct referrals to St. Columcille’s Hospital (SCH) and SVUH for advanced radiology, endoscopy, and radiology MDT services. The programme offers pathways out of community care to specialised clinics, including the Severe Asthma Clinic, Interstitial Lung Disease Clinic, and Rare Lung Disease Clinic.

Looking ahead, future service enablers include direct pathways to the hub for St Columcille’s Acute Medical Unit (AMU), point-of-care laboratory units for in-house oxygen clinics, and the implementation of reflex testing algorithms for the PFT lab. These initiatives underscore SVUH’s commitment to innovation, patient-centric care, and continuous improvement in respiratory health services, ultimately making every patient contact count.

For media inquiries, please contact:

Jennie Cotter | Corporate Communications Manager | 086 776 1890 | jcotter@svhg.ie