Aut Even Hospital Kilkenny

AUT EVEN EVEN HOSPITA AUT H UT EVEN HOSPITAL KILKENNY KILKENNY KILKEN VEN HOSPITAL

KILKENNY

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John Bannon Ltd has become a market leader in the Irish Medical industry.

The companies’ competitive advantage lies in the management of its customer relationships. Through the years strong relationships have developed built on trust, impeccable customer service and communication.

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contents

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Contents

2 CEO Welcome

22 Orthopaedic Services

38

Radiology

5 Access & Admission

25

40

Respiratory Medicine

5 Quality Initiatives

27 ENT Services & Paediatric Care

7 Lean Management 8 Aut Even Facilities

29

General Surgery

Ophthalmology

30 Urology

11 Insurance Cover & Patient Info

31 Urodynamics Services

13 Infection Control

32 Pain Therapy

15 Theatre CSSD

33

Psychiatry Services

16 Medical Services

34

Vascular Surgery

19 Endoscopy & DSU

35 Gynaecology

21 Pre Assessment

36 Cardiology Services

43 Dietetics 43

Departments

46 Directory

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ceo interview

Leading from the front Aut Even’s CEO, Annette Jolly, discusses the 100-year history of this unique hospital and her work to ensure it remains a leading healthcare facility.

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nnette Jolly oversees the activities of the entire Aut Even facility, ensuring that patient care is delivered and maintained to the highest standard. Her passion for the job is palpable as is the responsibility she feels for each and every patient that enters Aut Even.

Having built a successful career in healthcare, Annette was attracted to Aut Even by the strong ethos which the hospital has developed over the past century. “I’ve worked in a number of private hospital environments throughout my career and the one thing that sets Aut Even apart from any other hospital I’ve been a part of is the care and dedication of the staff. This is evidenced daily as I see staff from all levels going out of their way to be of assistance to our patients. At Aut Even you are treated as an individual instead of just part of a process.”

Founded by a local benefactor in 1915, Aut Even shares the accolade of being the oldest private hospital in Ireland. It was purchased in 1933 by St John of Gods, a Catholic healthcare organisation, and run by nuns before being sold to the Mount Carmel Medical Group in 2005. Annette attributes the hospital’s strong caring philosophy to its shared history with these religious orders. “We have a set of values which are: Integrity, Competence through continuous improvement, Accountability, Respect and Empathy,” she asserts. In fact, these values make up the appropriate acronym of ICARE. “Our vision is – through our commitment to clinical excellence and patient care – to be the hospital of choice for patients, doctors and staff.”

State-of-the-art environment Despite its long history Aut Even has never failed to move with the times and has all of the modern amenities of any first-class hospital. “We are a 71-bed elective acute hospital,” she explains. “We have an 18 bed day surgery unit and six x-flow, ultra-clean laminar flow operating theatres and I’m confident we are the only private hospital in Ireland to have these in all of our operating theatres. We also have a twin suite endoscopy unit which is attached to the day care unit. We have a very broad range of surgical specialties. In terms of beds, we have 25 medical in-patient beds and 46 surgical in-patient beds. of which 80% are private rooms.

While Aut Even does possess all the mod-cons one would expect, Ms. Jolly believes its stunning location, set in 25 acres of landscaped grounds among the outskirts of Kilkenny, makes it a unique facility. “When you drive in to the hospital you get an overwhelming sense of peace and calm, as you are greeted with a beautiful tree-lined avenue. It’s very different from going on to another hospital site because it’s not congested like most hospitals are. We have ample free parking which is a big difference between the stressful situations you find yourself in larger urban hospitals.

Coming to Aut Even is a relaxing experience, which we believe greatly aids the healing process.”

A journey In 2008 Aut Even sought accreditation from the US-based Joint Commission

“Our vision is – through our commitment to clinical excellence and patient care – to be the hospital of choice for patients, doctors and staff,”

International (JCI). Hospitals worldwide can seek accreditation to demonstrate quality, and a JCI accreditation is considered one of the highest seals of approval for medical facilities that excel in providing safe and effective care of the best quality.

Under Ms. Jolly’s stewardship, Aut Even achieved its goal of receiving accreditation and it’s something the CEO cites as one of the highpoints of her time at the hospital.

“It’s been a tremendous journey for the whole hospital. Unlike many other hospitals, we don’t have an accreditation manager as we believe it is part of everybody’s job to meet JCI standards.

Managers are responsible for a particular part of accreditation because the JCI organise it into chapters, therefore we have chapter leads. For example, our theatre manager has responsibility for all standards relating to the operating theatres. She then works with her staff towards the policies that they are going to work to in order to meet JCI standards. This delegation means everybody feels a part of it. I’ve been invited to join the JCI standards sub-committee which helps to lay out the standards. Every three years they change the standards and raise the bar that little bit higher.”

With so much achieved in her relatively short reign, Annette Jolly remains committed to facing the challenges of leading Aut Even Hospital forward, raising the hospital’s own standards even higher and by continuing to provide the first-class care she has always demanded, to each and every patient.

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Access and Admission

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Ease of Access at Aut Even As operational managers at Aut Even, Deirdre Moylan and Deirdre Dillon the hospital runs as efficiently as possible while also ensuring ease of access to services for both patients and General Practitioners.

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s Assistant Directors of Nursing at Aut Even, Deirdre Dillon and Deirdre Moylan are often the first point of contact for GPs when referring a patient for admission to the Kilkenny private hospital. With years of experience in the medical sector, their job revolves around ensuring the hospital runs as efficiently as possible for the patient while also making the task for the GP as efficient as possible.

Putting patients at ease Maintaining a comfortable environment for incoming patients is a priority for the ADON’s. Aut Even has developed a strong reputation for providing the best of available services to patients and a recent upgrade of patient accommodation has been a testament to the hospital’s continuing desire to provide the most comfortable and reassuring experience possible. All six of our operating theatres are Howorth’s Exflow™ Ultra clean ventilation theatres which have been proven to reduce the occurrence of microorganisms within the operating theatre and more specifically at the wound site, minimising the risk of infection.

Key Service Features The Direct Line to the Bed Manager 056 7775269 is available from 8.30am

– 5pm Monday – Friday and Bed Management on call on 056 7775275 for out of hours queries. There are minimal waiting times for bed availability and in most cases can admit the patient on the same day.

Our house doctors provide 24hour cover to our patients and we also offer access to highly specialized multidisciplinary team as follows:  Highly Skilled Nursing team  Senior Cardiac Technician  Senior Occupational Therapist  Senior Physiotherapists  Senior Pulmonary Lab Technician  Senior Dietician  Infection Control Clinical nurse Specialist  Haemoviggillance Clinical Nurse Specialist  Diabetes Clinical Nurse Specialist With an ever increasing number of patient referrals being experienced in Aut Even, the need to continually ensure an efficient and quality service to patient and GP’s is clear.

Admission Protocol for General Practitioners 1 Enquire if patient has adequate insurance cover for Aut Even Hospital 2 Contact the Bed Manager on

There are minimal waiting times for bed availability and in most cases can admit the patient on the same day.

056 777 5269 with the following information.

Name, DOB, Insurance Cover 3 Presenting Complaint (acute or chronic) 4 Preferable Consultant if relevant 5 Routine or Urgent admission 6 Fax/post a detailed letter of referral with a list of patient’s current medications attached, to the relevant Consultant’s secretary or hospital admissions on 056 7762149.

7 Inform the patient of their admission time and date to Aut Even Hospital.

Shaping the needs of General Practitioners The GP liaison manager Kathriona Garry, whose role involves strengthening the communications between the hospital with the GPs. She provides a point of contact for GP’s to voice concerns, issues or enquire regarding services available within the Hospital. This feedback facilitates Aut Even to continually improve our services for the general practitioners and their patients, promoting a positive patient experience and helping us to shape our services. Key Service Improvements implemented from the feedback we have received from General practitioners in 2012.  Improved medical admission process.  Introduction of Direct Access endoscopy service in April 2012  Reduction in Radiology/MRI prices.  Reduction in MRI waiting times to 7 days, all urgent referrals is prioritised.

We aim to further reduce this waiting period to 2-3 days in 2013.  Self-payer package pricelist in October to provide more treatment options to patients without private health insurance.  Pain management specialist Dr Tadhg Lynch, Consultant Anaesthetist & Pain specialist due to start Clinics in January 2013.

Additional Dermatology services: Dr. Geraldine Morrow is seeing new patient in Kilkenny since July this year Mr. Michael Murphy, consultant vascular surgeon commenced in November 2012 and performs laser vein surgical options for patients.

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For the past 50 years the Whelehan Group has been a leader in the sales, marketing and distribution of pharmaceutical, medical products.

The Whelehan Surgical division’s focus is on the hospital supply area with particular emphasis on key areas of surgery, including cardiac, ENT, orthopaedic, ophthalmic, general and minimally invasive surgery. In addition, Whelehan Surgical division also supplies general medical and surgical consumables to other areas of the hospital such as accident and emergency departments. Each sector of the business is promoted by highly skilled specialist representatives, all with expert knowledge in their chosen sphere of activity.

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a unique approach to marketing, sales and distribution

Contact Us T: 01 806 8600 F: 01 836 2271 E: surgical@tpwhelehan.ie W: www.whelehansurgical.ie Bunkilla Plaza, Bracetown, Clonee, Co. Meath

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patient safety

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Putting Quality and Patient Safety first

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he hospital has a long tradition of care, having been founded by a local benefactor and run by the sisters of the John of Gods for over 70 years. Today the hospital takes pride in continuing this tradition of care within a framework of quality and patient safety.

Our Quality and patient safety framework At Aut Even Hospital we strive to place the patient at the centre of everything we do. Our definition of quality is that our patients and customers receive: The right service From the right staff In the right place At the right time In the right way.

Our robust Quality Programme ensures that an open and transparent Quality and Patient Safety agenda functions to meet the needs of our patients, their families, our staff and our wider customers. The programme is represented by all members of our staff base and strives continuously to mentor care through Clinical Governance, patient safety goals, on-going clinical risk assessments with monitoring of risks, education and competency assessments of staff based on evidence based health care. We hold a Clinical Audit Committee meeting at regular intervals, monitoring the following risks: 1. Unplanned Returns to theatre 2. Incidence of Mortality rates 3. Number of Transfers to other Hospitals 4. Blood Usage, 5. Complaints 6. Incidents Aut Even Hospital is a member of the Independent Hospital Association of Ireland and the CEO Annette Jollyattends quarterly meeting with Quality Managers from other IHAI member organisations nationally. This gives the opportunity to share best practice, discuss national quality and patient safety issues and to benchmark data within the group.

Accreditation Joint Commission International

Accreditation is an independent external process designed to create a culture of safety and quality within an organisation that strives to continually improve patient care processes and results. In 2008 we embarked on our journey of Continuous Improvement and gained accreditation status with the Joint Commission International (JCI) following our first survey in 2009. This standard has been sustained following our most recent triennial survey in November 2011.

Other external agencies assess our hospital standards at regular intervals.

We have successfully completed reviews from the Health and Safety Authority (HSA), Irish National Accreditation Board (INAB) in conjunction with St. Lukes Hospital Blood Transfusion Service, HACCAP and the Environmental Protection Agency (EPA).

International Quality Indicator Project Owned by Press Ganey, the IQIP allows hospitals to measure improve and trend their performance over time, as well as to benchmark their performance against a wide range of peer groups. Indicators are different depending on organisation type.

Aut Even hospital joined in 4Q 2009, reporting to the Acute Care Indicator set. To date there are 4 Irish participants and 49 European participants. All data entered is confidential.

Clinical and managerial performance indicators are monitored through clinical audit as part of the quality programme.

In 2009, Aut Even joined the International Quality Indicator Project (IQIP) owned

by Press Ganey Associates to allow us to benchmark our quality data nationally and internationally.

Survey Questions

Overall Total

Section 1: Access and Admission How would you rate the Information you received prior to admission

88.5%

Reception Staff were courteous and helpful

95.7%

Rate your Admission Experience

96%

Section 2: Patient Care Nurse Communication & Education

97%

Doctor - Communication & Education

97%

Other staff - Communication & Education

96%

Rate care received from nurses

98%

Rate care received from Doctors

98%

Rate care received from other staff

97.7%

Rate Privacy & confidentially

96%

Rate pain assessment & management

95.5%

Section 3: Hospitality Cleanliness

96.4%

Comfort

95.7%

Amenities

94.9%

Quality of Food

93.3%

Choice of Food

90.6%

Specific Diet Considerations met (eg diabetic)

93.9%

Section 4: Discharge Plan for discharge

93.1%

Prep and Ed for discharge

93.4%

Section 5: Overall Experience 96.6%

Overall Rating

Quality and Patient Safety Monitors Indicator Title

Category

Antibiotic prophylaxis for hip (and knee) Arthroplasty within 1 hour prior to incision

Infection control

Antibiotic prophylaxis for hip Arthroplasty (and knee) for a duration of <= 24 hours following surgery end time

Infection control

Total acute care inpatient mortality

Patient Safety

Unplanned returns to the operating theatre

Patient Safety

Documented inpatient falls (includes reason for fall and injury severity)

Patient Safety

Episodes with aspiration in the endoscopy suite

Sedation & Analgesia

Episodes with airway obstruction in the endoscopy suite

Sedation & Analgesia

Total incidence of MRSA infections per 100

Infection control

Needle stick injuries

Infection control

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SacredHeart nursing home Comfort & Care

Sacred Heart Nursing Home is a modern 35 bed purpose built nursing home situated in the heart of the countryside. Our philosophy is to create a ‘home from home’ for each resident and to care for every resident as one would for a parent. Sacred Heart Nursing Home is a family run facility with a strong commitment to ensuring that residents are happy and remain in close contact with their families, friends and home environment. Sacred Heart Nursing home has an excellent reputation as a residential, retirement and nursing facility since 1994.

Our Services & Facilities • 24 hour nursing care in private or semi private ensuite rooms

• Occupational Therapist working within the home

• High standard of care from highly qualified nursing & care staff

• Hairdressing services

• Sonas & reminiscence therapy

• Spritual needs of different denominations are catered and clergy of denominations visit

• Varied weekly activity programme, including gentle exercises, bingo, cards, art and music

• Our specially designed Oratory provides a tranquil setting for private prayers and spritual reflection.

• Newspapers provided daily

• Mass is celebrated Weekly & Ministers of the Eucharist visit Sundays

• Outings are arranged for those who wish to partake • We have a beautifully landscaped garden with an enclosed area designed to ensure the safety of each resident • Our clients have a choice of Doctor • Physiotherapist, Chiropodist, Dentist and Optician Services are arranged as required

• Choice of sitting rooms include a Large conservatory, quiet reading room, smoking room & TV room • Individual care plan for each resident • Open door policy to visiting • Pets are also welcome to visit

We are located in the country side with beautiful landscaped gardens. We are only a 15 minute drive from the town of Thurles and the villages of Freshford and Durrow, Situated in the county of Kilkenny, near the Laois and Tipperary borders. We have been caring for residents from Kilkenny, Laois and Tipperary for over 20 years.

NHI NURSING HOME ANCILLARY WORKER AWARD WINNER

Tel: 056 8831318 • Email: sacredheartnursinghome@gmail.com Mob: 086 6814881 • Web: www.sacredheartnursinghome.ie CROSSPATRICK, JOHNSTOWN, CO. KILKENNY Registered with the HIQA, VHI approved and members of Nursing Homes Ireland.

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leAn mAnAGement

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Lean Transformation – Making the difference Lean methodologies have been deployed at Aut Even to aid in quality achievement and putting patients at the forefront of what the hospital does.

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ounded a century ago, Aut Even has enjoyed a reputation for quality and excellence. In 2006, management at the hospital decided to bring a fresh perspective to the way in which the hospital was run in order to build on their excellent level of patient services.

“We decided to deploy lean transformation methodologies to help us achieve exemplary quality throughout our processes and systems, and to put patients and customers at the absolute forefront of what we do,” said Ann-Marie Garbutt, director of nursing. Developed more than forty years ago at Toyota, during the 1990s it was taken up and conceptualised by Massachusetts Institute of Technology (MIT) under the name of ‘Lean.

The methodology is beginning to appear more and more in the service industries, and has also begun to take root in hospitals. On this basis, lean results in innovation through better working practices becoming the norm, and the perpetuation of these practices to guarantee sustainability. “Primarily, lean methodology is about involving our staff and harnessing their expertise to lead change,” Ann-Marie explains.

“Not only are they encouraged to look at ways to improve the processes and systems that affect them directly, but also hospital-wide. They are the ones who are leading the improvements at Aut Even.”

Ann-Marie has previously worked in the NHS, England, where such methodologies have already been implemented with real success while in Ireland, Aut Even is one of the first hospitals in the country to adopt this methodology. Staff at the hospital are given the chance to visit other institutions which have employed lean methodologies to great effect, including the Royal Bolton Hospital in England which had been on the cusp of closure before the introduction of lean tools which turned its fortunes around. The applications in healthcare are very real and include reducing turn around times and errors in laboratories, reducing changeover times in operating rooms, more time for patients care with fewer falls and infections, reductions in patient delays, increased capacity, and the reduction of diversions and improvement of the flow in emergency departments. Aut Even has also changed the way in which patients are admitted, as part of improving the experience of GPs who refer their patients to the hospital. Where once there was three or four steps involved there is now only one; consisting of a single phone call to successfully refer a patient. The feedback from the network of GPs regarding such improvements has been ‘phenomenally positive.’ “We are very focused on access and customer satisfaction,” AnnMarie says. “We want to ensure that

“We decided to deploy lean methodologies to help us achieve exemplary quality throughout our processes and systems, and to put patients and customers at the absolute forefront of what we do,”

all of our processes and systems are free of waste and are defect-free. It’s a big ask, but that’s our vision and that’s where we’re heading.”

It has only been three years since Aut Even began to actively implement this innovative approach to management, but though the hospital is still in its infancy with regard to lean continuous improvement the results are already beginning to shine through. “We still see ourselves as being at the start of our journey,” says Ann-Marie. “We have increased overall productivity and, within some specialities, we actually operate on more patients using the same number of staff and in the same timeframes.

It has allowed us to reduce stock levels across our theatre environment.

It’s not only about money,” she continues, “It has allowed us to better utilise space and better organise our patient areas. Most importantly, lean supports a culture of continuous improvement which assures a service that is evidence based, standardised and safe – where improvements are sustained because everyone is involved.” Ann-Marie is confident in the lean transformation agenda at Aut Even, and remains convinced that its introduction will not only meet the operational challenges faced by the hospital but will ensure its continued competitiveness in the Irish health market.

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Facilities

Facilities Insight at Aut Even

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he role of Facilities Manager entails the maintenance of the equipment, mechanical and electrical plants such as the air-handling unit, the water system, electrical systems, ventilation, the hydronic systems and medical gases. also incorporating the maintenance contracts within the theatres, medical wards, the out-patients facilities, consultancies, pre-assessment and physiotherapies.

different trials to try and find the best fit for the business. Every single zone in the hospital is set up so that when there is an over-utilisation of energy, such as equipment or a light left on, a message is sent to notify us. It also works with regard to legionella levels, by checking the temperature of the water tanks every few seconds.

Operating in Theatres The six ultra clean ventilation (UCV) theatres which are validated every year through a partner company to make sure they meet the required standards. All of the theatres are backed up by an un-interruptible power system (UPS) which is a stopgap between the power going down

Sourcing Equipment The Clinical Staff are involved in the analysis and justification regarding the purchasing of equipment. This ensures we get the best value, while making sure equipment is practical and fit for use.

Some of the medical equipment that is purchased industry-wide would have a closed protocol system which would be agency-run; meaning maintenance and repair would be monopolised by one group. As a result of that, we try to make sure that we have access to equipment that can be easily repaired or replaced.

Following a Plan The tilisation of energy and water consumption in the hospital; one of our biggest expenditures per annum.

Weâ&#x20AC;&#x2122;ve conducted a number of

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Facilities

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just interact with them in terms of notifying them of accidents; we also look to their knowledge and expertise in how to develop safety systems and a safe plan of action. They visit us once a year to have a look over the site.

and the generator coming online. We also have preparations in place for any water shortage issues with a 48 hour emergency supply. We have a very important Legionella prevention policy in place here which is reevaluated every six months. The water storage also gets tested, de-scaled and cleaned out each year.

Safety First The health and safety responsibilities include overseeing fire safety plans, emergency plans, policies and procedures there after and updating them on an annual or bi-annual basis.

At the moment we’re looking at contractor safety and we’re installing

a ‘permit to work’ system and a safe plan of action system in combination with risk assessment and safety systems to make contractors aware that health and safety is paramount.

We’re looking at introducing blending stations to reduce the handling of detergents across the site; we’re currently looking at some new technology to reduce the risk and to mitigate against it. We always have to use detergents because of the business we’re in, but we’re trying to reduce the handling on the part of the housekeeping staff to ensure their welfare is maintained at all times.

We work very closely with the HSA on a regular basis. We don’t

“The six UCV theatres which are validated every year through a partner company to make sure they meet the required standards.”

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patient information

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Insurance Cover and Self-Payer packages

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t Aut Even Hospital we are happy to help patients understand what, if any cost, they may incur for any procedure.

To do this there a few simple steps  Check the name/type of your plan  Check your policy number  Confirm with Consultant’s Secretary the procedure name and code.  Contact your insurance provider to ensure there are no exclusions under the terms and conditions of your policy.  Call us on 056 7775194 with the above details It is the patients responsibility to understand their level of insurance cover, particularly as there are many variations of plans, many of which have an ‘excess’ included by the insurer.

All hospital accounts must be settled on admission.

Option for Patient without Private health insurance/ Self-Payers Aut even has recently introduced our all-inclusive self-payer package prices for procedures, in order to provide more treatment option to patients without private health insurance. Our self-payer packages include the following:  Hospital fee  Anaesthetic fee  Consultant fee F or quotations on procedures patient can contact our patient accounts department with the following information and will be given a procedure cost estimate in advance of treatment.

Confirm with Consultant’s Secretary the procedure name and code.

Contact our patient accounts department on 056 7775194

“Aut Even has recently introduced our allinclusive selfpayer package prices, in order to provide more treatment option to patients without private health insurance.”

Patient Information Prior to Admission We would ask that patients take note of the following:  If you are taking anti-coagulant therapy such as Warfarin, Aspirin, Diabetic medications or oral contraceptive pill, please contact your Consultant prior to your admission as you may need to discontinue this medication before your procedure.  Bring a list of your current medication; this may be obtained from your GP or from your pharmacy.  We advise that you organize transport to and from the hospital if you are having sedation or will be under a general anaesthetic during your procedure.  We recommend that you leave all valuables at home.  Smoking is prohibited in Aut Even Hospital.  Please bring dressing gown, slippers and towel with you on admission.  Bring with you any relevant scans/xrays to this admission.  It is important that you follow your fasting guidelines (strictly no food or fluids)  Please refer to our website www.autevenhospital.ie for further information in relation to your stay in Aut Even Hospital.

We recognise the following health insurance providers

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23/10/2012 12:15

DRAKELANDS HOUSE NURSING HOME KILKENNY

Caring for you in the comfortable surroundings of an elegant home At Drakelands House Kilkenny, each resident is welcomed as an individual where an holistic emphasis on Medical, Nursing, Social and Spiritual care encourages health and happiness. Residents can expect their quality of life to be enhanced by the provision of a happy, comfortable, secure environment. It is this sense of homely comfort and ease that creates the welcoming warmth and friendliness of Drakelands House, cherished by residents and friends alike. Drakelands House is an elegantly designed home with 66 private rooms and 3 semi-private room providing the following facilities and services:

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H E A LT H I N S U R A N C E A C C E P T E D

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infection control

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Education & protection With some of the most advanced screening equipment available, Aut Even has a proven track record in hygiene and patient screening.

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he old saying, ‘prevention is better than the cure’, could not be more apt for the infection, prevention and control programme of Aut Even Hospital.

All patients entering the hospital are risk-assessed and should an infection of any kind be found, the staff will put in extra precautionar y measures to prevent it spreading to elsewhere in the hospital. Infection Control Nurse, Dorothy Kealy-O’Brien, explains: “Surveillance is a key priority for us.

We actively collect data for MRSA, blood-stream infections, antibiotic prophylaxis, surgical site infections and needle-stick injuries. One of our latest focuses has been on preventing the spread of ESBL, which is a new type of multi-drug resistant organism. She adds: “Our sur veillance expands every year to deal with new and emerging infections. We also annually review and develop new policies here at Aut Even. At the moment, we have about 40 infection prevention and control policies. We do a standing audit ever y year and a hand hygiene audit, sharps audit and a MRSA audit.”

The education of staff from all disciplines including the management is also important when it comes to maintaining a high standard of infection control. Kealy-O’Brien says: “The infection control team hold regular training sessions, produce reminder posters and host awareness days for everyone in the hospital to ensure staff are kept abreast of any changes or developments.” Similarly, since 2010 the hospital has hosted a hand hygiene awareness day every May where the infection control team run promotional events and educational sessions for all staff members and the public.”

Screening process On admission, patients who meet the MRSA screening protocol are screened for MRSA and isolated pending results.

“We put a lot of importance on the education of staff regarding infection control. However, education alone is not enough,” says Kealy-O’Brien. “There is also the need for reminders, such as screening, swab flowcharts and visual reminders.” Luckily for Kealy-O’Brien, the team at Aut Even are more

“Surveillance is a key priority for us.

We actively collect data for MRSA, blood-stream infections, antibiotic prophylaxis, surgical site infections and needle-stick injuries.

than willing to learn and participate in the development. “Professional development is very important to us here at Aut Even, particularly when it comes to reaching the highest standard of patient care and safety. “ Facilities In terms of technology used to stop the spread of infection, Aut Even possesses the latest in a line of equipment which has a proven track record in stopping the infection at its source. The recent purchase of fogging machines, which pump a fine anti-bacterial fog into a room and neutralises any organism present, has been one of the latest additions to complement the current infection prevention and control measures in the hospital. This also cuts down on the amount of time needed to disinfect a room by the housekeeping staff. For patients suffering from respiratory infections like tuberculosis, rooms are dedicated to them which include a HEPA filter which extracts the air, cleans it and releases it again; this is one of the best available on the market today.

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Central Sterile Supplies Department (CSSD)

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Decontamination and Sterilisation The CSSD department at Aut Even Hospital has a dedicated frontline team who, through completion of a complex system of checks and balances, ensure that all operating instrumentation is sterile and fit for purpose.

W

hat happens in the Unit?

“Decontamination facilities are designed, constructed, maintained and controlled to provide effective segregation of clean and dirty activities and to provide an environment that minimizes adventitious contamination of clean and disinfected reusable invasive medical devices (RIMD) including flexible scopes.” HSE Code of Practice, v 2. (2010).

The sterilisation process at Aut Even is a three stage process which takes place in the purpose built three roomed unit on site. CSSD manager Ashlene Ayres overseas the department to ensure that every precaution is taken when re processing instruments. “Instruments are cleaned, disinfected and then sterilised in the unit. . Our purpose built department has a positive and negative airflow system to ensure prevention of

airborne contaminates.

The decontamination room contains two state of the art Miéle machines which wash and disinfect the equipment. These are computer controlled lessening the risk of human contamination. Each machine is serviced and validated four times a year to ensure that they are performing to the highest standards at all times.

Once the equipment has been through the sterilisation process, it is delivered to the appropriate speciality theatre for use.

Training and Technology As this is an area which is constantly evolving and improving it is important that Aut Even keep up to date with all developments. To this end the staff are regularly updating their training onsite, together with attendance at the National Irish Decontamination

The room contains two state of the art Miéle machines which wash and disinfect the equipment.

Institute (IDI) Conference. Ms Ayres together with her team are on hand to ensure that the hospital is at the forefront of modern technology and is constantly improving and modernising as appropriate.

The CSSD is also responsible for ensuring that all instruments used for surgical procedures are functioning and fit for purpose. This requires the staff to have an excellent knowledge of each instrument and its purpose. This is no easy task considering the complexity of the instrumentation sets, some of which consist of 100 items or more.

Much time is spent ensuring and validating the CSSD’s processes are correct and scientifically proven” to provide the highest levels of decontamination and sterilisation for safe and effective delivery of high quality care.

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Medical Services

Medical Services Aut Even’s highly skilled Medical team give us an insight into their particular areas of expertise, the facilities available to them at the hospital and their hopes for the future of their sectors

A

isling McEvoy, a Clinical Nurse Manager has been a staff nurse for over ten years now, having trained and worked in the James Connolly Memorial hospital in Dublin, before spending four years working in Saudi Arabia then returning home to Ireland to work at Aut Even in her native Kilkenny. “The facilities are great here,” she maintains. “It’s a small private hospital with a nice homely feel. Everybody knows each other from a staffing pointof-view and there’s a really friendly atmosphere in the place. The facilities are of the highest standards. The third floor medical ward has 11 semi-private beds and 14 private beds with their own ensuite bathroom which has its own toilet and shower facilities. And patients are always commenting on the high-standard of food in the hospital.”

Busy days Aisling’s average day is a busy one with constant referrals from our medical consultants, or patients admitted by GP referral. A particularly strong emphasis is placed on diagnostics as she explains.

“We have been able to diagnose a lot of complex issues and refer them to a tertiary care center if required. These diagnostic tools can include radiological procedures including x-ray, MRI, CAT scan, ultrasound, dexascan and barium studies. Other more invasive diagnostic procedures available include direct access endoscopy and exploratory laparoscopic procedures.” Aut Even also offers cardiology testing, and should the patient require further attention, they are transferred to those other specialty hospitals, with direct access between these hospitals and Aut Even.

“They will travel up by ambulance and usually be back in Aut Even by the close of business the same day, so it’s a very efficient service.”

Multi-disciplinary teamwork For other patients, Ashling states as par t of what she calls a “multidisciplinary” team consisting of physicians, surgeons, non-consultant doctors, anesthetists, physiotherapists, occupational therapists, dieticians,

Dr. Dilip Johndale pharmacists, respiratory therapists and the nurses and care attendants to provide a patient centered service.

Our feedback from these patients is overwhelmingly positive. “It’s always been great feedback from the patients. One thing that is always being said is that if a patient goes up to Dublin for treatment, they always mention that when they come back to Aut Even, it’s like they’re returning home. We get that a lot so we’re very proud of that.”

Expanding Role Of the nurse Ashling is positive regarding the outlook for the advancement of nursing over the next few years.

“It’s changing all the time,” she says.

“Nursing is one of those disciplines where you always have to maintain your professional developments which are updating all the time. Over the thirteen years that I have been in nursing it has been constantly changing.

One of the more positive changes has been that nursing has become more autonomous enabling the nurse to make effective clinical decisions in

Dr. Mohammed Akram

“Our team of Consultants, nurses, Allied health professionals and care attendants provide a patient centered service.”

co-operation with the medical staff.

Now advanced nurse practitioners are coming to the fore, currently one of our nurses here on the third floor is initiating the nurse prescribing initiative here in the hospital. She will be able to prescribe medication under the jurisdiction of the physicians. That was unheard of ten years ago. Care will always be a priority for the nurses, however.”

For Dr Muhammad Akram who maintains a private practice at Aut Even the future for his specialist area, nephrology, has a similarly positive outlook, particularly in the area of early diagnosis and prevention. “I definitely see improvements in the future,” he says if we treat disease it at an earlier stage it can be prevented; early diagnoses can prevent patients from suffering major complications.

Treatments Dr Akram came to Ireland in 1995 and received membership with the Royal College of Physicians of Ireland in 2000, and completed a specialist registrar scheme in general medicine and nephrology in 2001. On

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Medical Services

completion of his training, he worked as a consultant nephrologist, travelling between Waterford Regional and St. Luke’s hospitals. Influenced by the presence of his family in the country, he joined the private practice in Aut Even in 2007. “I look after patients in the general nephrology area, people who can’t be looked after outside the hospital. The bulk of my practice is in general medicine. I usually treat chest infections, chest pains, minor strokes, and clots in the leg etc.” One of the groups which Dr Akram treats most are those people coming with chronic kidney disease, hypertension, urinary tract infections, kidney stones and other conditions like electrolyte abnormalities.

Top facilities And similar to Aisling McEvoy, Dr Akram is full of praise for the hospital’s facilities in helping him to provide the best service possible for the patients he sees. “From the general medicine point of view we have diagnostic cardiology services as well as allied health professionals to include senior dietician, senior pulmonary technician, senior physiotherapists and occupational therapist. Aut Even has access to a range of Specialist Consultants in Neurology, Hematology, Rheumatology and Pain Medicine. We have developed strong relationships with Dr. Crowley and Dr. Hennessy

patients are seen on a weekly basis by these specialists or as required.

Dr Fahim Kahn runs early arthritis clinics and screenings for patients with rheumatoid inflammatory arthritis, attempting to see patients in a time frame of less than a week, through referrals from GPs. “We get patients through the GPs,” he explains. “When they come in they are asked for their medical history, then a clinical examination to detect any type of arthritis which takes 30 minutes to an hour. Once that is completed, a blood test will need to be done and possibly x-rays when combined take up to two weeks.

Rheumatologists would be treating arthritis with medication, tablet form and injection treatments, although we now have more up to date therapies with infections known as biologics.

There are different types of arthritis.

One type is known as ‘wear and tear’ arthritis (Osteoarthritis). These are most common in elderly patients.

The other type is inflammatory or rheumatoid which is the most common. These patients are put on medication and are monitored every three to six months to see how it is affecting them. Injections are for a particularly diseased joint such as a knee joint affected by rheumatoid or osteoporosis. The rheumatologist would clean the joint with antiseptic and the injection could be steroid or

Aut Even has access to a range of Specialist Consultants in Neurology, Hematology, Rheumatology and Pain Medicine.

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synovial fluid injection. Then through an ultrasound we can locate where the injection is necessary and clearly visualize it.”

A window period Dr Kahn graduated from the medical college in Khyber, Pakistan before travelling to the UK to undertake training. He then joined the senior house officer’s scheme in Ireland where he trained in rheumatology in Dublin, Cork and Leitrim before becoming a registrar. When you become a senior registrar, you can apply to become a consultant, and so Dr Kahn travelled to the US where he spent three years in a fellowship in Indianapolis before returning to the Irish private sector in 2000/2001. “We are providing the same treatment as anyone in the US, particularly the treatment protocols. I have my own ultrasound scan as well as MSK ultrasounds which are not common in Ireland. There’s a window period where we can diagnose rheumatism before it can strike and thankfully GPs are well educated and bring patients to us showing the signs. We provide academic activities including GP sessions, study days etc.

Aut Even is no different from the top clinics in the world.”

A pain-free future The future for arthritis suffers is looking bright, Dr Kahn maintains, especially in regard to providing pain free treatment for patients, and he is currently working with pain management clinics which have only just been established. “We offer Calmare therapy,” he says, “which along with the Beacon in Dublin are the only places in Ireland that offer such treatment. It is FD approved and uses electrodes attached to different parts of the body that would have only been treated with spinal injections in the past. Without the use of medicine or injections, the patient can be relatively pain free.

That’s an real breakthrough in pain management, and in fact, Ireland and Italy are the only two countries which use it. We have treated eight patients with it so far and they have had excellent results. When they presented to their GPs they said they were on a 10/10 scale of pain.

After the treatment, their pain was completely gone after ten days of session. Even the top hospitals in Dublin don’t have these facilities.”

AUT EVEN • 2013 AutEven.indd 17

28/3/13 15:48:38

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Strathmore Lodge Nursing Home is able to offer a wide range of services delivered by fully trained, qualified professionals in a friendly and caring manner. We offer Long-Term Care, Respite Care, Palliative Care and Convalescent Care. A comprehensive assessment is carried out on those interested in coming to stay with us, enabling us to deliver the best service and care possible. For all enquiries please telephone 056 7755515, where any staff member will be happy to help.

28/3/13 15:48:43

endoscopy and dsu

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Dedicated, Diagnostic Day Surgery Unit The opening of the day service unit (DSU) was a positive step forward in offering a more efficient and cost effective procedure ensuring patients can be admitted and discharged in the same day

A

ut Even provides consultant led diagnostic and surgical day care services to patients referred by both Consultants and General Practitioners. The DSU is a self contained dedicated unit, facilitating an efficient and stress free transfer of patients to and from the theatres.

The unit and theatres are managed by the Clinical Nurse managers who lead their team of highly skilled nursing staff in providing a positive patient experience, while ensuring internationally recognised standards of care.

A welcome addition The aim of the day surgery team is to provide a patient centered approach to care in an efficient manner to meet the needs of all who use the service. Our DSU provides a wide range of surgical procedures in our fully equipped Ultra clean ventilation theatres. The DSU also has its own purpose built washroom which is attached to the endoscopy suite. It contains all of the state-of-theart equipment required for cleaning, washing, processing, water validation and traceabilitydocumentation.

The diagnostic procedures available in the DSU include:  Gastroscopy  Colonoscopy  Broncoscopy  Cystoscopy  Hysteroscopy  Laparoscopy  Dental procedures Direct Access Endoscopy Service Key Service Features  Referrals: Triaged by GP’s preferred Consultant and suitable patients booked into next available slot.  Routine Appointments: Scheduled within 2 working weeks.  Urgent Referrals: By direct contact with Consultant.  Reports: Sent to referring doctor within 24hrs; urgent results given verbally.  Results/Management Plan: Verbal and written discussed with patient.  Insurance Cover: Available to

patients with/without private health insurance.  Radiology: Onsite Consultant Radiologist  Follow on Treatment: Access to follow on treatment if required Insurance Terms and Conditions The Clinical indications for which insurance providers pay for surveillance/screening colonoscopy: Individuals who have the following: 1 Two first degree relatives diagnosed with colorectal cancer.

2 A family history of polyposis coli.

3 A family history of hereditary nonpolyposis coli.

4 A first degree relative who developed colorectal cancer before the age of 60 years will be entitled to benefit for colonoscopy every 5 years, beginning at age 40 or ten years before the

The aim of the day surgery team is to provide a patient centered approach to care in an efficient manner to meet the needs of all who use the service.

age of the youngest affected relative, whichever is the first.

Insurance Cover at Aut Even Hospital For the majority of patients endoscopy procedures are carried out as a day-case procedure. At Aut Even Hospital we are happy to help patients understand what, if any cost, they may incur for any procedure. To do this there a few simple steps 1 Check the name/type of their plan 2 Check policy number 3 Confirm with Consultant’s Secretary the procedure name and code 194 or 455 4 Contact the insurance provider to ensure there are no exclusions under the terms and conditions of their policy.

5 Call our patient accounts department on 056 7775194 with the above details

AUT EVEN • 2013 AutEven.indd 19

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pre-assessment

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Assessing the situation Preoperative assessment is essentially a clinical risk assessment where the health of a patient is appraised to ascertain that the person is fit to undergo the anaesthetic for a planned operation. It establishes that the patient is fully informed and wishes to undergo the procedure.

F

or any vocation, preparation and having all the necessary information beforehand is vital before making any major decision; and undergoing surgery is no different. Consultants refer patients to the pre-assessment clinic once a surgery date has been decided between patient and consultant.

The principles of preoperative assessment are:  To identify before surgery a patient’s medical, physical, psychological and spiritual needs  To liaise, where appropriate, with external agencies to implement discharge planning  To ensure a more effective use of hospital resources such as theatre time and bed occupancy by:  reducing the number of DNA’s  the number of cancelled operations  the length of stay  To provide highly effective and efficient services - characterised by clear, good practice guidelines, aimed at meeting the needs of patients and the organisation  To provide continuous care, establish more person centred nursing, and inform and support the patient during

the surgical procedure  To identify patient suitability and/or fitness for surgery/anaesthesia  To provide information for informed choices and consent  To reduce fears and anxieties  To assist better use of theatre and ward resources  To improve the surgical patient’s hospital experience The process.

The first step of pre-assessment requires the Pre-Assessment Nurse, Mary Lavin to contact the patient and organise a time and a date for pre-assessment. The first call is usually the most important in establishing a friendly link between the hospital and the patient until their assessment date arrives. When the patient comes into the hospital for their pre-assessment, they will be asked routine questions about their past medical and surgical history as well as any regular medication they are taking. Routine investigations including blood tests, blood pressure reading and an ecg (tracing of the heart) are undertaken to determine whether the patient is a viable candidate for surgery. An echocardiogram is also

“it is important to identify a patient’s medical, physical, psychological and spiritual needs before surgery”

performed to evaluate the condition of the patient’s heart depending on their medical history. In the case of any abnormalities arising from these tests, the-pre assessment nurse will liaise with the Consultant Anaesthetist and Consultant Surgeon while the patient will be referred on for further investigations and other consultants if necessary. This may result in surgery being temporarily postponed until such time as the patient is fit for anaesthetic and surgery. The pre-assessment team will also liaise with GPs to monitor a patient’s abnormal results.

The Personal touch More often than not, a patient coming in for their pre-assessment may be nervous about their impending surgery and unsure of what to expect. That is why the pre-assessment nurse’s relationship with his or her patient is an important first step towards a successful operation. Pre-Assessment Nurse, Mary Lavin, explains the importance of easing patient’s fears: “The first phone call I make to the patient it is important to identify a patient’s medical, physical, psychological and spiritual needs before surgery. During the call, I will talk the patient through the process of preassessment and what will happen before surgery, on arrival into the hospital, during their stay and on discharge home. I sometimes ask if they would like to bring a family member in with them if they find themselves particularly nervous.”

With a continuing reputation as one of the best providers of healthcare in Ireland, Aut Even has seen its patient numbers rise over the last number of years. Currently, figures put the number of patients being seen at the preassessment clinic at 30 patients a week.

Similarly, last year patients at Aut Even were asked to fill out a satisfaction survey detailing what how they found their time spent in the pre-assessment clinic. Unsurprisingly, a huge majority of in-patients were quick to compliment the friendly and helpful staff.

Mary Lavin, Pre Assessment Nurse

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orthopaedic department

Orthopaedic Surgery The Orthopaedic Department at Aut Even is at the forefront of modern Orthopaedic care.

T

he service Aut Even Hospital offers a full range of orthopaedic services to its patients. Mr Breandain Long, Consultant Orthopaedic Surgeon performs the full range of sport injury surgery including:  Tendinopathies  Meniscal repairs  ACL reconstruction  Rotator cuff repairs He has also pioneered the use of the anatomical double bundle anterior ligament reconstruction in Ireland. This technique is gradually gaining acceptance as the best solution to the problems relating to the long term outcome of ACL stability and joint degeneration.

Breandain Long is the principal and consultant Orthopaedic surgeon

based at the Sports Injury Clinic.

He graduated in medicine from University College Galway and did his Orthopaedic training in Dublin and an arthroscopy fellowship in Birmingham, U.K. He is a fellow of the Royal College of Surgeons in Ireland and a Fellow of the Faculty of Sports and Exercise Medicine.

Mr Long also deals with Shoulder pathology such as degenerative disease of the rotator cuff and the acromioclavicular joint, issues with which increase with age. For patients who do not respond to the usual methods of treatment of injections and physiotherapy, sub-acromial decompression, AC joint resections and rotator cuff repairs are performed.

My own sub-specialty Mr Stuart Edwards explains: my own sub speciality

“My goal is the delivery of modern techniques in hip and knee replacement surgery, using modern bearing ceramic/ ceramic surfaces”.

includes primary and revision hip and knee surgery, both cemented and uncemented, minimal access surgery and resurfacing procedures. My goal is the delivery of modern techniques in hip and knee replacement surgery, using modern bearing ceramic/ceramic surfaces.

Service Features  Rapid recovery Programme 4-5 day’s.  Specialist pain management techniques.  Oral anti-coagulant therapy (Xeralto) post operatively.  Pre assessment service with In house Consultant Cardiologist, Senior OT and Senior Physiotherapist.  Full time 24hr house doctor  HDU initial 24hr post-operative period.

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orthopaedic department

Orthopaedic surgery is constantly evolving, there are always innovative procedures being pioneered and we at Aut Even are no exception.

I did a fellowship in improved specialist techniques. I perform the following procedures:  Hip replacement surgery  Knee replacement surgery  Knee arthroscopic surgery  Basic hand and foot surgery  Dupuytren’s contracture – contractions in the hand  Carpel tunnel decompressions The process When a patient is referred to me for a hip or knee replacement the first thing we must address is whether or not the pain is coming from the joint in question. To determine this and to achieve a correct diagnosis the patient is sent to our Radiology Department for an x-ray. Once diagnosis has been confirmed we can discuss all options with the patient and their GP. If replacement surgery is the best option then the patient will be sent to our pre assessment clinic where their heart, lungs and general health will be checked to establish that they are fit to undergo the operation.

They will then be seen by both our physiotherapist and occupational

therapist, where the procedure along with the recovery and rehabilitation process is fully explained. Once they have completed pre-assessment, the patient will be admitted to hospital on the day of the surgery. The procedure takes 45 minutes to an hour to complete. During this time the defective bone or cartilage is taken away and a hemispherical cup is placed into the socket.

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Foot and Ankle Surgery Mr Alan Laing has been part of the Orthopaedic team in Aut Even Hospital since 2009. Mr Laing has a sub specialist interest in surgery of the foot and ankle. He has completed Fellowships at the Hansen Foot and Ankle Institute, Harborview, Seattle and at the Clinique St Antoine de Padoue, Bordeaux.

He is a member of the American Orthopaedic Foot and Ankle Society.

His practice will offer a comprehensive Orthopaedic service encompassing the management of acute foot and ankle fractures, sports and dance injuries.

He has a particular interest in plantar fasciitis and Achilles tendon pathologies, deformity correction (flat foot and high arch pathologies), ankle arthritis (total ankle replacement) bunion and hammertoe deformities, rheumatological and diabetic foot conditions.

Areas of Interest:  Arthroscopy  Pantelar Fusion (Ankle)  Cheilectomy (Foot)  Cheveronosteotomy & Hammer toe correction  Clavicular fracture repair  Hardware removal pins/plates/screws  Hip Replacement  Injection under sedation  MTP Fusions/Hallux Valgus  Removal of Ganglion from foot/Hand  Total ankle replacement  Wiles/Scarf Osteotomy The future Orthopaedic surgery is constantly evolving, there are always innovative procedures being pioneered and we at Aut Even are no exception.

Post-operative care We have a rapid recovery programme here at Aut Even. The patient is up and walking the day after the surgery as the sooner the patient is mobile the lesser the risk of infection or blood clots forming. Most patients are in hospital for four or five days after the operation and work with the physiotherapist twice daily during their stay. Once they are independently mobile and can navigate the stairs with crutches they are discharged.

We use specialist techniques to reduce post-op pain. We inject around the hip or knee which reduces pain levels which in turn increases the patients’ chance of gaining quick mobility.

AUT EVEN • 2013 AutEven.indd 23

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General Surgery

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In safe hands Aut Even’s general surgery offering is one of the most comprehensive in the country.

Consultant Surgeon, Mr Ian Wilson gives us an insight into the services available.

G

eneral surgery at Aut Even represents one of the most important aspects of the hospital’s remit. Currently there are four highly skilled general surgeons operating in the newly refurbished UltraCleanAir theatres offering a wide range of surgical interventions and procedures.

Knowledge and experience A qualified surgeon for 24 years, Mr Ian Wilson is one of the most senior members of the surgical team at Aut Even, he says: “We have a purposebuilt day unit here at Aut Even where we do the bulk of the general medical procedures. The facilities here mean that we can really maximise the efficiency of dealing with patients, which is key.” For Mr Wilson, the general surgery facilities offered at Aut Even surpass any of its nearest rivals both in terms of scope and experience. “The facilities are excellent, for instance if a patient requires more than one day of recovery time (from a medical procedure) in the hospital we know we have the beds and facilities to deal with that,” says Mr Wilson.

The unit has a total of four surgeons, Mr Wilson, Mr Michael Hurley, Mr Paul O’Byrne and Mr Terry Christle, all of

whom are consultant surgeons with vast experience. Before the centre expanded, there were just three surgeons – Mr Wilson, Mr O’Byrne and Mr Hurley – working in the unit, however due to patient demand over the years the unit was able to expand both in terms of personnel and the number and scope of procedures on offer.

Procedures Mr Wilson says: “We do all of the typical abdominal procedures, which includes things like hernias, gallbladders and bowel surgery, many of which are direct referrals from GPs in the area, so we often deal with things like endoscopy and laparoscopy.”

Always changing, the field of general surgery has certainly seen many advances during Mr Wilson’s career, many of which have been successfully adopted at Aut Even. “Aut Even has definitely kept pace with the general curve, particularly with regard to technology in areas like laparoscopic surgery which has seen the greatest change during my career.”

The services on offer are certainly technologically advanced for the region, as Aut Even is the only hospital in the Kilkenny area with an MRI scanner,

The positive feedback is helped greatly by the highly skilled team of nurses and support staff available.

“The staff here are excellent.

Mr. Ian Wilson which is a vitally important diagnostic tool. Mr Wilson adds: “The next nearest hospitals offering MRI is Waterford or Dublin, which can be quite a journey for patients.”

Patient numbers The variety of procedures in the field of general surgery at Aut Even has certainly gained some favorable traction from attending patients. Mr Wilson says: “Patients have commented very favorably about their stay at Aut Even, both in terms of the efficiency of the hospital and the technology available and the courteous way in which we treat our patients.”

To date, patient numbers are holding steady and the satisfaction rate with general surgery continues to grow.

The positive feedback is helped greatly by the highly skilled team of nurses and support staff available. “The staff here are excellent. They are extremely flexible and provide above and beyond the call of duty,” says Wilson remarking on his colleagues.

No doubt, the positive patient feedback and innovative approach to new surgical technologies will continue to fuel Aut Even’s appetite and expansion long into the future.

AUT EVEN • 2013 AutEven.indd 25

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ENT

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In Safe Hands Offering extensive ENT services to patients in the Kilkenny area and beyond, Aut Even’s highly skilled team of ENT surgeons are putting the hospital on the map for ENT services in the east of the country.

Mr. Ali Khan

Mr. Neil Riley

A

skilled team of two ENT surgeons at Aut Even provide comprehensive evaluation and medical/surgical treatment of both adult and paediatric patients with all ear, nose and throat (ENT) conditions. The full gamut of ENT procedures is catered for at Aut Even, including tonsillectomy, laryngoscopy, endoscopic sinus surgery, adenoidectomy, nasal pollops, grommets in ears, repair of ear drum perforations, repair of nasal deformity and some ENT cosmetic surgery.

Why Aut Even?

ENT Consultant at Aut Even Mr Neil Riley, who has based his private practice at the hospital for a number of years and is highly complimentary of the facilities available, says: “The services here are excellent. The hospital offers highly skilled anaesthetists, well equipped theatres and excellent postop care to all patients.” Mr Riley adds that the hospital’s flexibility in terms of adult and paediatric procedures was what originally drew him to base

his private practice there. “One of the major advantages and differences to other private clinics is that here at Aut Even I can perform minor procedures such as insertion of grommets on children from the age of two. That kind of flexibility in terms of paediatric ENT isn’t as common elsewhere.”

Mr Riley’s surgical colleague, Mr Ali Khan, who has been based at Aut Even since 2003, offers similar services in paediatric and adult ENT procedures, from tonsillectomies and nasal pollops to ear problems such as glue ear, otitis media, perforated ear drums and ear infections. He says: “Aut Even has all the latest equipment we need here for ENT services. One of the services we offer is hearing tests and we are fortunate to have a Senior Audiologist Sinead Ryan to perform hearing tests for children of any age in terms of acoustic emission and a tympanogram.”

According to Mr Riley, “in the last two years the patient numbers have increased. It’s probably related to the reduction in patient numbers to the public sector who have left in

“One of the major advantages and differences to other private clinics is that here at Aut Even I can operate on children from the age of two. That kind of flexibility in terms of paediatric ENT isn’t as common elsewhere.”

response to the long waiting times,” he says. Mr Khan has also seen a significant rise in patient numbers, adding that every week he now treats up to 40 or 50 patients, which he attributes to the hospitals good relationship with referring GPs in the locality.

The future Always keen to develop new techniques and approaches to surgical procedures, Aut Even now also offers a procedure called coblation tonsillectomy to patients. Mr Riley says: “Coblation tonsillectomy is a relatively new procedure that effectively vaporises the tissue as opposed to cutting it during a tonsillectomy. In theory, this procedure means that a quite unpleasant procedure is now made a lot more bearable and requires a much shorter recovery time. It could even mean that we can see tonsillectomy patients on a day case basis if they live in the Kilkenny area, which is obviously a vast improvement on the traditional tonsillectomy.”

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Ophthalmology

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Leading the way in ophthalmology Ophthalmology has entered a new phase in its development. New treatments and technologies have brought the once niche service into the future. Consultant Ophthalmic Surgeons at Aut Even give us an overview of the ophthalmology services available at the hospital.

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ut Even Hospital provides the facilities for one of the most comprehensive ophthalmology services in the country with treatments for external eye disease, cornea, cataract and refractive surgery, glaucoma and a number of retinal conditions, including macular degeneration, diabetic eye disease, retinal vascular diseases and uveitis (intraocular inflammatory diseases).

Aut Even’s state-of-the-art custom designed UltraCleanAir theatres, coupled with the latest technological instrumentation for the performance of intraocular surgery, including small incision cataract surgery allows patients to receive the very best of care at the facility.

Eye care at Aut Even “Ophthalmology as a whole has become very technologically driven. Things have changed enormously in the last ten years, and very much to the advantage of patients” says Mr Tom Stumpf, Consultant Ophthalmic Surgeon at Aut Even. “The services offered are highly advanced and lasers have become frequently used tools in the treatment of many eye diseases, which is something we have embraced at Aut Even. We now offer Diode laser treatment of retinal diseases and YAG laser treatment of capsule opacification/ fibrosis following cataract surgery. In addition, a laser scanner (OCT) is used to diagnose and monitor patients with glaucoma and many retinal diseases,” he says. While Mr Stumpf ’s main focus is on cataract and glaucoma surgery, he also treats patients suffering from a wide range of other ophthalmic conditions.

Mr Stumpf ’s colleague at Aut Even, Mr Gareth Higgins, also a Consultant Ophthalmic Surgeon, believes that the service provided by Aut Even is second to none, particularly in the Kilkenny region. “All of my patients have been very happy with their treatment at Aut Even. So far, all of the procedures I have performed here have been day cases, so the patient can come in, have their procedure and go home again on the same day.” Mr Higgins’ area of focus concerns general ophthalmology as well as a number of other procedures

including eyelid surgery, pre-ocular tumours and blepharoplasty.

Specialty services In terms of the procedures offered, Aut Even’s five fellowship trained consultant ophthalmic surgeons (Mr Gallagher, Mr Higgins, Mr Kent, Mr O’Reilly and Mr Stumpf) certainly lead the way. Mr Stumpf, like his colleagues, performs all of his cataract surgeries using a technique called phacoemulsification. Describing the method, he says: “Phacoemulsification involves using ultrasound to break up the cataract inside the eye. It is effectively keyhole surgery in the eye and sucks out the fragments of the cataract leaving behind a capsule which is essential to hold the replacement lens in the eye.

The replacement intraocular lenses used in Aut Even are at the cutting edge technology and provide excellent visual results, which we have shown in our audit.”

Similarly, Mr Higgins’ special area of interest is in periocular tumours and reconstruction following tumour removal.

He says: “Certain tumours can be tricky to remove, as often it can be difficult to identify the margins of the tumour. Often I will work in conjunction with a specialist Moh’s surgeon, usually a dermatologist,

“The services offered are highly advanced and lasers have become frequently used tools in the treatment of many eye diseases, which is something we have embraced at Aut Even.”

who will examine slices of the tumour and will be able to tell if the entire tumour has been removed successfully.

Then the Mohs surgeon and I will liaise during the re-construction phase. This method can be used in about 10 per cent of cases. Obviously, this can save a lot of time and repeat surgeries if you can determine that the tumour has been completely removed. Similarly, in a third of patients it means you can remove less tissue than you might have done otherwise, which is also of benefit.”

The range of services offered in Aut Even by the innovative team of consultants allow for the provision of a comprehensive ophthalmic service for its patients.

Mr. Tom Stumpf

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Urology

Leading the field Aut Even has one of the leading urology units in the country, with expert care, the latest technology and ease of referral making is a trusted choice for patients and their GPs in Kilkenny and far beyond.

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he urology unit at Aut Even Hospital is one of the leading units of its kind in the country, paving the way for other hospitals by delivering some of the most advanced urology treatment technology available today. Mr Barry Jones, Mr. Ahmad and Mr Kashif Siddiqui are the consultant urologists working in the unit and have years of experience treating urological disorders in both Ireland and abroad.

Mr Siddiqui is responsible for treating all general urology, including botox injections for over-activity in bladder distensions and sling surgeries for stress incontinence.

His colleague Mr Jones was one of the leading pioneers in the treatment of sling surgery, now the mainstay of incontinence treatment – previously this would have been a long and complicated operation.

The unit also undertakes scrotal procedures ranging from hydrocele, varicocele, epididymal cystic incisions, circumcision and vasectomy. Many patients come to Aut Even for removal of bladder stones and uroteric stones. Renal stones are treated with extracorporeal shockwave lithotripsy (ESL), which is a non-invasive procedure that breaks up the stones in the body using sonic waves. Andrology is also a major component of the work done at the urology unit, treating people with erectile difficulties and Peyronie’s disease, all on an out-patient basis.

Neuro-urology, uro-oncology and the treatment of prostate cancer are all key interests of Aut Even’s urologists.

Utilising latest technology By far the most common urological complaint is regards the prostate. Mr Jones has put great emphasis on utilising the latest urological technology; all of which is available at Aut Even. “One of the latest developments of technology has been laser treatment of prostate enlargement,” he explains.

“This is great news for patients who have had heart conditions and might be on blood thinning medications as they can now have laser surgery where normal surgery would not be possible.” It also means a much shorter stay in the hospital for the patient: it is now usually just an

overnight stay, whereas a standard operation could require a three or four night stay “I also treat a benign prostate using this method, and also use it on patients who may have had radiation damage to their bladder; it has shown good results. It’s great to be able to treat people locally as opposed to sending Representation only supplied by Teckno Surgical them off to Galway for treatment.”

Aut Even is one of only four hospitals in therefore providing enhanced and Ireland to offer such a service. Surgical improved responsiveness to bleeders options available include prostatectomies during the procedure.The MOXY fiber or trans-urethral injections into the is also water cooled so has longer life prostate. expectancy per case, up to 650, 000 joules capacity.The Moxy fiber used in Green Light Laser Therapy combination with increased power facility Greenlight is an alternative therapy of the Greenlight XPS laser,(up to 180 to a TURP, to treat patients with BPH. watts), allows larger glands to be treated The laser transmits laser energy to effectively in a shorter period of time. the tissue.The laser is absorbed in the oxyhaemoglobin or red cells in the Easy access for patients prostate tissue; the laser energy is thermal and GPs and obliterates the prostate tissue.

Strong lines of communication between The main post- operative benefit is less the hospital, patients and their GPs risk of bleeding, conventional TURP carries are important to Aut Even Hospital. a high risk of post- operative bleeding. No According to Mr Siddiqui, the key to risk of TURP syndrome, as Normal saline running a successful urology unit is to instead of Glycine is used as the irrigation communicate with patients as much as solution.TURP syndrome is a side effect of possible and to leave open access for using Glycine, as it is the medium solution them to ask questions about urological used in a TURP procedure. problems which can often be quite Patients who are on Coagulative painful. “The reaction from patients has medications such as Plavix and Warfarin been very good. At the end of the day, can be treated.These patients are very they want availability, quick appointment often considered to be high risk for a and quick treatment. After that they TURP procedure due to the bleeding risk, expect a regular follow-up and easy to as it may not be advisable for these group deal with administration. I have had no of patients to come off their medication problems with patients because usually for any period of time, due to their co my appointments would be within two morbidities.The Greenlight Patients weeks. If a patient has any queries, they bleeding risk is lower that associated with can contact me or arrange a follow-up TURP.Therefore shorter hospitalisation through the full-time staff that I have in and quicker recovery time.

Aut Even to get in touch with me; both The MOXY fibers allow for more myself and Mr Ahmad and Mr Jones effective coagulation as it works with the are committed to providing a high-class TRu Coag feature on the laser machine, standard urological service.”

“One of the latest developments of technology has been laser treatment of prostate enlargement.”

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UROdynamics

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Urodynamic Service at Aut Even Hospital Aut Even provides an outpatient Urodynamics service which involves the investigation of functional disorders of the lower urinary tract i.e. the bladder and the urethra. Our nurse led service provides fast access for patients under the care of our specialist consultants and skilled nursing team.

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ur outpatient service is run on a monthly basis or as activity dictates by Staff Nurse Rita Rainey and Staff Nurse Niamh McGoff from the theatre department. When the service was initially set up here at Aut Even, there were limited options for patients living in the catchment area of the hospital to attend for urodynamic testing.

Before this unit was established, any patients looking to avail of the test were required to go to Dublin or Cork.

Urodynamic Service The aim of Clinical Urodynamics is to reproduce symptoms, whilst making precise measurements in order to identify the underlying causes for the symptoms and to quantify the related pathophysiological processes.

By doing so it should be possible to establish objectively the presence of a dysfunction and understand its clinical implications. Therefore, we may either confirm a diagnosis or give a new specifically urodynamic diagnosis.

Accessing the service Referrals are made to the service through the Consultant specialists working at Aut Even who will receive a copy of the test results which will be reported on and feedback given to the referring GP. Referring Consultants  Mr Barry Jones, Consultant Urologist  Mr Imitaz Ahmed, Consultant Urologist M r. Trevor Hayes, Consultant Gynaecologist M r Ray O Sullivan, Consultant Gynaecologist Tests Completed Uroflow This study measures your urinary flow rate.

Pressure Flow Study This study measures how well the bladder muscles, the sphincter, and the urethra work together. The computer will measure the strength of your bladder muscles and sphincter, as well as the urinary flow rate and voided volume.

Before this unit was established, any patients looking to avail of the test were required to go to Dublin or Cork.

Preparing the patient for Urodynamics  Complete a bladder diary or questionnaire. Please bring this with you to the appointment.  Patients should take your normally scheduled medications and may eat and drink prior to the study.  The series of tests typically take less than two hours. Patients be able to resume all previous activities, including driving, upon completion of the Urodynamics studies.  P lease arrive for the study with a comfor tably full bladder.

We have received a lot of positive feedback from the patients using the service. Before the patient comes for their appointment, they will be sent information from the Consultant secretary about what the test involves which prepares them for it and dispels any fears they may have prior to their appointment. The outpatient test is a relatively lengthy procedure, taking approximately two hours.

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Pain Clinic

©istockphoto.com/courtneyk

Dr. Tadhg Lynch Consultant Anaesthetist & Pain Specialist

Interventional Pain Therapy A new chronic pain service for patients in the Aut Even Hospital. Dr Tadhg Lynch explains.

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hronic Pain It affects many patients on a daily basis.The predominant symptom is chronic low back and neck pain but major joints, limb, abdominal and pelvic pain, facial pain and headache are all important pain sources.

Many patients seek treatment for daily severe pain. For the first time in the Aut Even, a specialist pain clinic is available to provide patients with appropriate investigation, diagnosis and interventional treatment.

Dr Tadhg Lynch is a graduate of NUIGalway, a consultant anaesthetist and pain medicine specialist with training and expertise in minimally invasive interventional pain treatments. He is extensively trained, having completed specialist training in anaesthesia, intensive care and pain medicine. He is a Member of the Royal College of Physicians of Ireland and a Fellow of the College of Anaesthetists he also is a diplomate of the European Society of Regional

Anaesthesia and holds the Diploma in Pain Medicine of the College of Anaesthetist.

Each patient with chronic pain has a unique set of symptoms. A variety of techniques are available to reduce the chronic pain that each individual patient is suffering from and treatment is offered to target each patients pain diagnosis.

Pain injection interventions can be both diagnostic and therapeutic, helping to locate the precise area of pain generation and reduce inflammation and nerve sensitization which are features of chronic pain syndromes.

After patient consultation and investigation, a range of interventions may be suitable and are tailored to suit each patient, including:  Epidural injections  Selective nerve root blocks  Facet joint blocks  Individual nerve blocks

“Chronic pain affects many patients on a daily basis.The predominant symptom is chronic low back and neck pain but major joints, limb, abdominal and pelvic pain, facial pain and headache are all important pain sources”.

 Sympathetic nerve ganglia blocks  Lignocaine/Ketamine infusions.

When chronic pain is reduced, patients can start returning to normal function, often with the help of appropriate multidisciplinary advice including physiotherapy. Sometimes, patient patterns of thought and fear of movement can be improved with cognitive behavioural therapy.

The future Our scientific understanding of the complex neuro-biological basis of chronic pain is constantly evolving.

Medications to treat chronic pain have improved and can provide benefit. Interventional therapies to restore normal nerve function can be most effective for patients suffering with chronic pain. Neuromodulation (changing nerve function) through minimally invasive and radiofrequency procedures is an effective strategy for the management of chronic pain.

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Psychiatry Services

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Getting to the source Mental illness has historically been a taboo issue in Ireland. However, societal changes in recent years have opened people’s minds to seeking help from trained professionals. Luckily psychiatry and psychological analysis is just one of many Out - patient services on offer at Aut Even.

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n a changing Ireland where mental health issues have at long last been recognised as genuine medical conditions it is important to have facilities in place which will enable sufferers to seek and receive treatment. Aut Even Hospital offers an excellent outpatient facility for those suffering from mental health issues in the south east of the country.

Methods of treatment Consultant Psychologist Dr Nicky Carrigan is on site to see patients who come to Aut Even seeking help for a myriad of psychological disorders. “Some of the most common problems patients come to me with are depression and anxiety disorders ranging from panic attacks to obsessive compulsive disorder to post traumatic stress disorder.” However, Dr Carrigan has also dealt with patients suffering from psychotic illnesses such as schizophrenia.

As a psychoanalytical psychotherapist, Dr Carrigan offers an holistic approach to therapy. When possible he will use psychoanalysis to help patients to understand and resolve their problems.

However the severity of the patient’s illness often dictates the approach which must be taken. If a patient is suffering from severe depression or trauma and poses a risk to themselves then Dr Carrigan will opt to medicate the patient. “Once they start to feel the effects of the medication, then we can start to look at therapy options.”

This interventional approach is often necessary to give the patient a more instant release. For depression, Selective Serotonin Reutake Inhibitors (SSRI’s) are the most common form of treatment.

“Once they start to feel the effects of the medication, then we can start to look at therapy options.”

Mental health in Ireland Irish society has tried to move on from the past, but it appears dealing with mental health remains an obstacle

for our society. Many people, who do decide to go for treatment, are entering a public health system which is inadequately funded and resourced to deal with the problem. “I’ve worked in the public sector in the past which I felt was extremely lacking in the necessary resources required to treat the number of patients that were presenting.” He adds: “I think there simply aren’t enough therapists and psychologists; there can be anything of up to a year long wait to see a psychologist in the public sector, which for patients who are suffering is simply unacceptable.”

When looking at the suicide statistics in Ireland it is clear that mental health, particularly depression, is no longer an issue which can be ignored. It is a problem which is taking more young lives than any other illness. The first step to tacking this epidemic is to ensure that treatment is readily available to sufferers throughout the country.

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Vascular surgery

Vascular Surgery at Aut Even Hospital Utilising a team of highly experienced surgeons, Aut Even offers the best in vascular surgery for its patients.

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ur team of vascular surgeons Mr. Paul O Byrne and Mr. Michael Murphy provide a range of treatment options to patients in the following areas:  Vascular  Endovascular  Endovenous  Chronic venous disease  Venous Ulceration Mr Michael Murphy was educated in Dublin and Wexford, graduating in medicine from UCD in 1993. He trained initially in Belfast and Dublin, and gained his MD following research in venous disease in the RCSI in 2002.

He completed specialist training in vascular surgery in the University of Oxford (2002-2008) where he was Clinical Lecturer in Surgery. He has published widely and was author and co-editor of the Oxford Specialist Handbook of Vascular Surgery. Prior to commencing his Dublin practice, Mr Murphy worked as a Consultant in Manchester (Central University Hospitals), a position he was appointed to, following an endovascular fellowship in Australia. He was granted privillages in Aut Even hospital in 2012 providing treatment to patient’s in the south east.

recovery with strong patient satisfaction.

First pioneered in 1999 by Dr. Robert Min and Dr. Luis Navarro in conjunction with AngioDynamics, the VenaCure EVLT procedure continues to undergo refinements and enhancements reflecting the company’s ongoing commitment to the science and practice of vein management. The VenaCure EVLT system currently utilizes an FDA-approved catheter with a gold-tip “jacket” to disperse energy from the diode laser in a manner to reduce pain and discomfort after the procedure. This easy-to-perform procedure has patients back on their feet in approximately 45 minutes.

Compare Alternatives Laser treatment of varicose veins shows clear patient benefits over surgery and other alternative treatments. These benefits include:  Up to 98 percent success rate with minimal-to-no scarring or hospitalization  Lower risk of complications  Fast recovery with strong patient satisfaction

Mr. Paul O’Byrne

“Laser treatment of varicose veins shows clear patient benefits over surgery and other alternative treatments.”

Mr. Michael Murphy

Remarkable Results and Significant Advantages in Vein Care The VenaCure EVLT system is the #1 physician choice in laser vein treatment, and brings remarkable results and significant advantages to remedying superficial vein reflux. The VenaCure EVLT procedure is a minimally invasive, clinically proven alternative to surgical vein stripping that effectively and safely treats varicose veins using a diode laser fiber to occlude the vein.

The procedure is easy to perform and gets patients back on their feet in approximately 45 minutes.

To successfully treat chronic venous insufficiency, it is important to fully understand the venous anatomy, learn how to properly diagnose the affected veins based on how the patient is presenting, and ensure proper steps are taken in the treatment process to ensure reimbursement.

Endovenous Laser Therapy Endovenous Laser Treatment for the elimination of varicose veins is quickly becoming the gold-standard in the treatment of varicose veins.The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day.

Laser treatment of varicose veins with the VenaCure EVLT procedure shows clear patient benefits over surgery and other alternative treatments, including a success rate of up to 98 percent with minimal-to-no scarring or hospitalization, a lower risk of complications and a quick

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Gynaecology

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An Innovative Approach to Gynaecology Aut Even offers one of the largest private gynaecology facilities in the country with a large team of consultants offering their expertise to patients at the hospital. Consultant Gynaecologist based at Aut Even, Mr Ray O’Sullivan offers an overview of the services on offer.

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highly skilled team at Aut Even provide one of the most comprehensive gynaecology services in the country. Gynaecology at Aut Even cover a large range of conditions including fertility problems, vaginal prolapse, endometriosis, fibroids, polycystic ovarian syndrome and treatment for ovarian cysts. Other unique surgical procedures include hysterectomy, colposcopy, tubal ligation and pelvic floor repair.

Gynaecology at Aut Even “We are offering some of the most advanced gynecologically advanced surgery in the country,” says Mr Ray O’Sullivan Consultant Gynaecologist.

For Mr O’Sullivan, the decision to base his private practice at Aut Even was an easy one: “The facilities here are fantastic.

It’s a modern private hospital and when you compare it to the facilities available elsewhere, Aut Even is right up there on a par with any private clinic in the country.”

In terms of the standard of patient care,Mr O’Sullivan is also highly complimentary. “Due to the hospital’s JCI accreditation, the standards here have to be extremely high. However, the management and staff go beyond that with the level of patient care and services. Any of my own patients who have been treated here always compliment the level of care,” Mr O’Sullivan says.

Speciality services In regards to the scope of procedures and surgical approaches offered by Aut Even, the hospital leads the way in terms of innovation. Mr O’Sullivan works with a team that is well prepared to undertake keyhole surgery, diagnostic investigations, hysterectomy and infertility and endometriosis treatments.

He says: “We primarily focus on fertility investigations as well as the investigation of endometriosis which is a common problem is Irish women. Women are coming from all over the country and even overseas for that kind of surgery,” says Mr O’Sullivan.

Aut Even takes pride in offering a large array of services covering a broad field of gynecology. The state-of- the- art

equipment available offers a medical service well-equipped for the diagnosing of the full gamut of gynecological problems. Mr O’Sullivan says: The expertise we’ve developed here at Aut Even means that we can take on any challenges presented to us.”

There’s new technology all the time but it’s more from a technique point of view that the technology comes along but the overall principle remains the same. We now use the merina coil but if that doesn’t work we use endometrial ablation and those technologies are really coming along. It’s a day case procedure to get rid of the heavy periods and patients back to normal the next day which is a god send for women who suffer from heavy periods.

Welcoming New Colleagues Dr.Yahya Kamal Consultant Gynaecologist was granted admitting and operating privillages at Aut Even Hospital in June 2012 Dr Yahya Kamal has been working in Ireland since 1996. He returned to work as Assistant Master at both the Coombe Hospital and Rotunda Hospital, between 2008 and 2010.

Dr. Kamal has served as a Lead Colposcopist at the North East Regional Colposcopy Unit Dundalk from January 2010. Dr. Kamal is currently appointed as a Consultant Obstetrician & Gynaecologist at Coombe Women and Infants’ University Hospital Dublin.

Dr. Kamal has published ten peerreviewed research papers and abstracts.

He has presented both nationally and internationally on his specialist areas. He has private clinics in Kilkenny.

Mr. Ray O’ Sullivan

“The facilities here are fantastic. It’s a modern private hospital and when you compare it to the facilities available elsewhere, Aut Even is right up there on a par with any private clinic in the country.”

Dr. Yayah Kamal

Areas of Interest:  Laparoscopic surgery  Endometrial ablation procedures  Hysteroscopic surgery  Prolapse repair  Colposcopy  Urogynaecology  Peri-menopausal care  S urgical Treatment of urinary stress incontinence Future innovations Regarding the future of the service, Mr O’Sullivan is confident the expertise already at hand will continue to develop. “We’re implementing new technology and techniques here all the time. An example of this is our new procedures for the treatment of women with heavy periods. We now use the mirena coil and endometrial ablation when required.” He adds “It’s a day case procedure and patients are back to normal just one day after the procedure, which is both time and cost effective for them.”

According to Mr O’Sullivan the procedure is relatively unknown to many women who suffer needlessly from heavy periods and is now seen as an alternative to a hysterectomy. “It’s a relatively new procedure and Aut Even is one of the only clinics in the country to offer it, however, it’s a godsend to many patients who may be considering a hysterectomy. The results from both procedures are the same, the patient won’t have any more periods, however with the mirena coil and endometrial ablation they will still have a womb and they won’t be subjected to major surgical investigations if they have the ablation.”

Mr. Trevor Hayes

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cardiology

Expanding Cardiology at Aut Even Hospital The Cardiology Department at Aut Even provides an excellent cardiac service for those living in the South East of the country. Dr John Clarke, Consultant Cardiologist, discusses the importance of the cardiac service to this area.

Dr. John Clarke

Dr. de Buitleir

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ackground Dr John Clarke trained in UCD. He worked in the Mater Hospital, Dublin before moving to London where he completed his MD and Phd. He then went on to work in Stanford, California where he completed a post-doctorate fellowship before returning to Ireland and taking up employment in Aut Even Hospital, with which he has a long association.

Dr de Buitleir has worked in Aut Even since 2000. Prior to his appointment he worked internationally in the UK and United States where he was awarded fellowship of the prestigious American College of Cardiology.

The Service The Cardiology Department at Aut Even Hospital offers a range of non interventional cardiac services.These include: � Outpatient Consultations � Echocardiography � Stress Testing � Arrhythmia Monitoring � Dse Patients generally present with a number

of common problems such as chest pain, shortness of breath, heartburn, heart palpitations, dizziness or loss of consciousness. A patient may also be admitted for testing if the patient has a family history of heart disease or there are any other adverse risk factors such as a heart murmur, high cholesterol or long term high blood pressure. If the patient requires more invasive cardiac testing or indeed cardiac surgery, they will promptly be referred to Blackrock Hospital with which Aut Even has a strong working relationship.

The Facilities Aut Even Hospital provides an invaluable service to those living in the catchment area of Kilkenny, Waterford, Carlow and the hinterland as far as Thurles and Enniscorthy. Often rapid access to service is key when dealing with heart diseases.

Ease of access for a patient is a very important factor. If a patient needs bypass surgery, they can be seen by Dr Clarke at Aut even and transferred to Blackrock for surgery the very next day.

The future of cardiology in Aut Even Hospital Cardiology is a dynamic game which is

“Cardiology is a dynamic game which is constantly evolving. This evolution of the service is particularly beneficial for our elderly patients.”

constantly evolving.This evolution of the service is particularly beneficial for our elderly patients. Open heart surgery is no longer the only treatment method; instead a catheter inserted through the groin can be equally effective.This is a great advancement for elderly patients who may not be strong enough to survive major surgery.

Sudden Cardiac Death Syndrome Screening The sudden death of a young athlete is a tragic event that has devastating effects on families and communities.These deaths are usually due to unsuspected heart disease. Unfortunately many heart conditions are still not detected by routine screening measures.The goal of screening is to detect an abnormal medical cardiac condition that could harm or kill the athlete when they exert themselves. It is for this reason that Dr. Clarke along with his clinical colleague Dr. Kindler (a specialist in cardiology and cardiac MRI) and Dr. Gerard King (specialist in cardiac echocardiography) have proposed a screening programme to help in the detection of sudden cardiac death in players for the GAA and also, through collaborative efforts with a group

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cardiology

in Boston, to further our knowledge and understanding of the various contributors to sudden death in young people.

This screening programme will be held on site and include a questionnaire, a resting electrocardiogram (ECG) and an echocardiogram.The fee will include the interpretation of all teats and a written report.

The total cost of this will be 150.00 euro By carrying out these tests we hope to help in the detection of Sudden Cardiac Death (SADS) in our athletes but also to further our research efforts with our colleagues in Boston to gain a further insight into the causes of these tragic events.

Who Performs the Screening?

Karen Coen, Senior Cardiac Physiologist Karen trained in the cardiology department of the Mater Misercordiae Hospital in Dublin. She gained paediatric experience while working in Crumlin Children’s Hospital. She is currently a BLS instructor for the Irish Heart Foundation and an associate member of the society for cardiology science and technology.

Karen has been a valued part of the team in Aut Even Hospital since 2007 Dr. Gerard King, PhD Chief Cardiac Clinical Physiologist Dr. Gerard King is regarded as a leader in the field of Sudden Cardiac Death

Syndrome internationally. Gerard is a renowned specialist in cardiac echocardiography and has published extensively on the subject in peer reviewed medical journals. He was recently invited by a prestigious American Cardiology Journal to write the editorial in relation to the effects of exercise on the performance of the heart chambers.

This was done together with his coworkers from Massachusetts General Hospital in � Boston.The right ventricle of the elite high end endurance athlete cannot be underestimated. King G, Wood MJ. American Journal Soc Echocardiogr.

2012 Mar;25 �E arly diastolic filling dynamics in diastolic dysfunction.

Cardiovascular ultrasound �M yocardial stiffness and the timing difference between tissue Doppler imaging Ea and peak mitral valve opening can distinguish physiological hypertrophy in athletes from hypertrophic cardiomyopathy.

European Journal of Echocardiography � Alterations in Myocardial Stiffness in Elite Athletes assessed by a new Doppler Index Heart journal The tests will be carried out by Dr. Clarke’s highly experienced team.

We recommend that individuals aged 14 years or older involved in high intensity, highly competitive sports have a cardiac investigation.Treatment and prevention of complications is possible in most people once cardiovascular disease is identified.

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Process Involved 1st Line Screeneing Health Questionaire / Resting ECG / ECHO (if abnormal ECG or ECHO proceed to next step

2nd Line Screeneing Physical Presentation consultation with dr clarke

3rd Line Screeneing EST / Holter Monitor / Event MOnitor as indicated

further diagnosis electrical presentation epstudies

mechanical presentation cardiac mri / angiogram

treatment electrical presentation icd / pacemaker

mechanical presentation ICD / Pacemaker / surgery

©istockphoto.com/blublaf

©istockphoto.com/jamesbenet

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radiology

Diagnostic Imaging Department The Radiology Department offers an excellent diagnostic imaging service to patients.

Mary Prendergast and Mary Murray explain.

T

he facilities The MRI Department at Aut Even Hospital operates as a stand alone service. Patients come directly to the MRI reception, where once their details are taken they are brought straight in for their scan. All details are double checked by the radiographer on staff to ensure that it is safe for the scan to proceed.

The MRI scanner on site is a state-of-the-ar t 1.5 Tesla Magnet Siemens Symphony which produces computerised sectional images of most parts of the body in high quality detail. The approach to scanning is extremely patient centred and every attempt is made to ensure the patient is kept as comfor table as possible. The scanner is open both ends and the MRI suite has a large window, with a

view of the fields beyond the hospital which goes a long way to alleviate anxieties and stressors relating to claustrophobia which can present difficulty for certain patients.

Aut Even has a full range of services available including MRI, Ultrasound, Dexa scanning for bone mineral density/osteoporosis assessment, Barium Studies, IVP and General x-ray with a full time staff of five and three part time staff to run the Department.

The service The MRI suite runs six days a week, 12 hours per day and sees approximately 25 patients daily. Most of our patients come directly from GP referrals but we also treat in-patients. We pride ourselves on making prompt appointments; once a referral letter

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radiology

arrives we make contact with the patient straight away to arrange their scan. We also contact the GPs immediately upon receipt of the scan results. All MRI referrals are reviewed by the radiographer on staff to assess their urgency. If urgent, the x-ray can be done that same day however for non urgent cases the average turn around is five days.

The average patient will be checked in and have undergone their scan within an hour of arrival. Each scan takes approximately 20-30 minutes and the report is done that night and posted out to the patients GP the next day. The GPs will have the report within 5 days of the scan. Each patient will also be given a CD copy of their scans upon leaving the Hospital. If they are later referred to a specialist then they will be able to give them their scans directly.

Insurance Upon arrival, patients can inform reception of their private healthcare details and the Hospital will arrange direct billing. This way the patient need not pay on the day nor worry about payment. The Hospital will liaise

directly with their insurance provider.

This is really important to some of our patients who can rest easy knowing their scan is completely paid for.

Aut Even Hospital deals directly with the following insurers:  VHI  Laya Healthcare  VIVAS  ESB Medical Provident Fund  St Paul’s Garda Medical Aid  GLO Health Patient centred care The Radiology Department has a great relationship with referring GPs, who are in regular contact to discuss patients and get results. We take a very hands on approach and believe that maintaining a good working relationship with our patients GPs is of the utmost importance. Good communication between GPs and hospitals ensures the best care is provided to the patients. Our on-site Radiologist, Dr Murray is at hand to determine whether a patient needs urgent attention. Dr Murray has been here for a number of years. Patients know him and find it easy to approach him and talk to him. He is also very

The average patient will be checked in and have undergone their scan within an hour of arrival. Each scan takes approximately 20-30 minutes

39

quick to reply to patients. If something is very urgent, we can have a report going off within an hour of the scan.

This rapid access to the service is greatly beneficial to patients living in the south east of the country.

Dr. Tom Murray

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respiratory and sleep services

A breath of fresh air The Respiratory Function Laboratory and Sleep Medicine Clinic at Aut Even is one of the most advanced facilities in Ireland.

As a nation seeing a dramatic rise in respiratory diseases, the need for the best available services is paramount.

R

espiratory diseases are on the increase in Ireland with latest figures showing us ranked second worst in Europe in lung health.

That is why it is vital for a person suffering from a respiratory condition to avail of the latest diagnostic technology to ensure a condition is diagnosed and treated appropriately.

Aut Even is a leading centre in respiratory diagnosis with state-ofthe-ar t diagnostic equipment. When a patient is referred to the pulmonary department, they can expect to avail of a range of diagnostic studies including spirometry (to measure airway obstruction), DLCO (to measure oxygen absorbing capacity) and measurement of lung size and responses to inhaled therapies (bronchodilator response testing).

These provide reliable information on lung capacity and may indicate the presence of lung disease. This equipment is also ideal for measuring the effectiveness of treatment for diseases such as chronic obstructive pulmonary disease (COPD), sarcoidosis, asthma, emphysema and lung fibrosis.

Treating allergies One of the most common conditions seen at the Pulmonary Laboratory in Aut Even is allergic asthma. Asthma is becoming more common in Ireland where it now affects about 490,000 people; one of the highest rates in Europe. Often ignored or under treated, asthma should be diagnosed and characterised with spirometr y and allergy testing, both of which are available at Aut Even. Skin prick allergy testing is also available and can be used to determine the presence of an allergy to cer tain dusts like pollen or cat dander. Other examples of allergic disorders include eczema, hayfever and nasal allergies (allergic rhinitis).

In the respiratory laboratory, specific respirator y related allergens are used to discover the precise source of an allergic disorder.

One of the team working in the Pulmonary and Sleep Diagnostics Laboratory, Aisling McDonald, describes how they perform and measure respiratory allergies: â&#x20AC;&#x153;Where a patient has a history of asthma, it is likely there is an allergic element to

Aut Even is a leading centre in respiratory diagnosis with stateof-the-art diagnostic equipment.

their condition. That is why a skin prick test provides valuable information on identifying these triggers and lets the patient become aware of potential environmental triggers which may subsequently have a direct effect on their health.â&#x20AC;?

Difficulties sleeping Another problem that is rising in incidence and severity (affecting about 100,000 people in Ireland) are sleep disorders due to snoring and/ or sleep apnoea syndrome.

Obstructive sleep apnoea syndrome is a breathing disorder that occurs during sleep where a person pauses or stops breathing. In some cases it appears that the muscles of the airways collapse during sleep and cause nocturnal choking, which in turn causes interruptions in sleep. Patients suffer the consequences of poor sleep quality: excessive sleepiness throughout the day. Often it is difficult for the sufferer to understand the condition, because it occurs during sleep. Some patients complain of morning headache, daytime fatigue, snoring, or sleepiness.

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respiratory and sleep services

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Aisling Mc Donald, Senior Sleep Scientist That is why a sleep diagnostic service is available in Aut Even to diagnose and treat sleep disorders. Sleep studies are vital for the correct diagnosis and management of sleep and circadian disorders including periodic limb movement disorder, narcolepsy, and sleep apnoea syndrome. The ideal way to fully understand a patient’s sleep disorder is through a formal sleep study known as polysomnography (PSG). PSG provides eight hours (about 1000 pages of tracings) of simultaneous measures of rapid eye movements, EEG, Oxygen saturation, EMG, ECG, periodic limb movement, microphone, respiratory movements and heart rate. The study provides the data on which the interpretation of the sleep test relies: quality of sleep, snoring, periodic leg movement and the presence and extent of any respiratory related sleep disorders.

Following a diagnosis of sleep apnoea, a patient is treated for their condition by using a continuous positive airway pressure machine (CPAP) which acts like an air splint. It consists of a mask which the patient wears during the night and connected to the machine via a tube supplying air into the airways under a specific pressure. This keeps the airways open

throughout the night thus preventing airway collapse and apnoea. Patients who have been diagnosed with sleep apnoea are also assessed within Aut Even to measure the effectiveness of CPAP. All of these services are provided by the physicians, scientists, and nursing staff at Aut Even Hospital who have been trained to treat patients with sleep disorders.

Dr John Faul is one of the Respiratory Consultants at Aut Even and he has an interest in sleep medicine. As a Fellow of the American Board of Sleep Medicine, he is optimistic about the new therapies which patients can obtain at the Sleep Medicine Clinic: “Some patients who meet the criteria for an overnight sleep study. This can be a strange night’s experience and all patients are expected to sleep less than they would at home. This way we can compare how patients sleep compared to all our other patients.”

According to Dr Faul, Many patients who attend the sleep studies are simply not getting to bed in time. A hectic and disorganised schedule can lead to reduced sleep time because it disturbs a person’s normal sleep schedule.

Before any sleep study, patients need to improve their sleep habits and timetables

“We receive a large number of in-patient referrals for pulmonary function tests and skin-prick allergy testing, and we have excellent diagnostic facilities at Aut Even when investigating Respiratory Conditions.

and need to understand the benefits and risks of the procedure. An initial consultation, which attempts to improve a patient’s respiratory status while awake, can vary between 20 minutes and an hour. An overnight study requires hospital admission during the afternoon to become accustomed to the recording equipment. Most patients rise at 7 am and have a shower and breakfast before going home or straight off to work. The results of the sleep study usually take about two weeks to process, analyse, and quantify the 1000 pages of data.

Patient’s feedback Feedback from the patients attending the Pulmonary Laboratory and Sleep Studies Clinic has been very favourable; particularly in relation to the quality of care and facilities available: “We’re kept very busy with patients coming in for sleep diagnostics,” says Aisling McDonald.

“We receive a large number of in-patient referrals for pulmonary function tests and skin-prick allergy testing, and we have excellent diagnostic facilities at Aut Even when investigating Respiratory Conditions., so it’s a good starting point for anyone suffering from a breathing-related illness.”

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Phone: 056 7762805

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Dietetics

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You Are What You Eat Rachel O Reilly., BSc., M.I.N.D.I graduated from University of Ulster, Coleraine in 1999 with a degree in Human Nutrition and Dietetics. She has worked in hospitals in Ireland and the UK. She is dietitian in Aut Even Hospital in Kilkenny for the last five years.

H

ere in Aut Even a private hospital we aim to educate people regarding diet and nutrition. Each person is given nutritional advice that is specific to the individual and their medical condition.

We provide an inpatient and outpatient service covering all medical diets for women’s and men’s health.

Rachel has a wide ranging interest in how nutrition affects health and specialises in the following:  Bowel disorders especially irritable bowel syndrome  Coeliac disease  Diabetes  Weight and cholesterol management The first consultation may take up to 50 minutes. And the follow up review appointment usually takes about 20 minutes. Most people will need at least one review, and depending on the patient’s condition several reviews may be required.

Access to the Service A referral letter from GP/Consultant is not required to access this service but is advisable for the purpose of patient’s background history. Any recent bloods or copy of tests pertaining to the patient’s medical condition may be helpful in assessment.

Rachel is a member of the Irish Nutrition and Dietetic Institute and as such is recognised by private health insurers as being qualified to give advice on nutrition. All patients will be entitled to claim partial cost from their private health insurer. They will be advised to contact their health insurer for more information in relation to claiming expenses. � Out Patient Fees � Initial Consultation: 85.00 euro � Follow up: 40.00 euro The future of Dietetics in Aut Even Rachel has recently undertaken skills training course on the application of the low FODMAPs diet for those with functional gastrointestinal disorders.

Healthy Eating Award Aut Even Hospital has been recertified

the Happy Heart at Work Eating Award for the 5th year; initial audit was in 2008 by the Irish Heart Foundation.

This award recognizes the commitment and hard work of Aut Even Hospital to ensure that the food and menus in the staff restaurant still meet the healthy eating guidelines as set out by the Irish Heart Foundation and Department of Health and Children.

63 companies have been certified and recertified with the Healthy Eating Award in 2012, which equates to almost 40,000 employees nationwide.

Over 300 companies of all types have achieved the award over the years.

The objective of the catering audit is to assist a staff restaurant to adopt healthier cooking practices and provide healthier food choices for staff, visitors and patients without incurring substantial cost. Recommendations given to the catering manager would meet the Irish Heart Foundation and the Department of Health’s ‘Healthy Eating’ Guidelines.

The Healthy Catering Guidelines are based on the key goals of the Happy Heart at Work Healthy Eating Programme, which aims to:  Reduce saturated fat and total fat  I ncrease fruit and vegetable consumption  Increase fibre  Reduce salt and sugar

“We provide an inpatient and outpatient service covering all medical diets for women’s and men’s health.”

The catering audit was carried out by a consultant Dietitian from Irish Heart Foundation in conjunction with the catering manager Lillian Connolly and in liasion with Senior Dietitian Rachel O ‘Reilly. This audit is an independent assessment identifying Aut Even Hospitals individual needs and includes an assessment of:  Overall food choice  Food counter layout  Food preparation practices  Menus recommendations to reduce fat, sugar and salt and to increase fruit, vegetables and fibre  Employee feedback When the assessment has been carried out, the catering staffs then implement the recommendations. A follow up monitoring visit by the dietitian to check and assist in the implementation of recommendations will take place 8 10 weeks after the audit.

Further Information: Aut Even Hospital, Freshford Road, Kilkenny.

Hospital Number: 056 7775187 Fax: 056 7775292 Mobile: 087 9536547 Email: roreilly@mcm.ie or racheloreilly1@gmail.com (Out patients)

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internAl telephone directory

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aut eVen HosPital internal telePHone DireCtory Consultant DireCtory reception/general enQuirieS

day Surgery unit

wardS 1st floor

056 777 5275

056 777 5191 056 777 5253

accountS

gp liaiSon manager

2nd floor

056 777 5194

056 777 5121 086 025 0049

056 777 5140

audiology Sinead Ryan 056 777 5172 086 6097762

Bed management 056 777 5269

nutrition and dieteticS

056 777 5130

3rd floor 056 777 5158

Rachel O’Reilly 056 777 5187

pathology 056 777 5185

Bone denSity appointmentS 056 777 5250

phySiotherapy 056 777 5173 056 777 5223

BooKingS office/ admiSSionS

pre aSSeSSment clinic

056 777 5268

056 777 5155

cardiology

pulmonary function laB

Dr. John Clarke 056 777 5133

056 777 5279

Dr. Micheal De buitleir 056 776 2754 056 7775175

radiology x-ray/mri appointmentS

cardiac technician

radiology reportS

056 777 5125

056 777 5128

056 777 5250

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Consultant Directory

Consultant Directory Consultant Directory Anaesthetist

cardiology

Dr E Barnor

Dr M de Buitleir T: 056 7762754 F: 056 7762754 Clinic Days: Mon-Fri

Anaesthetist

cardiology

Dr G Browne

Dr M Conway T: 056 778 5769 St. Lukes Clinic Days: Mon

Anaesthetist

cardiology

Dr G Elbastawisy

Dr H Kindler T: 056 7775133 F: 056 7775136 E: Heiko.kindler@eaglelodge.ie

Anaesthetist

dermatology

Dr J Cudmore

Dr A Smith T: 056 7775145 F: 056 7775333 E: adamderm@hotmail.com Clinic Days: Mon, Tue, Wed

Anaesthetist

dermatology

Dr S Prasad

Dr G Morrow T: (01) 4970392 F: (01) 4974119 E: Dermatology.secretary @gmail.com Clinic Days: Fri/Sat Monthly

Anaesthetist Dr T White drtwhite@indigo.ie

Endocrinology

Anaesthetist

Dr M Ryan T: 061 490516 F: 061 312939 E: mary.ryan@BHL.ie Clinic Days: Tue, Wed. Twice Monthly

Dr Rao Vinjamuri somsasi@gmail.com

ent surgery

cardiology

Mr A Khan T: 0 56 7775177 056 7756864 F: 056 7756864 Clinic Days: Tue, Thur

Dr J Clarke T: 056 777 5133 F: 056 7775136 E: info@eaglelodge.ie Clinic Days: Wed

ent surgery Mr N Riley T: 056 7775258 F: 056 7775178 E: nrileykk21@gmail.com Clinic Days: Thursday, Every Third Friday

gastro enterology Dr Aftab T: 0 56 7775149/ 056 7722078 F: 056 7722109 Clinic Days: Direct Access

gastro enterology Dr. S Nugent T: 051 359909 F: 051 359911 E: Suite3@whitfield.ie

GENERAL MEDICINE / nephrology Dr M Akram T: 0 56 7722078/ 087 9895440 F: 056 7722109 Clinic Days: Mon Alternate Tuesday Clinics

General surgery Mr T Christle T: 056 7750070 F: 056 7750071 E: freshfordclinic@eircom.net Clinic Days: Monday Mornings

General surgery Mr P O’Byrne T: 056 8832022 F: 056 8832024 pamfreshford@eircom.net Clinic Days: Monday Afternoon

General surgery Mr M Hurley F: 056 7762222 F: 056 7764344 surgeonhurley@hotmail.com Clinic Days: Monday Afternoon

General surgery Mr I Wilson T: 056 7775142/ 056 7771468 F: 056 7775285 E: wilsonkk@eircom.net Clinic Days: Wednesday

gynaecology Mr R O’Sullivan T: 056 7795302 F: 056 7795303 Clinic Days: Mon-Fri

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Consultant Directory

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Consultant Directory Consultant Directory gynaecology

OPHTHALMOLOGY

Pain specialists

Mr T Hayes T: 056 7795302 F: 056 7795303 E: jeandonegan@gmail.com Clinic Days: Mon-Fri

Mr T Stumpf T: 056 7786070 F: 056 7702616 E: stumpf.tom@googlemail. com Clinic Days: Mon, Wed, Thurs

Dr T Lynch T: 056 7775281 F: 056 7775285

gynaecology Mr Y Kamal T: 083 426 6080 F: (01) 8215857 E: Ykamal6@gmail.com Clinic Days: Saturday Clinics

Neurology

OPHTHALMOLOGY Mr D Kent T: 056 7722021 F: 056 7770776 E: david.kent@thevisionclinic.ie Clinic Days: Wed

DIABETES SPECIALIST/ GENERAL PHYSICIAN Dr Dilip Jondhale Marie 056 7722078 E: drdilipjondhale@eircom.net

oral surgery

Plastic Surgeon

Mr S Nayyar T: 057 8662111 F: (01) 7719101 E: sharifnayyar@gmail.com

Mr P Meagher T: 01 2135608 F: 01 2935962 E: Suite5beacon@ireland.com Clinic Days: Twice Monthly

Dr I Fraser T: 056 7775280/ (01) 4065166 F: 056 7775285 Clinic Days: Second Friday of the Month

oral surgery

Plastic Surgeon

Ms M Cashman T: 021 7916732

Dr L Purcell T: 0 87 2774884/0872323876 F: 045 898427 E: lizpurcell@gmail.com

OPHTHALMOLOGY

oral surgery

Psychiatrist

Mr G Higgins T: 087 1530727 F: 058 75797 E: garethhigginsophth@ gmail.com Clinic Days: Alt Wed

Mr J O’Connor T: 051 561170 F: 051561170

Dr N Carrigan 056 7734191

OPHTHALMOLOGY

orthopaedic

radiologist

Mr J O’Reilly T: 056 7786070 F: 056 7702616 theeyesurgery@eircom.net Clinic Days: Tue, Alt Fri

Mr S Edwards T: 056 7775126 F: 056 7775276 E: orthojoint-kilkenny@ mcm.ie Clinic Days: Wed, Thur

Dr T Murray T: 056 7775251 / 056 7775225 F: 056 7771359 E: Radiology-kilkenny@mcm.ie Clinic Days: Mon-Fri

OPHTHALMOLOGy

orthopaedic

RESPIRATORY

Ms C Cleary T: 061 482 378 F: 061 482529 Clinic Days:

Mr B Long T: 056 7723252 F: 056 7723253 E: cootesinjury@eircom.net Clinic Days: Thur, Every third Tue

Dr J Faul T: 056 7775280 F: 056 7775285 Clinic Days: Mon, Third Fri

Dr P Crowley T: 087 242 0773 F: 056 7703452 Clinic Days: Thur

oncology

OPHTHALMOLOGY Mr. M Gallagher T: 059 91 43882/ 056 7786070/ Rachel 087 328 8009 E: drmjgallagher@gmail.com Clinic Days: Mon, Wed, Thur

orthopaedic Mr A Laing T: 056 7775156 F: 056 7762149 E: deirdrefarrell@mcm.ie Clinic Days: Tue, Fri

radiation oncolOgy Dr D Hacking T: 051 319857 F: 051 337445 E: hackingdj@upmc.edu Clinic Days: Thur, Every third Tue

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Consultant Directory

Consultant Directory

rheumatology

urology

Dr F Khan T: 056 7721726 / 056 7775146 F: 056 7789846 E: drfahimknan@gmail.com Clinic Days: Thur, Every third Tue

Mr K Siddiqui T: ( 01) 645 9618 / 087 629 8020 F: (01) 6459616 E: kashifsiddiqui2@gmail.com

urology Mr B Jones T: 056 7752442 / 086 819 0322 F: 056 7752442 E: barryjones@eircom.net Clinic Days: Thur, Every third Tue

urology Mr I Ahmad T: 056 7775280 F: 056 7756864 Clinic Days: Every Second Tue

VASCULAR SURGERY Mr P O’Byrne T: 056 8832022 F: 056 8832024 E: pamfreshford@eircom.net Clinic Days: Monday Afternoon

vascular surgery Mr M Murphy T: 01 202 4613 E: Michael.Murphy@ beaconhospital.ie

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