Cappagh 2014 by Ashville Media Group

Cappagh

National Orthopaedic Hospital

Cappagh National Orthopaedic Hospital

Cappagh National Orthopaedic Hospital, Finglas, Dublin 11 | Tel: 353-1-814 0400 | Fax: 353-1-814 0327 | www.cappagh.ie

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Faye Jameson When mother Jacinta Jameson’s first child was born without his tibia on both legs it was a shock. When her second child was born with the same rare condition, her life changed dramatically. But neither she nor her children have let limb-loss stop them from leading full and active lives.

Have you or a loved one recently been discharged from hospital and find that you need some extra care and support while you finish recuperating? Are you worried about losiing your ability to continue living in your own home?

Faye is 11 years old, loves boxing, soccer and swimming – not things you expect from an amputee. Faye lost her left leg when she was only a year old after she had been born without her tibia bone. “I remember noticing I was different when I was about two or three”, she says cheerfully, “I don’t really notice anymore though as it never stops me doing anything!” “The kids at school think my prosthetic leg is really cool and they’re always looking at the pictures on it” – Faye currently has pictures of her idols Katie Tyler and Michael Carruth and likes to change the covers every time she gets a new leg (previous stars include the Irish duo Jedward and football team Celtic).

Home Care Plus can help. We provide fully trained and vetted carers to help your loved one continue living independently from as little as one hour per week right up to 24hr live in care. We also provide night time care.

“The kids at school think my prosthetic leg is really cool and they’re always looking at the pictures on it” Faye’s mother Jacinta adds “Faye always finds a way to participate – she’s never let her prosthetic leg stop her from doing anything”. Jacinta’s first child Sean, now 15 years old, is a bi-lateral amputee. Sean lost both his legs when he was nine months old to the same condition. He also enjoys soccer and has won awards for his swimming in recent years.

Faye and Sean are both patients at Cappagh hospital’s Ottobock / IDS clinic and have been treated there through the health service since their childhood. “The team at Ottobock / IDS have been fantastic and are always happy to help. If the kids ever break one of their prosthetics, it’s fixed right away”. Jacinta goes on to describe what it is like to be a mother to two children with congenital limb loss, “It was very hard in the beginning. It’s hard to accept. But I’ve never treated them differently and it’s never stopped them achieving anything.”

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Faye

The future for Faye and Sean is bright as prosthetic technology continues to improve, but as congenital limb-loss is genetic, their mother fears for their future. “There’s a good chance that their own children will have the same condition, and it does worry me – but to see how well both Faye and Sean are doing helps.” And what about advice for other parents who might be faced with a similar future? “Try everything. Even if it seems to hard or impossible – give it a try because you’ll be surprised at just how much they can do. It will always be hard at the start, but never stop encouraging them”. Ottobock / IDS is a specialist Prosthetics/Orthotics/ Footwear provider based in the Cappagh National Orthopaedic hospital in Dublin. It is the largest supplier of such services in Ireland, covering the majority of the country via their main clinic in Dublin and a further 13 satellite clinics across the country.

IDS Ltd, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11 T: 01 834 8970

E: admin@idsltd.ie

For a free assessment from one of our trained supervisors call us on

01-2605002

or for further information visit our website at

www.homecareplus.ie The services we offer include: - Companionship - Light housework - Meal preparation - Transportation duties - Personal care - Convalescence care - Medication Management and Reablement

Home Care Plus

Tel: 01 2605002 Fax: 01 2600851 E-mail: info@homecareplus.ie 6b Woodbine Park Booterstown County Dublin

www.idsltd.ie

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Managing Editor: Mary Connaughton Editor: Ruraidh Conlon O’Reilly Art Director: Jane Matthews Design & Layout: Antoinette Sinclair Advert Design: Colm McDermott, Jennifer Reid Illustrations & Photography: iStock Photo, Thinkstock Production Manager: Mary Connaughton Sales Director: Paul Clemenson Ashville Media Group Old Stone Building, Blackhall Green, Dublin 7, Ireland Tel: (01) 432 2200 Fax: (01) 672 7100 www.ashville.com

Contents

Welcome

39 Hip Replacement

Overview

40 Sports Medicine

Cappagh Hospital Foundation

43 Surgical Pre-Assessment

Quality and Accreditation

44 Musculoskeletal Triage

Central Decontamination Training

45 Aftercare

retrieval system or transmitted in any form or by any means without written permission from the publisher. Opinions and comments expressed herein are not necessarily those of Ashville Media Group. Readers should make their own independent evaluation of the information contained within this

12 Higher Surgical Training

47 Active Rehabilitation Unit

13 Radiology

49 Occupational Therapy

20 Tumour Ablation

52 National Bone Bank

22 Upper Limb Surgery

54 DEXA Bone Screening

25 Foot and Ankle Surgery

57 Physiotherapy

29 Joint Register

58 Under the Microscope

32 Spinal Surgery

59 Same Day Admissions

34 Rheumatology

60 Radiology Consultant Directory

36 Paediatric Orthopaedic Surgery

61 Patient Information

publication and make such other investigations as they consider necessary (including obtaining independent financial advice) before acting in reliance on this information.

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For more information contact our Telecare Support Team on: 090 644 5080 or Email: helplinksouth1@gmail.com www.helplinksouth.com Cappagh 1-31 2014.indd 2 228164-1C-HELPLINK-AMA-CAP.indd 1

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INTRODUCTION

CEO ADDRESS

Cappagh CEO Gordon Dunne with Giovanni Trapattoni at the opening of the MRI Suite in 2011.

WITH ITS EXCELLENT TRACK RECORD IN FACILITATING INNOVATIVE TREATMENT, THE PRESENT AND FUTURE OF CAPPAGH HOSPITAL LOOKS BRIGHT, WRITES CHIEF EXECUTIVE GORDON DUNNE.

t present, Cappagh Hospital has 159 beds and 22 orthopaedic surgeons supported in their work by a myriad of consultant anaesthetists, radiologists, physicians, rheumatologists, microbiologists and pathologists providing a complete complement of dedicated professionals determined to ensure that our elective orthopaedics possess the expertise required to meet our patients’ varying needs and requirements. The hospital is fully furnished with seven operating suites, three of which were built in 2011 to the highest international standard of surgical facilities and are completely state-of-theart. For instance, one of these theatres

comes equipped with an extra large canopy enabling us to facilitate extra large patients and large spinal cases which often demand added space due to the sheer complexity and longevity of the procedure. Given the growth in BMIs and the intricacies of spinal surgery – particularly within older patients, a growing demographic of the national population – such a facility has become more critical than ever, and here at Cappagh Hospital we are thrilled to have added it to our already extensive assets.

HIGH TECHNOLOGY We further augment our array of tools through possessing two MRIs, one of which is a 3T MRI, the only one of its kind

currently available to public patients in the Republic of Ireland, which was installed in 2011 and commissioned in 2012. The second is a 1.5 MRI, and both of our machines are typically used for the treatment of public patients. Additionally, we provide a full complement of X-ray facilities, ultrasound and DEXA for ascertaining bone density. Augmenting this substantial array of tools are the peripheral services we provide here in the hospital – some of which are unique to Cappagh – and to patients across the country, as well as the regular services demanded by a large teaching and operative site such as ours. Included in this is the only national

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INTRODUCTION bone bank featuring samples harvested from other orthopaedic sites nationwide, ensuring the large and varied supply needed to adequately treat the wide variety of patients who visit our facilities each year. Typically, the bone is sent to Cappagh, processed to IMB standard, reused and redistributed around the country for bone grafting and other orthopaedic procedures in both public and private hospitals. In this way, Cappagh comprises a key hub in the orthopaedic infrastructure of the country, a role we continue to take great pride in. Furthermore, we provide an aurotransfusion service, ‘blooding’ patients prior to surgery so that should a blood transfusion be necessary, the patient has the piece of mind in knowing that their own blood will be used, curtailing any risk of acquiring undesirable infections or rejecting the transfusion. Both of the aforementioned services (Irish Medicines Board licensed and approved) are unique to Cappagh on a national level, demonstrating our commitment to the continuous innovation and perfection of our service and desire to spare no expense in bringing cutting-edge medical care to our patients.

SUPPORT The consultant body are fully supported by the extensive allied health professional body at the hospital comprising radiological scientists, physiotherapists, occupational therapists, social workers and pharmacists who work closely with our patients during the duration of their stay in Cappagh to ensure a smoothly managed patientcarer pathway from beginning to end. By nature, surgeons relish racking up hours in the theatre operating on patients in order to maximise their surgical capacity. In this respect, as a standalone hospital, Cappagh facilitates the surgeons to maximise time in theatre and they are sheltered from interruptions. This affords our surgeons the luxury of knowing what patients are due in advance and what work awaits them as soon as they enter the premises, adding to the satisfaction derived from

working at a facility such as Cappagh. We have a comprehensive medical preassessment clinic where patients are inspected prior to surgery to ensure no surprises or complications arise on the operating table. The fact that we have more orthopaedic surgeons than any other single hospital in Ireland enables the wanton exchange of thoughts and academic linkages between the department, cultivating a good working environment for consultants and training clinicians. They can develop both their careers and their capabilites, secure in the knowledge that other surgeons will be at hand to lend advice should the necessity arise. Given the often difficult and intricate orthopaedic cases referred to the hospital, this cross-fertilisation of knowledge is crucial, and is very much integral to everything we do. The previous administration of the hospital had the foresight to imbue Cappagh with an external accreditation process; we are now on the CHKS external accreditation for our fourth consecutive rotation, comprising assessments every 18 months. Since commencing this independent accreditation programme we’ve constantly retained our accreditation status, being the first public hospital in the state to do so. This laid the foundation at the hospital for a strong governance structure and operational guidance which has truly raised the bar of our standards, to the point where basic quality structures governing areas such as our bone bank or hygiene processes are firmly embedded throughout the organisation. All our staff now work within the parameters of this quality system and the culture it has generated. This has been one of the main catalysts of quality outcomes for our patients and enabled us to retain staff effectively through providing an excellent working environment. As such, we have a wonderful staff who have been very much at the forefront in driving quality in the hospital.

COST-EFFECTIVE Given the current climate, Cappagh is perfectly poised to deliver a quality

The medical body at Cappagh is very forward thinking, forever attempting to embellish our service to the benefit of our patients service to Irish patients, with a track record of delivering exceptional treatment while reducing cost year-on-year. Between 2008 and 2012 we reduced our costs from €37.5 million down to €29m without detracting from our rates of outpatient or inpatient activity. We pride ourselves on being a lean, adaptable organisation, and believe we can be of great benefit to the Department of Health in fulfilling a growing demand for elective orthopaedic procedures given the growing but aging population of the region and nation as a whole. Working at Cappagh has enabled me to apply my extensive private sector experience – spanning areas such as FMCG, hospitality and agricultural science – to a public body over the past decade. Like the private sector, the public sector presents an array of challenges, particularly at a dynamic environment such as Cappagh, a standalone surgical hospital where things get done quickly. The medical body at Cappagh is very forward-thinking, forever attempting to embellish our service to the benefit of our patients. I look forward to continuing my work with them over the coming years.

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OVERVIEW

THEN AND NOW A LOOK AT THE HISTORY AND GENESIS OF CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL.

n September 15th 1907 Lady Martin, the original owner of the house on the property and widow of Sir Richard Martin, passed away and very generously bequeathed the property to the Religious Sisters of Charity “to provide a school for poor children in the neighbourhood”. As the surrounding district was sparsely populated at the time, it was not considered practical to set up a school. Instead, it was used as a convalescent home for the Children’s Hospital, Temple Street and a training school for nursery nurses. Underprivileged children were transferred to Cappagh for continuing treatment. After World War 1, work commenced on the building of the hospital. Initially, old army huts were used as wards. In 1921, Cappagh became an “open air” hospital in its own right for the surgical treatment of TB. Between 1921 and the mid 1950s, the building of the hospital continued and the number of beds and cots increased from 60 to 260. A modern operating suite, X-ray Department and Physiotherapy Department were added. Because of the long-term nature of the treatments (counted in years rather than

months), a national school was established in 1923 for the education of the children. It still exists today, with one full time teacher working there. In addition, Occupational Therapy was introduced from an early date and patients were taught handcrafts of all kinds, with a new Occupational Therapy Department opened in 1961. The decade between 1945 and 1955 saw the rapid decline or tuberculosis and rickets and these welcome developments meant fewer admissions of children and fewer cots needed. Today, the vast majority of admissions are for adult patients. In 1961, the original operating theatre was replaced and a second theatre was added in 1971, fitted with the new clean air facilities required for total hip replacement operations. In 1989/1990, two additional clean air operating theatres were added. A new Imaging Department and Pathology Department were also added. Continuous other upgrades and ongoing refurbishments progressed over the years at Cappagh Hospital, with an MRI scanner arriving in 2001. Medical/nursing education has always been the hallmark of Cappagh. The

hospital provided the only postgraduate orthopaedic training course for nurses for many years. In 1991, approval was granted for the Diploma Course in Orthopaedic Nursing for this hospital by the Royal College of Surgeons in Ireland for postgraduate nurses. Since 1999 this course has been upgraded to that of a Higher Diploma in Orthopaedic Nursing. The Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland was officially opened in March 1992, with the appointment of Timothy O’Brien as the first Professor of Orthopaedic Surgery. At the present time the hospital has the services of 22 orthopaedic surgeons, each with a major sub-specialty and rheumatologists, consultant anaesthetists, consultant radiologists, a haematologist, a biochemist, a histopathologist and a microbiologist each giving their expertise to Cappagh. The hospital is a major elective orthopaedic facility and provides elective orthopaedic services for St Vincent’s, St James’s Hospital, the Mater Hospital, Beaumont Hospital, James Connolly Memorial Hospital, The Children’s Hospital Temple Street, the Central Remedial Clinic and other tertiary referrals.

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FUNDING

CAPPAGH HOSPITAL FOUNDATION

Cappagh Hospital Foundation: CAPPAGH HOSPITAL FOUNDATION:

the funding arm of the hospital

THE FUNDING ARM OF THE HOSPITAL

CAPPAGH HOSPITAL FOUNDATION, FORMERLY CAPPAGH HOSPITAL TRUST,TRUST, WAS ESTABLISHED IN CAPPAGH HOSPITAL FOUNDATION, FORMERLY CAPPAGH HOSPITAL WAS 1988 WITH THE PURPOSE OF RAISING FUNDS FOR CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL. ESTABLISHED IN 1988, WITH THE PURPOSE OF RAISING FUNDS FOR CAPPAGH NATIONAL THE FOUNDATION IS A REGISTERED AND RECEIVED CHARITABLE STATUS NO 9282) IN ORTHOPAEDIC HOSPITAL. THE CHARITY FOUNDATION IS A REGISTERED CHARITY AND(CHY RECEIVED OCTOBER 1988. CHARITABLE STATUS (CHY NO 9282) IN OCTOBER 1988. Cappagh Hospital Foundation,Achievements Achievements to date:to date: formerly Cappagh he funds raised by Hospital Trust, was established in Operating Professional Medical Out Patients Car MRI 3T MRI the Foundation are 1988, with the purpose of Theatres Department Library Department Parks Scanner Scanner channelled into improving raisingfor funds for Cappagh the facilities patients at National Orthopaedic Cappagh and giving training Hospital. The foundation is a registered 1988 1989 1991 1992 1994 1995 1996 1997 1998 1999 2001 2008 2009 2011 to healthcare professionals charity and received working in the hospital so that charitable status (Chy No they can give the best care 9282) in October 1988. Bone Bone Tumour Sanitary Lady Martin Hospital Isolation possible to patients to ensure Tumour Cancer Facilities Auditorium Entrance Unit they return to full mobility Cappagh Hospital Foundation Research Registry and health without delay. is the funding arm of the Funds are also channelled hospital and is solely Top Funding Priorities into research on how dependent on the the generosity • Ward refurbishment Priorities practice of orthopaedics of the Irish public.can The funds Top Funding • Recovery room refurbishment be enhanced to the t raised by the benefi foundation are • Ward • Increase research and enhance medical training roomthe Active Rehabilitation Centre of patients. Cappagh Hospital channelled into improving • Recovery • Creating • Increase research and enhance medical training Foundation, formerly Cappagh the facilities for patients at • Outpatients Department development the Decontamination Active RehabilitationUnit Centre Hospital Trust, was established Cappagh and giving training • Creating • Central • Outpatients Department development in 1988 the purpose of towith healthcare professionals Decontamination Unitvisit www.chf.ie raisingworking funds forin Cappagh the hospital so • Central For more information, thatOrthopaedic they can give the best National Hospital. care possible to patients These six priorities be phased in over the next five to seven years and For more information, visitwill www.chf.ie. The foundation is a registered andreceived so thatcharitable patients can will require an investment of over €7 million from the private sector. We charity–and full mobility and initiated andthe more approach ourrequire fundraising Thesehave six priorities willan beambitious phased in over nextstrategic five to seven years andtowill an investment of statusreturn (Chy Noto9282) in health initiative to ensure success. a broad and inclusive outreach, million from the private sector.Conducting We have initiated an ambitious and more strategicwe approach October 1988.without delay. Funds over €7 are also channelled into be requesting investment from Conducting former patients, contacts, to ourwill fundraising initiative to ensure success. a broadcorporate and inclusive outreach,family we will be research onFoundation how the practice members and friends of thepatients, hospital. This iscontacts, an unprecedented undertaking requesting investment from former corporate family members and friends for of the Cappagh Hospital is of orthopaedics can be Cappagh. Securing these funds provides us withSecuring an extraordinary hospital. This is an unprecedented undertaking for Cappagh. these fundschallenge provides usbut with the funding arm of the hospital enhanced to the benefit of an extraordinary a special opportunity. We need the generosity, spirit and support of the entire challenge but a special opportunity. We need the generosity, spirit and support of the and is solely dependent on patients. Cappagh ‘family’ to ensure success. entire Cappagh ‘family’ to ensure success. the generosity of the Irish public. The funds raised by the foundation are channelled GET INVOLVED! DONATE TODAY! into improving the facilities for patients at Cappagh and ie donate online at www.chf.ie Or Donate Online at www.chf.Or giving training to healthcare GET SOCIAL! professionals working in the Get Social: Facebook: hospitalFacebook: so that they can giveHospital Foundation Cappagh Cappagh Hospital Foundation the bestTwitter: care possible to @cappaghhospital Twitter: patientsLinkedIn: – and so that patients Cappagh Hospital Foundation @cappaghhospital can return to full mobility and LinkedIn: health without delay. Funds Foundation Cappagh Hospital Cappagh Hospital Foundation National are also Cappagh channelled into Orthopaedic Hospital researchFinglas on how the practice of Cappagh Hospital Foundation Dublincan 11be orthopaedics National Orthopaedic Hospital, 01-8340325 enhanced for the good of Finglas, Dublin 11 patients.

GET INVOLVED! DONATE TODAY!

01-8340325

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SETTING THE STANDARD SIOBHÁN COUGHLAN, CLINICAL QUALITY & TRAINING MANAGER AT CAPPAGH HOSPITAL EXPLAINS THE PROCEDURES AND STANDARDS IN PLACE TO ENSURE THAT THE HOSPITAL IS AT THE FOREFRONT OF NATIONAL AND INTERNATIONAL STANDARDS.

ur role here is to ensure that there is a standard of care in Cappagh that adheres to all national and international standards,” explains Siobhán. Cappagh received the highest score in the country at the last HIQA National Hygiene Services Quality Review in 2008. “That was an award that we were very pleased to receive and we worked very hard to obtain it, but audits only provide a snapshot of where the hospital is at that time and we have to continually strive to ensure standards do not slip at any level in the hospital and to ensure we are always ‘audit-ready.’ The department is responsible for the implementation of the following standards:

• CHKS Accreditation Standards • National Standards for Safer Better Healthcare • National Standards for the Prevention and Control of Healthcare Associated Infections • HSE Standards and Recommended Practices for Healthcare Records Management. • HSE Standards and Recommended Practices for Central Decontamination Unit (CDU). “Our department co-ordinates the hospital audit programme including quality audits, hygiene audits, medical record audits, etc, to ensure that the hospital is in compliance with these standards and adhering to best practice,” says Siobhán.

NATIONAL ORTHOPAEDIC HOSPITAL

CAPPAGH

QUALITY & ACCREDITATION

They are also responsible for the efficient co-ordination and maintenance of the hospital document control system, ensuring that current policies, procedures, forms, check-sheets etc which are based on evidence-based best practice are available to all staff. “We are very fortunate in Cappagh to have a strong cohesive effort from all staff to keep standards very high at the hospital. What we reinforce with everyone here is that quality is part of everyone’s job, not an addendum to it. We work very hard to ensure our systems are reviewed and updated on a regular basis. One of the key drivers in maintaining levels of quality is securing the opinions of those that matter most in Cappagh: the patients. All in-patients at Cappagh receive a survey which allows staff to make an assessment of patient satisfaction and implement action when required.” The department is also responsible for: • Co-ordination of continual improvement activities throughout the hospital and monitoring, review and reporting of key performance indicators (KPIs). • Provision of support, direction and focus with respect to quality for all activities undertaken at the hospital. • Preparation of annual quality reports. • Management of the preventative maintenance programme for the hospital’s medical devices/equipment. • Promotion of quality throughout the hospital through training in qualityrelated issues, notification of changes or updates in best quality practices and participation on hospital committees. • Health, safety and risk management.

CONTACT INFORMATION Ms Claire Falvey Ms Siobhán Coughlan General Quality & Training Manager Clinical Quality & Training Manager Phone: +353 (1) 8140 308 Phone: +353 (1) 8140 307 Email: claire.falvey@cappagh.ie Email: siobhan.coughlan@cappagh.ie

HOURS OF SERVICE Monday – Friday: 8.00am – 4.30pm

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CHKS AWARD

ACHIEVING AND MAINTAINING HIGH STANDARDS

CLAIRE FALVEY IS THE GENERAL QUALITY AND TRAINING MANAGER AT CAPPAGH NATIONAL ORTHAPAEDIC HOSPITAL, WHICH HAS RECENTLY WON THE CHKS QUALITY IMPROVEMENT AWARD. FIVE ORGANISATIONS WERE SHORTLISTED FOR THE INTERNATIONAL AWARD, WHICH RECOGNISES SIGNIFICANT IMPROVEMENTS IN PATIENT CARE AND PATIENT EXPERIENCE AS WELL AS STAFF WELFARE, SAFETY AND MORALE. THE CEREMONY TOOK PLACE IN MIDDLE TEMPLE HALL, LONDON ON APRIL 30TH 2013.

ccreditation standards are important to hospitals nowadays: they help to ensure that patient safety and quality of care are of the highest standard. The CHKS International Accreditation Programme for healthcare organisations enhances public confidence and demonstrates commitment to quality patient care, commitment to the continuing improvement of the quality of that care, and to the application of evidence-based international standards of quality care and services. There is no guarantee that problems will not arise – however, if they do arise, the hospital is well equipped by the standards to identify these problems and take effective action to address them. For all these reasons and more, Cappagh Hospital decided to seek CHKS accreditation. “The hospital first went for accreditation 10 years ago, prior to Clinical Quality Manager Siobhán Coughlan or I starting, so a lot of the groundwork of getting management and staff to buy into the idea was already done,” explains Claire Falvey, General Quality and Training Manager at Cappagh National Orthapaedic Hospital. However, prior to the last accreditation survey in March 2011, the CHKS Standards had been updated in mid-2010 so the hospital’s quality management system and associated systems had to undergo a comprehensive gap analysis against the standards and were subsequently updated to comply to the new principles.

Getting so many departments and disciplines to commit to the process wasn’t too difficult, she explains: in spite of the country’s economic uncertainties, Cappagh has a dedicated, loyal and committed staff, executive management team and Board of Directors. “The accreditation process is one of change, and throughout this change the hospital’s staff have been the drivers of so many developments that it has become embedded in the hospital’s culture. The sense of willingness and need to continually improve are now openly apparent and staff feel supported to challenge any aspect of service delivery that they think can be improved upon. There is a real sense of duty to the patient and advocacy on behalf of the patient. This confidence is a spin-off from the accreditation process. Staff have been empowered with the mechanisms and the processes to enact changes and regularly drive change within the hospital.” Even so, the process threw up a few challenges – for example, while trying to ensure that the hospital met the revised CHKS accreditation standards and that documentation reflected current practice, they decided to purchase and install Q-Pulse, a quality management software system. It allows the team to manage and control their policies, procedures and forms electronically instead of the previously time-consuming and error-prone manual method.

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CHKS AWARD “Although this posed a challenge, trying to implement both systems simultaneously, Q-Pulse brought with it a standardisation of policy development, approval and management. This project, including the training of staff in the use of the system, required a lot of resources,” says Claire. “However, the CHKS survey team acknowledged that hospital documentation was now of a very high standard and training was readily available to all staff due to the implementation of this system.”

THE INSPECTION PROCESS Then it was time to begin the inspection process. Prior to the survey, the Quality Department, in conjunction with the relevant departments, completed an online self-assessment questionnaire designed to give an accurate reflection of the hospital’s compliance with the standards and criteria. This information, together with the documentary evidence provided prior to the audit visit, was used as the basis for the interviews and observation of working practices carried out by the CHKS survey team. The CHKS survey team consisted of five auditors with backgrounds in nursing, medicine, physiotherapy and healthcare management, and spent five days onsite scrutinising the hospital’s quality management system. The survey entailed a walk-around of the hospital, a review of documentation, a review of hospital and patient records, and staff were interviewed to ensure that the practice on the ground reflected that documented in policies, procedures and the requirements of the standards. On the final day of the survey, the auditors met with the Senior Management Team, the Quality Team and the Head of the Medical Board Professor John O’Byrne, to relay their findings. “To our joy and relief, they indicated that the hospital met all relevant standards and associated criteria, with an overall compliance rate of 96 per cent with the CHKS accreditation standards,” says Claire. Following this meeting, the survey team then presented their findings to the remainder of the hospital staff. In January 2012, Cappagh Hospital was invited by CHKS to submit an application

for the CHKS Quality Improvement Award. This international award recognises significant improvements in patient care and patient experience as well as staff welfare, safety and morale. The CHKS Quality Improvement Award 2013 was open to all healthcare organisations accredited by CHKS in 2012. Having reviewed the submissions from the healthcare organisations, the CHKS awards panel notified the hospital that it had been shortlisted as one of five organisations: • ASL4, Italy • Cahercalla Community Hospital and Hospice, Ennis, Co Clare • Cappagh National Orthopaedic Hospital, Dublin • The New Victoria Hospital, UK • Ygia Polyclinic, Cyprus Each organisation was hugely endorsed and applauded by the judging panel.

THE CEREMONY Cappagh Hospital’s win was a complete surprise to Claire and the team. She and Clinical Quality Manager Siobhán Coughlan travelled over to London in April 2013 to attend the ceremony in Middle Temple Hall, where the winners of the CHKS Top Hospitals programme awards were announced. All shortlisted organisations were highly commended by the judges, with Ygia Polyclinic coming runners-up and Cappagh National Orthopaedic Hospital announced as winner of the 2013 CHKS Quality Improvement Award. “It was a memorable occasion and great honour to accept the award on behalf of Cappagh,” Claire says. “The award is recognition of the hospital and its staff for their constant dedication to maintaining and improving the health and safety of patients in their care.” So what’s the next challenge? “Quality is an ongoing process where the hospital is constantly challenged internally through our auditing and continual improvement processes, and externally through audits by regulatory and accreditation bodies. For the foreseeable future, our efforts will be concentrated on the implementation of the national standards for safer

“The award is recognition of the hospital and its staff for their constant dedication to maintaining and improving the health and safety of patients in their care.” and better healthcare, and the latest version of the accreditation standards.” Claire joined the Quality Department as the General Quality and Training Manager in 2009. Her colleague Siobhán Coughlan, Clinical Quality Manager had joined Cappagh in 2008. Collectively, they are responsible for the management of the hospital quality management system, the management of risks and incidents, and the management of health and safety throughout the hospital. These systems are managed through the implementation and compliance of the hospital with the CHKS Accreditation Standards, all relevant national and HSE healthcare standards and all relevant health and safety acts and regulations. The Quality Department is ultimately responsible for the quality systems at the hospital – however, the development, implementation and adherence to quality systems is a function of the entire hospital. All staff take pride and ownership in their work and this is reflected in the standards of patient care and cleanliness of the hospital, creating a clinical environment which enhances both patient and staff experience – an approach vindicated by Cappagh Hospital’s CHKS Quality Improvement Award.

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CDU

CAPPAGH OPENS MAJOR NEW CENTRAL DECONTAMINATION UNIT A NEW STATE-OF-THE-ART CENTRAL DECONTAMINATION UNIT WILL HELP ENSURE THAT PATIENTS HAVE ACCESS TO THE BEST POSSIBLE CARE.

new €5 million Central Decontamination Unit at Cappagh National Orthopaedic Hospital was officially opened on Friday April 11th by Mary O’Rourke, patron of Cappagh Hospital Foundation and Mr Nikolai Burkart, Chairman of Zehnacker Ireland Healthcare. Funded by the HSE, the Cappagh Hospital Foundation and Zehnacker Ireland Healthcare through a joint venture agreement at the hospital, the new Central Decontamination Unit is the first of its kind in Ireland capable of providing commercial central decontamination services to the wider healthcare and associated industries, in addition to meeting the needs of Cappagh National Orthopaedic Hospital. The HSE introduced standards for the decontamination of reusable invasive medical devices in 2011 which require all decontamination facilities to achieve

specific standards regarding quality of service. This new unit was constructed to be fully compliant with the HSE standards, European standards and ISO standard 13485. This will ensure that all medical devices processed in the new unit are decontaminated to the most current Irish and European requirements.

MAJOR STEP This development at Cappagh National Orthopaedic Hospital is another major step in its infrastructural plan to ensure that patients have access to the best possible care using the most current equipment and processes.The new unit is commercially managed by Zehnacker Ireland Healthcare to provide fully accredited, HSE- and European standardcompliant decontamination services to the Irish healthcare industry. The unit was specifically developed to allow other healthcare facilities avail of the

decontamination process, a concept which is common in most European healthcare settings. This sharing of facilities and services has the potential to ensure a better quality service to patients and reduce the overall cost of decontamination. “Zehnacker Ireland Healthcare is happy to be associated with CNOH from conception to final construction of this new facility,” said John O’Carroll, CEO of Zehnacker Ireland Healthcare. “We see the practice of sharing state-of-the-art facilities between hospitals as the cornerstone for ensuring quality and achieving cost savings. This has been the experience of healthcare organisations internationally, including our parent company in Europe.” The new CDU is the latest in a long line of developments at Cappagh: in recent years the hospital has completed major developments including new theatres, a 10-bed isolation unit and the purchase of a 3-Tesla MRI unit.

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HIGHER SURGICAL TRAINING

WORLD-CLASS CARE HIGHER SURGICAL TRAINING IN CAPPAGH HAS SET A STANDARD OF EXCELLENCE IN PROCEDURES AND PATIENT CARE, EXPLAINS PROFESSOR JOHN O’BYRNE.

he Department of Orthopaedic Surgery at the Royal College of Surgeons in Ireland (RCSI) was established in 1991, with the appointment of Professor Tim O’Brien as the first Abraham Colles Professor of Orthopaedic Surgery. The department established a Higher Surgical Training Programme in Trauma and Orthopaedic Surgery with the Irish Institute for Trauma

Cappagh is the chief Orthopaedic teaching unit in the country.

(post-HST level),” explains Professor John O’Byrne. “We were inspected in May 2012 and reaccredited for a further five years. The hospital takes its turn to host the intercollegiate specialty examination in trauma and orthopaedic surgery (Joint Royal Colleges of Surgeons of Great Britain and Ireland), which the higher specialist trainees take in the fifth/sixth year of training. Orthopaedic surgeons in Great Britain and Ireland cannot apply for consultant posts without having passed this exam – as a minimum requirement. “The exams held in Cappagh are normally the largest held in the British Isles, by virtue of our facilities and the kindness of our patients who volunteer to attend. It is a huge logistical undertaking by the hospital in general, and the goodwill of all staff is crucial to its success. “The hospital organises transport, catering, clinical materials etc for 50 to 60 patients and 120 exam candidates and over 50 examiners and examinations board secretariat. We are assisted in this through funding from Cappagh Foundation,” he says.

and Orthopaedic Surgery to monitor trainees and liaise with the mandated training bodies. Higher specialist training is controlled by the Irish Institute for Trauma and Orthopaedic Surgery, which is based in RCSI. Appointment of trainees and their supervision of the six-year training programme are co-ordinated through that office.

The Irish Institute for Trauma and Orthopaedic Surgery, which is a subcommittee of the Higher Surgical Training Committee of the Royal College of Surgeons in Ireland, retains oversight of higher specialist training in orthopaedics for Ireland, and has its offices at the Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin 2.

“Cappagh is the chief orthopaedic teaching unit in the country. We are accredited for six Trainees in years one to six of the scheme and with scope for more than two fellows

In 2005, Professor John O’Byrne was appointed as Abraham Colles Professor of Orthopaedic and Trauma Surgery. Among his roles, he assumed the responsibility

of introducing a comprehensive musculo-skeletal module to the RCSI’s undergraduate teaching programme. This programme was designed and is a core part of the intermediate undergraduate cycle and commenced in February 2006. The musculo-skeletal programme examination results form part of the overall surgical OSCE result. Professor O’Byrne has established the Abraham Colles Medal in Orthopaedics, which is presented following a clinical examination contested by the top three students in each intermediate cycle. The winner has his/her name added to a prize board specially designed, and available to view in college halls for posterity. Through the Professorial Unit, significant research links and collaborative projects have been undertaken and are ongoing between Cappagh National Orthopaedic Hospital and University College Dublin, the Royal College of Surgeons in Ireland, Dublin City University and Trinity College Dublin. It is planned to increase these links over the next five years to highlight the role and profile of Cappagh National Orthopaedic Hospital.

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RADIOLOGY

NEW FRONTIERS PROFESSOR STEVE EUSTACE REVIEWS THE WIDE RANGE OF MINIMALLY INVASIVE IMAGE-GUIDED THERAPY AND MINIMALLY INVASIVE SPINAL INTERVENTIONS AT CAPPAGH AND WHY THE HOSPITAL IS EXCELLENTLY POSITIONED TO CATER FOR THE NEEDS OF PATIENTS.

fter 14 years working in Cappagh Hospital as director of radiology, Professor Steve Eustace, Newman Professor of Radiology at UCD explains why Cappagh is so well designed to cater for the needs of patients attending with spinal disorders. “In my time at Cappagh I have seen massive improvements in the infrastructure within radiology, predominantly due to incredible support from the Cappagh Hospital Foundation. When I joined the hospital, the radiology department had a single X-ray suite. Today, the department now has both a 3Tesla and 1.5Tesla MRI, state-ofthe-art ultrasound, flash beam DEXA, computed radiography units and a state of the art biplane interventional unit.”

Annually almost 2,000 image-guided spinal interventional procedures are carried out in radiology at Cappagh, with many done as day cases and a small number as in-patients.

IMAGE GUIDED SPINAL INTERVENTIONAL PROCEDURES AT CAPPAGH HOSPITAL: • Selective and non-selective epideural blocks • Facet joint and sacroiliac joint blocks • Pulsed radiofrequency and thermal radiofrequency (rhizotomy) blocks of facet joints, sacroiliac joints and of median sensory branches • Vertebroplasty, kyphoplasty and vertebral body stenting • Percutaneous discectomy spinal discectomy.

A discectomy is a procedure to remove herniated spinal disc material (the removal can be referred to as decompression) that is pressing on the spinal cord or a nerve root, causing pain to the patient. The majority of discectomies are performed under general anaesthesia by dedicated spinal surgeons such as Mr Keith Synnott and Mr Damian McCormack in Cappagh Hospital. A smaller number of patients with smaller disc bulges are suitable for the recently introduced percutaneous approach which is performed under image guidance in the radiology department. Percutaneous discectomy is performed under local anesthetic over approximately 20 minutes and involves image-guided positioning of a probe within the disc to remove central nucleus material, and hence decompress the disc. The

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In my time at Cappagh I have seen massive improvements in the infrastructure within radiology predominantly due to incredible support from the Cappagh Trust.

procedure is enhanced by concomitant intra-discal injection of ozone gas which leads to disc dehydration and shrinkage. “In this form, percutaneous discectomy offers an exciting, effective, minimally invasive alternative to conventional surgery, rapidly performed without need for general anaethesia, with rapid post-procedural recovery. This procedure is often performed in collaberation with spinal orthopaedic surgeons and could not have been introduced without the support of orthopaedic colleagues.”

VERTEBROPLASTY AND KYPHOPLASTY Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), primarily due to osteoporosis, less frequently due to metastases (cancer) and painful hemangiomata. Typically, vertebroplasty is recommended after less invasive treatments, such as bed rest, a back brace or pain medication, have been ineffective, or once medications begin to have undesired side effects. In vertebroplasty, using X-ray guidance,

cement or bone substitute is injected into the affected area. In kyphoplasty, a balloon is used to create a hole or cavity in the affected area. The balloon is then removed and the bone cement is injected into the cavity created by the balloon. More recently, Professor Eustace performed the first vertebral body stent to reconstitute vertebral body shape in Ireland under image guidance in Cappagh.

FACET RHIZOTOMY Facet joints are found in the spine. They add stability and allow controlled

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movement of the spine. Like other joints, they can suffer from arthritis, etc, causing back and neck pain. The first treatment for this is facet joint injections. When this doesn’t work, a facet rhizotomy may be necessary. The pain from facet joints is transferred through a single nerve – the median branch nerve. The nerve can be eliminated with no loss of function. This completely cuts off all sensation of pain (from the facet joints) for the patient. The procedure is brief, can be done on an out-patient basis, and usually requires

no general anaesthetic. The joints are visualised with an X-ray. A needle-like probe is placed in the vicinity of the medial nerve. The probe heats the nerve with a high-frequency signal until the nerve no longer functions. A variant, pulsed radiofrequency has recently been introduced and appears to be as efficacious with considerably less risk of collaborative damage.

CAPPAGH ETHOS Professor Eustace explains: “Our aim in radiology in Cappagh is to make the experience for the patient

as comfortable as possible. Despite incredibly sophisticated equipment people are still treated as people, merging the strengths of first world radiology with the incredible compassion and caring attitude of Irish people. “Despite being small, the intimacy of Cappagh is balanced by state-of-theart practice that would stand beside any medical institution in the world. As a national orthopaedic unit, Cappagh Hospital is a jewel in the crown of the Irish health care system.”

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RADIOLOGY

CENTRE OF EXCELLENCE CAPPAGH ORTHOPAEDIC HOSPITAL STRIVES TO DELIVER THE HIGHEST STANDARDS IN DIAGNOSTIC AND THERAPEUTIC RADIOLOGY. CONSULTANT RADIOLOGIST DR EOIN KAVANAGH DISCUSSES SOME OF THE WORK DONE IN THE RADIOLOGY DEPARTMENT.

hen it comes to MRI, the strength of the magnet involved is paramount and, at Cappagh, we possess a 1.5-Tesla MRI scanner which, for the past decade, has delivered the finest quality service to our patients, including international athletes and members of the Irish soccer team. In September of last year, we added to our impressive compliment of instrumentation with a brand new 3-Tesla MRI scanner: the most modern scanner of its kind to be found anywhere in the country. This state-ofthe-art equipment – unveiled by Giovanni Trapattoni – affords us an excellent view of all body parts in high resolution and is used to diagnose a catalogue of different injuries, including sports-related ailments. Our MRI scanners are situated side by side but in different rooms, allowing them to service a greater number of patients at any one time. I generally perform procedures under X-ray or ultrasound guidance, but we offer a wide variety of other procedures such as epidurals, nerve root blocks, facet rhizotomy, percutaneous spinal discectomy performed by my colleague Professor Eustace by removing a disc using specialised equipment; and arthrography – injecting a joint with a dilute dye before commencing the MRI scan, illuminating any potential problems that are then exposed by the machine. We also have a new ultrasound in place.

PATIENT PRIORITY At Cappagh, patient care remains top priority and, to ensure that patients receive the best treatment from us, we have at our disposal the full complement of MRI, X-rays and ultrasound equipment. Our X-ray department is fully furnished with top-of-the-range equipment, including a full selection of imaging modalities to facilitate all medical requirements. A specialty of

Annette White alongside the 3-Tesla MRI Scanner

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ours is carrying out fluoroscopy procedures, by which a C-arm that can be operated at any angle allows me to perform a range of intricate procedures under X-ray guidance, including bone biopsies and vertebroplasty (injecting bone cement into vertical bones

to reseal fractures). I perform around nine procedures per morning, interpreting 3040 MRIs in that same space of time, while my industrious colleague Prof Eustace does 20 to 25 procedures a day. Together we comprise the consultancy axis of the

radiology department, and are aided by a specialist registrar. We do most of the consultations and interpretations in our office. Some of the things we do are relatively straightforward, such as X-ray interpretation. We also do a lot

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RADIOLOGY it’s easy to see on screen. Coupling the incredibly clear images with our knowledge of anatomy and pathology, we can then provide a diagnosis. Radiologists are the primary diagnosticians in a hospital. Often people don’t know this unless they spend a lot of time in a hospital environment. The National Bone Tumour Centre is also here in Cappagh, so we see all of the bone tumour cases for the country. We have two tumour surgeons and they have very specific ways that they like us to biopsy bone and soft tissue tumours. The organisational side of things is one of the most impressive features of the hospital. In terms of diagnostics we offer the crème de la crème of equipment and imaging, including the best magnet in Ireland. We complement this on the interventional front with the most innovative and up-to-date therapies available.

WARM & FRIENDLY ATMOSPHERE Because of the facilities we have on offer, we can cater for a large volume of postprocedure recovering patients at any one time, with the array of comfortable beds in our day ward providing ample space for recuperation. It has a warm and friendly atmosphere, cultivating a great environment to work in and in which to recover after surgery. Furthermore, in an effort to make our hospital as convenient for patients as possible, we have some of the most extensive parking facilities of any hospital in the country. Parking is critical for orthopaedic patients, many of whom need easy access to the hospital as their injuries impede them from journeying long distances on foot. To remedy this, we have made efforts at Cappagh to facilitate as many patients as possible within our car park, guaranteeing them minimal discomfort on transit to the hospital.

of MRI interpretation, providing this service to surgeons so they know exactly where to go during surgery and can plan the whole procedure accordingly. MRI is incredibly powerful technology and

Cappagh accepts referrals from everywhere and has a new direct settlement agreement with VHI: 80 to 90 per cent of what we do here is purely public work and the waiting lists aren’t that long – only a week or two in a lot of cases. Our advanced equipment allows us to service a high volume of patients in a short time frame. We offer a lot of novel treatments that are not available elsewhere. Prof Eustace does intradiscal ozone therapy for percutaneous discectomy using special wand-like needles,

removing portions of the disc before putting in ozone that breaks down some of the disc and thus removes pressure. We are the only facility in the country that offers this service.

LOOKING TO THE FUTURE At present, I am attempting to expand Cappagh’s already extensive range of services by acquiring platelet-rich plasma therapy, a treatment in which you take the patient’s blood and spin it in a centrefuge, isolating blood cells and thus leaving platelet-rich plasma that can in turn be used to heal tendons. This will complement our existing technologies, including our new ultrasound and 3-Tesla MRI. Irish medical facilities are often superior to their overseas counterparts, and Cappagh is certainly an example of this. Prof Eustace has worked tirelessly to improve the hospital. Over the course of the last decade, our specialty has completely changed as a result of improved facilities. In July 2013 Cappagh Hospital joined the National Integrated Medical Imaging System (NIMIS). NIMIS is a nationwide project that provides a seamless data flow of patient images between hospital sites. We are delighted to become part of this exciting development and we believe it will greatly benefit all Cappagh patients. Cappagh has proved a terrific place to work since I started here in October 2010. As well as my radiology work, I have also been employed in the US as a consultant and have brought back a range of experience which I am eager to put to use here. The efficiency of our staff is truly commendable. It’s a fantastic hospital.

CONTACT INFORMATION Ms Anne Smith Radiography Services Manager Phone: +353 (1) 8140 431 Email: ann.smith@cappagh.ie

HOURS OF SERVICE

m Ir

MRI Department Monday – Friday: 8.00am – 4.00pm X-Ray Department Monday – Friday: 8.00am – 5.00pm

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TUMOUR ABLATION

WORLD’S FINEST

MICROWAVE THERAPY at Cappagh Hospital

THE NATIONAL ORTHOPAEDIC ONCOLOGY UNIT IS BASED IN, AND CO-ORDINATED FROM, CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL. IN CAPPAGH, MICROWAVE ABLATION IS A NEW THERAPY BEING USED TO COMBAT TUMOURS TO GREAT EFFECT, EXPLAINS MR GARY O’TOOLE, CONSULTANT ORTHOPAEDIC SURGEON.

umours can progress to invade local nerves and they can cause awful symptoms to the patient. Treatment strategies can vary from observation – doing nothing and watching how the tumour grows; they often stop growing spontaneously – to surgery and adjuvant therapy. However, because these lesions are benign in nature, big operations are usually avoided by the treating surgeons. Here at Cappagh, patients presenting with these tumours are now being treated in a unique and novel fashion by Professor Steve Eustace, one of our consultant interventional radiologists. Prof Eustace performs ultrasound-guided microwave ablation of these troublesome extra-abdominal desmoid lesions. Cappagh offers this service in-house and we are currently the only centre in the world in which it is provided. We are indeed very fortunate in Cappagh to have Prof Eustace who, following individualised patient case discussions, can plan this minimally invasive procedure. The actual technique is complex but only requires a light anaesthetic and an overnight stay – far less of an imposition on the patient

than if they should have had to undergo a full operation to remove the tumour. The follow-up with patients is similarly tightly controlled and, thus far, when their post-procedure MRI scans are taken, there has been an up to 59 per cent reduction in the size of the tumour. As a bonus, patients are less troubled by pain and discomfort and are delighted with the results. We have a number of potential patients on our waiting list for this procedure. This is an example of how Cappagh Hospital continues to strive to provide the best possible treatment for our patients, pioneering a treatment that might someday be used in all centres worldwide.

CONTACT INFORMATION

Despite the benign nature of extraabdominal desmoid lesions, they create a significant challenge to doctors.

Imaging Department Cappagh National Orthopaedic Hospital, Finglas, Dublin 11

Main Hospital Phone Number: +353 (0)1 8140 400

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UPPER LIMB SURGERY

RESTORING INDEPENDENCE UPPER LIMB CLINIC THE SHOULDER AND ARM ARE INTEGRAL TO INDEPENDENT LIVING. THE HEALTH OF THE UPPER-LIMB ENSURES THAT A PERSON CAN REMAIN ACTIVE WELL INTO THEIR RETIREMENT YEARS. MR DARRAGH HYNES TALKS THROUGH SOME OF THE WORK HE DOES AT CAPPAGH’S UPPER-LIMB CLINIC.

hese days, a large percentage of workers have what are known as ‘cubicle jobs’ – jobs where the worker spends the greater part of their day sitting at a desk, tapping away at a computer. This has led to an increase in people’s musculoskeletal frames being stuck in the crouched positions they adopt during their working day. On top of this, people are living longer and want to spend their golden years being active and enjoying life. As a result, care of musculoskeletal conditions of the upper limb is becoming an increasingly important area at Cappagh National Orthopaedic Hospital. Mr Darragh Hynes, upper-limb consultant at Cappagh, explains: “In the years past, when you were 65, many people decided ‘that’s it, sure, haven’t I had a great life?’ Now, when you are 65, you want to be active. You want to play on. There is an emerging population that’s living longer and wants to be active – it’s also important to keep these people active for their general health.”

Most of these patients have instability, i.e. the ball of the shoulder joint jumps out of place. Most times these patients require surgery, sometimes not. There are no typical cases, that much is clear. Every shoulder is different and every case is different. As Mr Hynes puts it: “We do different types of shoulder surgery depending on what the shoulder instability problem is, and what the needs of the patient are.” Aside from these more usual cases for an upper limb surgeon – rotator cuff tendinitis, arthritis, recurrent dislocations – Mr Hynes also runs a specialist clinic which deals exclusively with congenital upper-limb abnormalities.

THE CASES

The most common instances can include: partial absence of the limb due to amputation and failure of a portion of the limb to separate, leading to fused fingers and duplication – and resulting in extra digits. The clinic at Cappagh is unique among those that deal with congenital upper-limb cases as it is run with consultants from Temple Street Children’s University Hospital and Our Lady’s Children’s Hospital, Crumlin.

Mr Hynes’ purview covers everything from the nerves of the brachial plexus from the side of the neck to the tips of the fingers, and from the very young to the very old. A large part of his work in Cappagh is taken up with middle aged and older patients with degenerative condtions of the shoulder, including conditions of the rotator cuff tendons in the shoulder. As well as these older patients, the clinic deals with younger patients with sports related problems in their shoulder.

When a patient comes to Cappagh, they are seen by the three consultants; Mr Hynes and plastic surgeons Mr Kevin Cronin from Temple Street and Dr Patricia Eadie from Crumlin – as well as the Prosthetic and Orthotics Department, all together in the same room. According to Mr Hynes, Cappagh’s is the only clinic run along these lines, and he is quick to share the benefits: “It’s a one-stop shop. You are getting three opinions at the one

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time so the consensus is there. We have the discussion in front of the patients about what needs to be done.There are no nuances, and the parents and their child get clear advice and are encouraged to ask questions of the entire team.”

THE HIGH-TECH HUMAN TOUCH For shoulder care, says Mr Hynes, Cappagh has a huge advantage in its twin MRI scanners, purchased with funding from the Cappagh Trust team. He is keen to highlight the importance of these scanners to his work. They are integral to the diagnosis and treatment of a variety of shoulder and upper-limb conditions. Yet while much has been made of these machines and Cappagh’s imaging capabilities, Mr Hynes says they’re only a small part of what makes Cappagh such a successful centre for diagnostic imaging: “It’s not just the hardware. It’s actually

also, I would say, staff such as those in the imaging department. There’s no point in having the best machines if you don’t have the finest musculoskeletal radiologists to interpret them. What we have at Cappagh, personality-wise and expertise-wise, are the best you are going to get anywhere. They are very passionate about their service and they’re willing to engage on the clinical side. They see patients as people, not just images and scans.” This seems to be very much an ethos at the Cappagh upper-limb clinic – patients are people, and it’s not about treating the condition so much as getting the person back to a comfortable, pain-free, fully functioning life. Mr Hynes says that while other hospitals will engage in acute medical emergencies, that has never been what Cappagh is about. “In general, patients limp into Cappagh and walk or drive out. That’s

kind of the overall strategy here. You can’t use your arm, then you can use your arm afterwards. You are leaving independent and better able to get on with your life.” Mr Hynes specialises in shoulders, elbows and hands. After completion of his orthopaedic training in Dublin and Cork, he undertook speciality training with fellowships in Norwich, England and Buffalo, New York.

CONTACT INFORMATION Appointments Desk Phone: +353 (1) 8140 401/408 Fax: +353 (1) 814 0402 Clinics are run on an appointment basis. A referral from your general practitioner or a consultant from another hospital is required prior to receiving an appointment.

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FOOT AND ANKLE SURGERY

IMPROVING QUALITY OF LIFE MANY ORTHOPAEDIC SURGEONS BELIEVE THAT DESPITE THE FOOT AND ANKLE BEING ONE OF THE MOST IMPORTANT AREAS OF THE HUMAN BODY, IT IS ONE OF THOSE WE LOOK AFTER LEAST. MR ROBERT FLAVIN IS A CONSULTING FOOT AND ANKLE SURGEON AT CAPPAGH HOSPITAL AND IS PART OF A PROCESS THAT CAN MAKE A VAST IMPROVEMENT TO THE QUALITY OF LIFE OF PATIENTS.

oot and ankle surgery is one of the most delicate procedures undertaken on the human body, and it is also one that can immeasurably change the life of someone suffering with such a problem. Having recently being appointed to St Vincent’s University Hospital/Cappagh National Orthopaedic Hospital, Mr Robert Flavin has brought with him a number of new skills and technical abilities from his time working with some of the leading

authorities in the field of foot and ankle surgery during his time in the United States and Canada,

cent of women who were examined were found to have one of the most common forms of foot disorders: bunions.

NUMBER OF CASES

However, while being the most common form of disorder, bunion surgery is a very precise procedure that requires much preparation, as Mr Flavin explains: “When it comes to bunion surgery, there are a number of algorithms and mathematical equations to define what our target is and it has to be made clear to the patient

What may come as a surprise is that there is a high number of people who suffer from foot and ankle injuries or disorders who would never seek treatment for them. Studies on the prevalence of foot and ankle disorders by the American Orthopaedic Foot and Ankle Association found that 55 per

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that there isn’t just one operation to fix all bunions. It is a case of looking at two or three options and deciding which combination would be best suited to correct it.” With the help of Mr Flavin, Cappagh Hospital has a surgeon equipped with a high level of expertise in mathematics and bio-engineering. As a result, he developed a fascination with the complexity of the foot and ankle and their workings. At Cappagh, the most common problems presented to Mr Flavin and the staff involved with orthopaedics range from small to medium-sized operations such as deformity correction and bunion surgery, to more comprehensive surgeries such as ankle fusion and total ankle replacements. As the foot and ankle are such intricate and complex components of the human body, and unfortunately the surgery carries an inherently higher infection risk, keyhole

surgery is the usual course of action, where possible, when treating specific conditions. “A lot of the work I do at Cappagh is keyhole surgery in all joints around the foot and ankle,” explains Mr Flavin. “I also do a lot of fusions arthroscopically, to avoid large incisions. I also treat a lot of ankle sports injuries which can range from basic arthroscopic debridements to more complex ligament reconstruction of the ankle and deformity correction.”

TECHNOLOGICAL ADVANCES Thankfully, as with many areas of medicine, the speed at which the technology used to operate and treat patients is growing at an exponential rate. As Mr Flavin explains, some of the work that he is doing hopes to change how a patient is assessed and treated before surgery to tackle the problem head-on: “In UCD we run research and development investigating the use of computer modelling of the foot and ankle

and we’re embarking on a new era of surgical planning computer modelling. “That is why these are indeed exciting times in University College Dublin at the moment, where a lot of this technology is based, which can then be used for the patients in Cappagh. We’ve done a lot of research in total ankle replacement and in-depth analysis with total ankle surgeons and we recently presented all the work to the American Foot and Ankle Association.”

ROAD TO RECOVERY Cappagh is equipped with the latest equipment and technology for the treatment of some of the most severe or complex foot and ankle surgeries. Mr Flavin says he is thankful for the facilities that Cappagh Hospital has to offer and the change in a person’s life it can bring: “Cappagh has great facilities from a structural point of view.

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FOOT AND ANKLE SURGERY

55 per cent of women who were examined were found to have one of the most common forms of foot disorders: bunions.

“What many people may not realise is that the services we provide, whether undergoing ankle fusion or bunion surgery, can greatly impact a person’s quality of life because it can give them the ability to get walking again and getting fit – and thereby potentially reduce a person’s chances of developing diabetes and obesity, or helping to tackle them, as well as aid in cardiovascular rehabilitation programmes. This is of particular relevance to Ireland, and many other countries where we have an ever-increasingly ageing population.” However, foot or ankle surgery is not a quick fix. While the surgery procedure itself may only take a short time, the drastic change in a person’s ability to walk can take months before reaching the desired level. This, as Mr Flavin explains, is where the real healing process begins: “With ankle surgery, it tends to be, on average, 70 per cent surgery and 30 per cent rehabilitation.

With regard to rehabilitation, a number of factors are important from having a good instructor, to being well-motivated, as the patient has to be mentally and physically fit for surgery. I would deem a surgery a failure if the patient doesn’t make an 80 per cent recovery. That is why I believe that physiotherapy is a major part of my practice and I work very closely with a number of physiotherapists in Dublin who can then contact me at any time with questions about the patient.” Recovery times can vary between patients, but on average the recovery time for 7580 per cent of patients ranges between six to 12 months, with another 10 to 15 per cent taking longer. Despite having the best of care available to patients in Cappagh Hospital, Mr Flavin advises patients to take care of one of the most under-valued parts of our body: “The foot or ankle is such a complex part of the body, anybody undergoing foot and ankle surgery must know that it takes a while to get used to the

corrected foot/ankle after surgery. ‘I do not make feet normal, I make them better’: that is the standard message to all my patients and I endeavour to ensure all my patients understand this prior to consenting for any surgical procedure. It can be considered one of the most important parts of the body, but one of the parts that we look after least.”

CONTACT INFORMATION Cappagh National Orthopaedic Hospital, Finglas, Dublin11 Main Hospital Phone Number: +353 (0)1 8140 400 Clinics are run on an appointment basis. A referral from your general practitioner or a consultant from another hospital is required prior to receiving an appointment.

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JOINT REGISTER

INNOVATION AT WORK CAPPAGH HOSPITAL HAS OPERATED AN ORTHOPAEDIC JOINT REGISTER SINCE 2005. MR PADDY KENNY, CONSULTANT ORTHOPAEDIC SURGEON, EXPLAINS THE BENEFITS OF THE SYSTEM AND HOW THE REGISTER AT CAPPAGH HAS CONTRIBUTED TO THE ESTABLISHMENT OF A NATIONAL REGISTER.

appagh National Orthopaedic Hospital opened a joint register clinic in 2005, which provides a review for all patients of primary and revision hip and knee replacements. These reviews are conducted postoperatively after six months, two years and five years. The hospital currently holds up to seven years of data. According to Arthritis Ireland, there are over 915,000 people in the country who suffer from the condition. The condition accounts for 30 per cent of all visits to GPs. “A significant majority of patients suffer from the less severe osteoarthritis, which can be managed with lifestyle change and pain medication.

However, joint replacement surgery has been shown to be the most effective intervention in alleviating the pain and disability suffered by those who present with more severe forms of osteoarthritis,” says Mr Paddy Kenny. The joint register dealt with 2,796 cases in 2011, up from 1,759 in 2010. The register’s objective is to provide a lifelong review for all patients following both primary and revision hip and knee replacements. Its goal is to effectively monitor the performance of the prostheses (implant) used during the operation and to measure outcomes. The clinical service is nurse-led and aims to

undertake reviews at six months, two years and five years. The first five-year clinics commenced operation in 2010, assessing the 400 patients who underwent procedures in 2005. The clinic is dependent on the active cooperation of all departments within the hospital. As the amount of data collected by the register has expanded, so too has the demand for the output of clinical information which relates to arthroplasty surgery at Cappagh Hospital. To date 7,000 separate events have been recorded. The register is staffed by a full-time secretary and part-time nurse.

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JOINT REGISTER CAPPAGH’S CONTRIBUTION TO A NATIONAL ORTHOPAEDIC REGISTER Perhaps the most beneficial single achievement of the joint register at Cappagh is that consequent to the availability of these statistics, a national project aimed at developing a joint register which reflects nationwide activity based on the Cappagh model is being developed. “The Irish Institute of Trauma and Orthopaedic Surgeons (IITOS) has championed the introduction of an Irish National Orthopaedic Register (INOR) for many years. The efforts of the institute are finally bearing some fruit under the clinical direction of Mr David Moore, Mr Connor Greene and myself, with IITOS, the Department of Health and the HSE on the verge of launching a workable system,” says Mr Kenny. “The register will define the epidemiology of joint replacement surgery in Ireland, provide timely information on outcomes of joint replacements and identify the risk factors which could lead to a poor outcome. The INOR will also provide the procedures and information technology to support the capture of joint replacement data and patient outcome information in a national repository. “The INOR will use patient-reported outcome measures (PROMs), adverse incident recording systems and surgical revision rates to monitor implant performance and patient outcome. This will provide continuous feedback to participating centres and surgeons, enabling the early detection of poorly performing or optimally performing implants, as well as identifying suboptimal pre-operative, peri-operative and post-operative surgeons and centre performances. “Through the process of audit, and improvement, this data will be used in a number of different ways: to reduce surgical revision rates, to optimise the pre-operative, peri-operative and postoperative processes; to enable early detection and to review at-risk groups, to reduce the cost of service provision, to increase patient safety and confidence and to improve overall experience, and to provide orthopaedic surgeons with the opportunity to participate in and contribute to any measurable clinical audit.”

CAPPAGH Hospital

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SPINAL SURGERY

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SPINAL SURGERY

SPINAL SURGERY MR KEITH SYNNOTT, CONSULTANT ORTHOPAEDIC SPINAL SURGEON AT CAPPAGH HOSPITAL, SPEAKS ABOUT HIS WORK AT THE HOSPITAL AND THE INTER-DEPARTMENTAL CO-OPERATION THAT ENHANCES PATIENT CARE AT THE HOSPITAL.

pinal problems are very common in the population. It is estimated that 80 per cent of people will suffer from back pain at some time during their lifetime. This is probably an inevitable consequence of the evolutionary decision to stand upright and free our hands for complex tasks. Back pain is one of the most common reasons for patients to consult doctors as a result. The function of the spine is to provide stability while facilitating motion and protecting the spinal cord and nerves. To achieve this requires the complex interaction of many elements – bones, joints, discs, tendons, ligaments and muscles. Spinal disease can result from problems with any of these structures, usually in combination and potentially with resultant dysfunction of the spinal cord or nerves. The vast majority of spinal problems are self-limiting and will settle on their own. For those that don’t, the approach to diagnosing and treating the complaint is multidisciplinary. A history and clinical examination will often reassure that there is no significant pathology and frequently physical rehabilitation is all that is required to address the problem. The physiotherapy and MSK team in Cappagh are expert in this management approach. If that fails then it might be necessary to investigate further, often with advanced imaging modalities such as MRI. Again, Cappagh is fortunate to have two MRI scanners and an experienced team to help further investigate these patients. In a small number of patients physical therapy is not sufficient to manage

their problem. In this case it might be necessary to use specific injections to address inflammation to provide pain relief. These injections can be done by the radiology or surgical teams. It is often useful for these teams to liaise in such cases and here again, the multidisciplinary team approach in Cappagh is a great benefit. Far less frequently, surgery is required to treat spinal problems. This may be because of the need to relieve pressure on the spinal cord or nerves as a result of disc prolapse or arthritis of the joints of the spine. It may be because of spinal instability caused by the relative failure of arthritic joints. Occasionally, patients may have spinal deformity as a result of conditions like scoliosis or degenerative conditions that require correction and stabilisation. While it is somewhat controversial, there are cases where back pain caused by degenerative discs can be treated with surgery. The surgeons in Cappagh frequently carry out these operations. There are certain very acute spinal conditions that require urgent surgery. These include situations where patients are in danger of paralysis perhaps as a result of a fracture, cancer or infections or occasionally very large prolapsed discs. The urgent nature of these conditions mean that they often present to emergency departments rather than to elective hospitals like Cappagh. One of the problems with surgery for spinal conditions is that the operation itself is often very invasive. In some cases the effect of the operation can be greater than the problem itself! For this

reason, many less-invasive techniques have been developed. Where appropriate, these procedures are carried out. Some of these procedures are carried out in the X-ray department but it is important when doing these procedures that the facilities exist to convert the procedure to a traditional operation if the need arises. This is another example of the value of a team approach on these often challenging situations. Cappagh National Orthopaedic Hospital is very fortunate to have all the elements of the team that is necessary to look after spinal problems. None of these elements can work indepentently and the size of the hospital allows an excellent working relationship to be developed. Combination treatment is often required and it may be necessary to change treatment as conditions progress. Cappagh is well placed to meet these needs.

CONTACT INFORMATION Orthopaedics Department Cappagh National Orthopaedic Hospital, Finglas, Dublin11 Main Hospital Phone Number: +353 (0)1 8140 400 Fax Number: +353 (0)1 8140 327 Clinics are run on an appointment basis. A referral from your general practitioner or a consultant from another hospital is required prior to receiving an appointment.

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RHEUMATOLOGY

EXCELLENCE IN RHEUMATOLOGICAL CARE PROFESSOR GERALDINE MCCARTHY, CONSULTANT RHEUMATOLOGIST AT CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, SAYS THAT THE HOSPITAL IS IDEALLY SUITED FOR PATIENTS PRESENTING WITH RHEUMATOLOGY-RELATED CONDITIONS IN AN OUTPATIENT SETTING.

“I

’ve worked here at Cappagh Hospital as a consultant rheumatologist since 1999, to offer a multidisciplinary rheumatology service. Our patients can either be referred by orthopaedic surgeons within Cappagh Hospital or by other methods of referral, such as general practitioners,” says Prof McCarthy. The rheumatology clinic at the hospital is an outpatient service but consultants can also advise on in-patient cases where relevant. Rheumatology covers a wide range of connective tissue disorders. The prevalent conditions presenting at the hospital are typically variants of osteoarthritis, rheumatoid arthritis and other forms of inflammatory arthritis such as ankylosing spondylitis. Other conditions presenting include gout and other crystal deposition diseases causing arthritis. Rheumatoid arthritis is recognised as one of the most common causes of potentially treatable disability in western countries. It is now known that the earlier patients are treated, the sooner they will achieve disease control and thus joint damage, deformity and d sisability can be prevented. In addition, osteoporosis can be diagnosed and treated through our service. Cappagh National Orthopaedic Hospital offers assessment of patients with suspected rheumatology conditions including early assessments, a full multidisciplinary programme and access to all available therapies at the hospital.

The clinic can also provide advice on the following: • An opportunity to discuss pain and recognise factors and activities which increase pain, and assist in identifying methods which alleviate pain and discomfort. • Prescribed medication and medication reviews. • Advice on the relationship between rest, exercise, relaxation, posture and its link to pain prevention and pain relief. • Pain relief modalities e.g. injection therapy, acupuncture and self help strategies. • Advice on joint protection and the benefits of exercise to maintain and enhance mobility/function. • Information and support in relation to the nature of the disease progression, how this may affect lifestyle and the longer-term management of rheumatic conditions. • Education on how to identify symptoms relating to the person’s particular disease and how to manage any exacerbation of a rheumatologic condition. • Advice on good foot care and the benefits of wearing well fitting footwear, with assessment of gait and provision of orthotic insoles (biomechanics), where appropriate. • The opportunity to discuss any fears and anxieties relating to condition and health care. • Advice on the use of special equipment to assist with activities of daily living. “Cappagh Hospital is a very efficient facility for patients, and in terms of rheumatology,

the most important complementary facility for our patients is the Radiology Department. “At Cappagh the imaging technology is world-class, using the very latest technology. They can carry out imageguided injections, which is extremely important for our patients. “We would work extremely closely with them and the hospital is ideally suited to providing results for our patients,” says Prof McCarthy. At Cappagh Hospital, patient focus in the provision of rheumatology services is paramount and the hospital’s facilities are geared towards providing as early as possible detection and appropriate treatments to patients.

CONTACT INFORMATION Outpatient Clinic Cappagh National Orthopaedic Hospital Finglas, Dublin 11 Main Hospital: +353 (0)1 8140 400 Fax Number: +353 (0)1 8140 327 Email: feedback@cappagh.ie Clinics are run on an appointment basis. A referral from your general practitioner or a consultant from another hospital is required prior to receiving an appointment.

CAPPAGH Hospital

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PAEDIATRICS

DEDICATED TO CARE FROM SURGICAL PROCEDURES TO UNRIVALLED NURSING CARE IN A DEDICATED PAEDIATRIC SETTING, CAPPAGH HOSPITAL IS IDEAL FOR TREATING CHILDREN AND YOUNG ADULTS, OFFERING CONTINUITY AND STABILITY DURING THE COURSE OF TREATMENT.

“I

would treat children from as young as three or four years of age at Cappagh,” says Noelle Cassidy, Consultant Paediatric Orthopaedic Surgeon, who has worked at the hospital since 2004. “Frequently it would be children suffering from cerebral palsy in addition to a variety of other conditions.” At Cappagh Hospital, younger patients undergo a variety of tests to diagnose and treat musculoskeletal conditions. “Cappagh Hospital has a well deserved reputation for excellence in terms of its imaging capability, coupled with excellent radiological staff.”

patients with long-term needs, ensuring longterm treatment where necessary. In addition to paediatric surgery cases, Cappagh Hospital is noted for the expert diagnosis, care and surgical treatment of bone and soft tissue tumours in children, teens and young adults.

PAEDIATRIC LIAISON DEPARTMENT

Staff at Cappagh work exceptionally hard to make patients and their families feel comfortable in the hospital, which is critically important. The Paediatric Liaison Department was established to take care of children and their particular needs during their time in hospital. The liaison service starts prior to a SURGICAL & NURSING child’s day of surgery. The liaison nurse will EXCELLENCE contact the child’s parents and do a telephone “At Cappagh, we are very fortunate with triage. The patient can meet with a member the very good quality of the nursing and of the paediatric liaison team and discuss any the support that they give to each patient,” particular requirements which they may have. adds Noelle. “We have core of personnel This is especially beneficial for addressing any who establish a rapport with the patients concerns which parents or guardians may have, throughout their treatment and their in addition to addressing the specific needs of expertise is fundamental to the success of the each particular patient. hospital.” The staff at Cappagh understand the dynamics of paediatric cases – including The paediatric nurse specialist is available from their growth and developmental stages – and Monday to Friday from 7.45am to 5:15pm to their approach to surgeries and rehabilitation discuss any queries if they do not meet with is always age-appropriate. Cappagh Hospital the patient and their parents/guardians prior to also offers continuity of care for complex surgery.

During the term of their stay at Cappagh, children are nursed on St Paul’s Ward, which is dedicated to paediatric cases. For children attending the hospital as day cases there is also a dedicated area within the day ward where the paediatric nurse can work with patients post-surgery. At all times in the ward, the paediatric nurse will work alongside the family and the patient to ensure excellent quality of care and also work and liaise with other relevant departments on behalf of the patient, such as occupational therapy and the relevant personnel in preparation for the patient returning home.

CONTACT INFORMATION Ms Margaret Phillips CNS – Paediatric/Adolescent Liaison Email: mags.phillips@cappagh.ie Ms Bairbre Webb O’Maolagáin CNS – Paediatric/Adolescent Liaison Email: bairbre.webb@cappagh.ie Phone: +353 (1) 8140 468

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HIP REPLACEMENT

HIP REPLACEMENT SURGERY

HIP REPLACEMENT SURGERY IS GENERALLY CONDUCTED TO RELIEVE ARTHRITIC PAIN AND IS CURRENTLY THE MOST COMMON ORTHOPAEDIC SURGERY PERFORMED.

TOTAL HIP REPLACEMENT A total hip replacement is an operation designed to replace a hip joint which has been damaged, usually by arthritis. The hip joint is a ball and socket joint. The ball is formed at the head of the thigh bone and fits snugly into the socket in the pelvis. The surface of the bones in the joint are coated by a smooth and compressible substance known as gristle or articular cartilage. Arthritis occurs when this cartilage wears away, exposing the underlying bone. This causes roughening and distortion of the joint, resulting in painful and restricted movement. A limp will often develop and the leg may become wasted and shortened. In a healthy hip, smooth cartilage covers the ends of the thighbone and allows the ball to glide easily inside the socket. In a

problem hip, the worn cartilage no longer serves as a cushion and as the roughened bones rub together they become irregular, creating a surface like sandpaper. The ball grinds in the socket upon leg movement, causing pain and stiffness.

PRE-OPERATIVE ASSESSMENT

Osteoarthritis of the hip is generally a disease suffered by the older person but may occur in younger people following rheumatoid arthritis, fractures of the hip or other rare conditions. Depending PROSTHESIS on the patient and the cause of the hip During hip replacement surgery the worn degeneration, pre-operative assessment head of the femur is replaced with a clinics may be necessary. The pre-operative stainless steel ball mounted on a stem and assessment clinic evaluates a patient’s the socket is re-lined with a cup made with suitability for joint replacement. This special plastic-polyethylene. involves blood tests, X-rays and a full medical examination. Physiotherapists These parts connect to create an artificial and occupational therapists are on site hip and are usually fixed to the bone by a to demonstrate pre- and post-operative type of cement called methyl methacrylate. exercises and to explain necessary safety In special cases other types of stems requirements in the patient’s home.Once may be used. Once healed, the smooth an assessment has been made, patients surfaces of the new joint aim to relieve who are suitable for surgery will be called pain, decrease stiffness and, in most cases, for operation within a few weeks from the restores leg length, improving mobility. time of assessment.

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SPORTS AND EXERCISE MEDICINE

COMMANDING

the FIELD

THE SPORTS MEDICINE CLINIC AT CAPPAGH IS ESTABLISHED AS A CENTRE OF EXCELLENCE FOR THE DIAGNOSIS AND TREATMENT OF SPORTS INJURIES AND CONDITIONS. COUPLED WITH CAPPAGH’S IMAGING ARRAY, IT IS THE HOSPITAL OF CHOICE FOR SPORTING PROFESSIONALS, DEDICATED AMATEURS AND FITNESS ENTHUSIASTS.

LEADER IN ITS FIELD Dr Pat O’Neill and Dr Noel McCaffrey both have over 20 years’ experience in the field of sports medicine. Working as sports medicine consultants in Cappagh Hospital they have been instrumental in making Cappagh one of the most advanced units of its kind in the country. The field of sports medicine is wide and varied, encompassing the musculoskeletal, orthopaedics and cardiovascular disciplines. Advancements in this field in terms of available technology and recommended treatments is rapid. For example, arthroscopic, minimally invasive surgery of the hip joint is now carried out at Cappagh using image guidance technology, leading to reduced recovery time for the patient. Shoulder surgery and spinal cases also present regularly at the clinic and they do regularly require surgery. The equipment at Cappagh is among the most advanced available anywhere, as Dr O’Neill explains: “We are able to carry out assessments and investigations using sophisticated diagnostic imaging and have two MRI scanners, one of which is a 3-Tesla MRI scanner which is optimum for assessing and diagnosing sports injuries. At Cappagh Hospital we have specialty surgeons for the various orthopaedic disciplines. In terms of percentages, approximately 10-20 per cent of injuries require surgery, which means that there is a large percentage that requires assessment and non-surgical treatment such as physiotherapy, rehabilitation

exercise therapy and other treatments.” Cappagh has strong support from ancillary services to ensure that patients receive the very best rehabilitation treatments.

PATIENT CARE Like every other department in Cappagh Hospital, the sports medicine clinic is oriented towards excellence in patient care and ease of access to treatment. “The clinic is much more established now,” explains Dr Noel McCaffrey. “It provides rapid access to treatments and is relatively inexpensive. Patient access to the clinic is via GP or physiotherapist referral. In some cases we can assess and provide treatment on the same day. The clinic has good interdepartmental links within the hospital so our patients can be assessed using the imaging department and further treatment or assessment can be done in the Physiotherapy Department, for example.” Dr McCaffrey explains that the clinic sees a wide range of injuries from those involved in professional sport, and also amateur enthusiasts. “It’s a mixture of elite and non-elite cases presenting with a variety of problems.” Regardless of the calibre of athlete presenting to Cappagh, recovery time is a major concern for all patients. Early diagnosis and treatment can mean a significant difference to post-operative recovery. The support services available at Cappagh such as intensive physiotherapy also go a long way to aid a swift recovery.

THE FUTURE LOOKS BRIGHT Orthopaedic surgery is an area which is progressing rapidly, with less invasive treatments continuously being pioneered. With the assistance of robotics and the advent of interventional radiology the area will continue to improve and evolve. Cappagh is at the forefront of this and is eager to remain the leader in the field. As such it has one of the most advanced training centres for undergraduate and postgraduate sport medicine students in the country. Keeping abreast with the up and coming ensures that Cappagh will continue to pave

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SPORTS AND EXERCISE MEDICINE

The equipment at Cappagh is among the most advanced available anywhere

the way to less invasive and more innovative treatments. Dr O’Neill asserts that working with the students is one of the most rewarding aspects of his work at Cappagh Hospital. “We want to educate other health care professionals and doctors, which is why we have fostered strong links with the various universities. Professor John O’Byrne of the Orthopaedic Centre has expanded the educational side of things for both undergraduate and postgraduate medical and allied medical professionals.” Cappagh has excellent educational facilities including a sophisticated auditorium and a dedicated tutorial room located in the professional unit.

Interest in sports medicine has always been high among undergraduate students and Cappagh is very happy to foster and lend its support to the universities when it comes to clinical, research-based and undergraduate training. Dr McCaffrey explains that there is also scope for developing co-supporting structures between Cappagh Hospital and DCU to develop a research and rehabilitation centre for musculoskeletal injuries. Cappagh Hospital is not only a high-tech facility but also a place of healing and recovery. Both Dr O’Neill and Dr McCaffrey

stipulate that Cappagh provides a unique and tranquil atmosphere which is conducive to a swift and comfortable recovery. “It’s a particularly friendly hospital as it doesn’t have the hustle and bustle that you would find in a bigger general or community hospital.”

CONTACT INFORMATION Outpatients Clinic Appointments Desk Phone: +353 (1) 8140 401/408 Fax: +353 (1) 814 0402

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SURGICAL PRE-ASSESSMENT

FIT FOR PURPOSE DR CORMAC REDAHAN, CONSULTANT ANAESTHETIST, EXPLAINS HOW CAPPAGH’S PRE-ASSESSMENT CLINIC WORKS.

he preoperative clinic was set up back in 1996. Its aim was to prepare patients for their surgery, explain to them what was involved in their hospital stay and identify medical issues which needed to be addressed that otherwise would have delayed their admission to the hospital. Since then the clinic has expanded and now has a multidisciplinary team approach consisting of nursing staff, physiotherapists, occupational therapists and anaesthetists, with the availability of social workers and surgeons should they be needed. Due to the nature of a lot of the work we do in Cappagh, our patients tend to be elderly and this group of patients present with a unique set of medical problems. What exactly does the preoperative assessment involve? When people arrive for their appointment they are seen by a member of the nursing staff, they have a visit with our phsiotherapist and occcupational therapists and have blood drawn, an ECG and X-rays appropriate to their procedure. They also will meet a doctor from the Department of Anaesthesia. However, a lot of the work has begun well before their visit to the hospital. Approximately two weeks prior to their visit the nursing staff will ring and go through a questionnaire with them, identifying what medical problems they have, what hospitals they have attended. Based on this we send off for their notes from other hospitals

so that they are available to us on the day they attend the clinic. This process is designed to streamline their admission to the hospital when they eventually come for surgery. The success of the clinic is due to the hard work done by the nursing staff. While the doctors attend the clinics on a daily basis and dictate their findings, the nursing staff are constantly going through the charts, updating files, notes and blood results. They are keeping in touch with the patients, updating them on developments and informing them of appointments made. The nursing staff are the powerhouse behind the clinic. Even though the clinic is efficent there is always room for improvement. The recent development of triaging the patient over the telephone and changes to our admission policy to admission on the day of surgery has improved our efficency both at the clinic and for the hospital itself.

CONTACT INFORMATION Ms Sandra O’Donovan Clinical Nurse Manager II Phone: +353 (1) 8140 407 Fax: +353 (1) 8140 378 Email: sandra.odonovan@cappagh.ie

HOURS OF SERVICE Monday – Friday: 9.00am – 4.00pm

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MUSCULOSKELETAL TRIAGE

MUSCULOSKELETAL TRIAGE SERVICE CAPPAGH HOSPITAL’S CHARTERED PHYSIOTHERAPISTS ARE A BUSY TEAM, BUT NEW INITIATIVES AND INNOVATIONS SUCH AS A MUSCULOSKELETAL TRIAGE SERVICE MEAN THAT WAITING TIMES AND LENGTH OF STAY HAVE BEEN REDUCED.

t Cappagh Hospital we are lucky to have a team of very experienced chartered physiotherapists working in different areas such as orthopaedic inpatients and out-patients, pre-assessment clinics and the Active Rehabilitation Unit for older people, alongside our consultant colleagues in musculoskeletal triage and sports medicine clinics, and in physiotherapy-led post-operative review clinics. The orthopaedic service is very busy as we continually strive to reduce the length of stay for patients in our hospital without compromising the quality of care and rehabilitation they receive. This year, nearly two thirds of patients undergoing total hip replacement and one third of patients undergoing total knee replacement completed their physiotherapy within just four days of admission to hospital. Reducing length of stay has obvious cost benefits to the hospital, but we understand that patients often need reassurance and further help when they

go home, so physiotherapists in our out-patient service host regular group sessions for these patients where they can ask questions, talk to other people who have had the same surgery and continue their rehabilitation programme supervised by a chartered physiotherapist. This year, one of our senior physiotherapists developed a physiotherapy-led post-operative review service for patients undergoing certain types of shoulder surgery. This has freed up space in the consultant’s out-patient clinic, allowing him to see more new patients and concentrate on those with more complicated conditions. The patients benefit by accessing physiotherapy sooner, without the need to attend the consultant first to be referred for physiotherapy. The musculoskeletal triage service is now three years in operation. Nearly 2,400 patients on a waiting list to see an orthopaedic surgeon or a rheumatologist have been assessed instead by clinical specialist physiotherapists and referred for appropriate treatment. There is no

waiting list for this service and patients are therefore seen very quickly. The benefits to Cappagh are reduced waiting lists, more efficient and effective use of healthcare resources and better patient satisfaction. The Active Rehabilitation Unit celebrated its first year in operation in October 2012. Older people admitted to an acute hospital can be referred to this service for intensive rehabilitation with a view to returning home. The unit has been very successful – to date, 93 per cent have gained a significant improvement in their function and 76 per cent of patients have successfully returned home. Physiotherapy staff on this unit presented their research findings at the Irish Gerontological Society’s conference in Dublin (September 2013) and at the Irish Society of Chartered Physiotherapists’ Conference in Killarney (November 2013). New services this year include injection therapy; two clinical specialists have been trained to administer injections for certain musculoskeletal conditions and this will further assist our medical colleagues in their busy out-patient clinics.

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PATIENT THERAPY

GOING HOME & AFTERCARE ALTHOUGH CAPPAGH IS IN MANY WAYS A ‘HOME FROM HOME’, EVERYONE LONGS FOR THEIR OWN HOME, THEIR OWN BED AND TO RETURN TO NORMAL LIFE, WRITES FIONA ARMSTRONG, OCCUPATIONAL THERAPY MANAGER AT CAPPAGH HOSPITAL.

ollowing your surgery and rehabilitation in Cappagh Hospital you will be discharged home. In order to be discharged you need to have achieved a certain level of competence in certain activities all required for managing activities of everyday life. The Physiotherapy Department will work with you until you have reached a certain range of movement in specific

joints, until you are to walk up and down stairs and are able to carry out your home exercise programme. The occupational therapy team will have coached you in bed transfers ensuring independence, practised dressing with assistive devices if required, advised you on kitchen tasks and discussed managing in the bathroom. The occupational therapist will also have advised you on any specialised equipment required for your home following the surgery. The nursing staff

will have organised your wound review and removal of stitches if required, ensured that prescriptions are ready if required, and notified outpatients of your need for follow-up appointment with your consultant. The medical social worker will have met with you to discuss further rehabilitation or convalescence if this is necessary or to assess your need for support services in your community if you are going

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PATIENT THERAPY directly home from hospital. You will have discussed managing at home following your surgery, with all of the members of the rehabilitation team. You will be leaving Cappagh with a positive future and an ability to achieve a better quality of life. This is a wonderful but daunting feeling. Each person will vary in how quickly they recover and regain their mobility, however, patients returning home from any joint replacement surgery can expect to need the help and support of family, friends and/ or an outside agency for a period of time after their surgery. When you were assessed at the preoperative clinic you would have discussed returning home with the various members of the team. If you have any concerns, particularly about returning home after surgery, a referral will be made to the medical social worker who will either contact you prior to your admission for surgery or see you in Cappagh when you are admitted. You will have received much information about the surgery and your recovery and you are now at the stage of returning home with your new joint. The nurses, physiotherapists, occupational therapists and medical social worker have extensive experience of people having this type of surgery, and they will do their best to reassure you and answer any questions you have about your recovery. The physiotherapists and occupational therapists will refer you to your local health centre for further rehabilitation if required. The medical social worker is also available to meet with you if you have any concerns about other issues in your life which you feel may impact on your recovery, as at Cappagh we view the patient in a holistic manner. Once you have returned home and have settled back into your normal routine you may have questions about aspects of your recovery. Cappagh Hospital rehabilitation team are available for any queries and concerns and are always happy to talk to you if you have concerns. You can call the ward you were staying on or call the physiotherapist or occupational therapist directly. The contact numbers are available in the booklet you will have received from the hospital. Each person discharged from Cappagh has a referral letter sent to their general practitioner (GP) advising them of the reason for the inpatient stay in

Cappagh. On some occasions we may notify your local public health nurse (PHN) that you have been an inpatient and have now returned home. You will be reviewed by your consultant between six and eight weeks after your surgery and this appointment will be sent to you by post. You will also be offered a review appointment with the physiotherapist and a phone review by the occupational therapist. You will also be invited back to the joint register where you will meet with a nurse and discuss how you are managing from six months after your surgery. The joint register will also contact you at 12 months, 24 months and 60 months post operation. If at any stage you are unsure about something related to your surgery we welcome your call and we will do our best to assist your query. The aim of the surgery

is to improve your independence and your level of function, resulting in an increased quality of life. We are all working together towards active independence.

CONTACT INFORMATION Cappagh Hospital 01 834 1211 Occupational Therapy 01 814 0429 Physiotherapy 01 814 0462 Medical Social Work 01 814 0325 Nursing Administration 01 814 0469

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ACTIVE REHABILITATION

GAINING INDEPENDENCE WITH

PROGRESSIVE REHABILITATION

CAPPAGH HOSPITAL’S ACTIVE REHABILITATION UNIT HAS BEEN OPEN SINCE OCTOBER 2012 AND IS RESPONSIBLE FOR THE CARE AND INTENSIVE REHABILITATION OF PATIENTS OVER THE AGE OF 65 WHO ARE RECOVERING FROM A RANGE OF MEDICAL CRISES.

atients are admitted to the Active Rehabilitation Unit for a maximum stay of 42 days, generally after release from an acute hospital. At the unit, they undergo holistic therapy to facilitate their return home; to enable them to live independently again. Professor Dermot Power is the lead consultant for the Active Rehabilitation Unit, which has grown from 20 to 36 beds since it opened last year and now employs 25 staff. A graduate of medicine from UCD, Prof Power is also a consultant in geriatric medicine at the Mater Misericordiae Hospital in Dublin and is Medical Director of St Mary’s Hospital, Phoenix Park, Dublin. As Prof Power explains, the type of treatment in this facility is progressive: “The manner in which the patient is dealt with is respectful, and we take a holistic approach to their treatment and care. It’s all about enabling people to cope independently. So philosophically it’s about getting people fit for home, and that involves getting them up out of bed, into their clothes, and not treating it as if it’s a hospital. It’s all about trying to make them feel like it’s a stepping stone to home rather than to another hospital.” The response of patients to the treatment has been remarkable, with the unit boasting discharge rates of between 70 and 80 per cent. Prof Power attributes their success to the staff: “They’ve managed to create something

from nothing; the unit wasn’t here this time last year. So there’s a group with a good atmosphere and a common good sense of purpose.”

A NEW INITIATIVE The introduction of the unit is an entirely new initiative for the hospital and has been meticulously planned and implemented into St Mary’s Ward. As Yvonne Doran, Manager of the newly built Active Rehabilitation Unit explains: “We’ve had to learn a lot and change our mindset. The rest of Cappagh Hospital is geared towards elective orthopaedic surgery, but this is very much medical rather than surgery-based treatment. We take a multi-disciplinary team (MDT) approach. The team comprises of four physiotherapists, a physiotherapy assistant, three occupational therapists (OTs), an OTs’ assistant, a social worker and our own pharmacist. We also have registrars, senior house officers (SHOs) and our medical interns as well, and they all work exclusively in this ward.” During the week, a typical day starts at 7am and maintaining a normal routine and atmosphere in the ward is an integral part of the rehabilitation process. “They would be assisted in what we would call their ADLs (activities of daily living), their washing and dressing. “They’re encouraged to change into their day clothes rather than remain

in their pyjamas. Patients attend daily physiotherapy sessions and the OTs assess them individually in terms of their ability to wash and dress themselves independently. “As they improve, the patient progresses to a purpose-built kitchen to see how they manage making a cup of tea or boiling a pot of water for food preparation at home,” explains Yvonne. Patients undergo daily therapy and treatments administrated by a multitude of staff members. Fiona Armstrong is the Occupational Therapy Manager of the Active Rehabilitation Unit and explains that a proactive and integrated approach is taken when treating patients. “We talk to the patients to find out what is normal for them, who they live with, whether they live upstairs, downstairs or on ground level. Then we work out a programme of activities so they gradually build up their abilities until they’re back at the level they need to be at in order to return home.” Fiona oversees the different therapies that are conducted in the ward, and while the majority of activity is physical, a cognitive approach is essential in the on-going treatment of patients: “If they have memory or perceptual deficits, we would assess that. For example, if you look out the window you might see a tree that is far away, whereas a person with perceptual deficits will have difficulty accurately judging distances.

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ACTIVE REHABILITATION

So we work on their memory, their sequencing, and their ability to follow instructions,” she says.

THE SOCIAL ELEMENT An important aspect of Cappagh Hospital’s rehabilitation programme is the social element of the treatment, as Fiona elaborates. “It’s something that breaks up the day. Their meal isn’t brought to their bedside, they have to get up and walk into the dining room. So they’re aware of time, they’re aware of their need to eat, they interact with everyone around them, they remember names – which works on their memory as well. They have the ability to follow directions from the ward to the dining room, and to orientate themselves topographically, which deals with the mapping of the brain. These are all things we take for granted, but if you’ve been very ill, all these skills have been compromised and you have to get yourself into doing them again.”

Educational fall classes are provided to help reduce the risk of an incident. “We do two types of classes: what to do in the event of a fall and general safety and awareness; how to prevent it from happening in the first place. We teach patients how to stand up slowly from the chair and steady yourself before you would start walking forward. We also demonstrate what to do in the event of a fall – how to get yourself off the floor, how to get up to a sitting position

and then gradually count to 10 and take it slowly before you attempt to stand up.” Home visits play an important role in ensuring that all preventative measures are in place and a safe, liveable environment awaits the patient returning home. “We check whether there are mats on the floor that need to be picked up to make it safer; are there pets that might add to the risk of a fall, is the phone easily accessible, is there adequate light, are heating controls within reach – all the little things that we take for granted,” concludes Fiona.

PATIENT FEEDBACK The staff conducted a focus group with the patients to gain a valuable insight into how they’re reacting to the treatment. It is apparent, judging by a direct quote from one of the patients, that the time and effort put into quality of care by staff in the Active Rehabilitation Unit is exceptional: “She got me to think about myself once again. I wasn’t bothered about, let’s say, putting cream on my face or combing my hair out properly, but she kept at me to think about doing myself up and try to be a personality again. Which was great because I’m kind of doing everything again now. I can get out of the bed, and into the bed, and onto the toilet and off again without any assistance. Which is a lot when you have lost a limb.”

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OCCUPATIONAL THERAPY

CENTRE FOR ACTIVE INDEPENDENCE OCCUPATIONAL THERAPY IN CAPPAGH HOSPITAL IS THE OLDEST OCCUPATIONAL THERAPY SERVICE IN IRELAND. IN 1959 THE SISTERS OF CHARITY HAD THE FORESIGHT TO EMPLOY AN OCCUPATIONAL THERAPIST AND THE SERVICE WAS BORN, WRITES FIONA ARMSTRONG.

ccupational therapy is a profession concerned with promoting health and wellbeing through occupation. Occupational therapists have historically worked with patients in the medical system to not only assist in the recovery from illness and injury but also to facilitate the development of or return to meaningful roles and activities that have been disrupted due to chronic illness or disability. In today’s health service which is under increasing pressure to provide effective and efficient care, occupational therapy is core to the wellness of the individual.

Occupation is at the heart of every individual in every aspect of life from the simple task of brushing our hair to

the complex activity of managing our finances. Occupational therapy is assisting each client to maximise their level of functioning to fulfil each of the roles they have set in their lives. Occupational therapy gives individuals the keys to independence. In Cappagh Hospital, occupational therapy aims for active independence for all of our clients. This goal is achieved through training and education of our clients in all aspects of their lives to enable competent performance of all required tasks.

DEVELOPING THE SERVICE In Cappagh Hospital the occupational therapy service continues to develop and includes a specialised hand therapy service, educational DVDs for patients having total hip and total knee

replacement surgeries and educational booklets for patients having total hip, knee and elbow replacement surgeries. The occupational therapists offer assessment and treatments to patients in the following areas: cognition, function, hand function, home visits, school visit and assessment, and also education of the patient about their condition and its impact on function and their life roles. We also act as a resource for all our patients and other outside agencies. Occupational therapists work with individuals and groups who have limitations in participation due to physical, psychological, cognitive or social barriers to help identify strategies to enhance engagement in desired activities. Our occupational therapists use a wide variety

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OCCUPATIONAL THERAPY of strategies such as adaptive equipment, environmental modifications, cognitive retraining, patient and family education, strengthening activities, and many other treatment interventions to enhance participation. Aims of treatments are achieved through interventions including individual one-to-one working and interactive group sessions with patients of the hospital. The occupational therapy service is available to all in-patients and all outpatients of the hospital. In addition we accept referrals from GPs and consultants, community care nurses, physiotherapists and occupational therapists. We provide the following assessment and rehabilitation treatment services: • Functional assessment • Cognitive assessment • Hand function assessment and therapy • Upper limb prosthetic training • Specialised upper limb splinting and hand therapy service, • Home visits • Medico-legal functional assessment and report • Rheumatology assessment and treatment • Specialised seating service. We have extensive expertise in orthopaedic joint replacement rehabilitation and are available for advice and support to all multidisciplinary colleagues. Written referrals should be addressed to the occupational therapy department with reason for referral, contact details of the referrer and relevant patient information.

CONTACT INFORMATION Cappagh Hospital 01 834 1211 Occupational Therapy 01 814 0429 Physiotherapy 01 814 0462 Medical Social Work 01 814 0325 Nursing Administration 01 814 0469

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BONE BANK

CAPPAGH BONE BANK A BONE BANK SERVICE WAS SET UP IN CAPPAGH BACK IN 1996 WITH A VIEW TO PROVIDING BONE ALLOGRAFTS. WHEN THE SERVICE BEGAN, IT WAS INITIALLY INTENDED TO BE USED FOR ORTHOPAEDIC SURGERY SOLELY WITHIN CAPPAGH, BUT SINCE THEN IT HAS QUICKLY EXPANDED TO A POINT WHERE IT IS NOW IN USE BY SURGEONS THROUGHOUT IRELAND. FIONA E CLARKE, A BONE BANK CO-ORDINATOR AT CAPPAGH, WRITES ABOUT THE SERVICE.

he original purpose of the bone bank was to retrieve and utilise suitable osteoarthritic femoral heads that were removed as part of the total hip arthroplasty procedure. Cappagh Hospital was an ideal site for the service due to the number of primary hip replacements we do here every year and to our growing orthopaedic specialisation in revision arthroplasty surgery. We found that bone allograft could be easily retrieved and used to benefit patients. As the need for grafts increased, the bank extended its operation and now incorporates two satellite units in the regional orthopaedic hospitals of Croom, Co Limerick and the Regional Orthopaedic Unit at Our Lady’s Hospital, Navan.

REGULATION The bone bank, as a tissue establishment (TE) falls under the regulation of EU Directive 2004/23/EU and, as such, is inspected and licensed by the appointed competent authority – the Irish Medicines Board. Cappagh Bone Bank was the first bone bank to be granted this tissue establishment licence in the Republic of Ireland. TEs have a comprehensive quality system with defined organisational structures and controlled documentation. These include standard operating procedures – which we must strictly adhere to – supporting the bank’s activities across all three sites. These activities include donor identification, consent, donor selection testing, tissue retrieval, processing, storage and distribution of tissues. This ensures the traceability from initial identification of the donor to the implantation of the bone allograft.

THE BONE BANK PERSONNEL Our bone bank team covers all three retrieval sites – here at Cappagh, as well as in Croom and Navan. The team is comprised of the bank director, four orthopaedic surgeons and three nurse co-ordinators. The quality systems manager of the Pathology Department ensures compliance with the comprehensive quality system over all three banks. There are close links between the multidisciplinary teams – medical, nursing, out-patients, phlebotomy, radiology, theatre and the Microbiology Department of the Pathology Laboratory. Under Irish legislation, the responsible person for the TE is the Bone Bank Director – Professor J. Conor O’Keane – who has overall responsibility for the bank. He determines the final outcome of a donation through rigorous review of the donor and donation data, and has final authority on the use of donations as allograft. The director is supported by the banks’ co-ordinators at each site. These co-ordinators are specially trained nurses who have responsibility for the day-to-day running of the bank. The co-ordinators are also involved with the allocation of an appropriate graft to match the surgeon’s request and the intended recipient’s need. Their experience and specialist qualification in tissue banking are crucial to the operation of the service.

SAFETY AND QUALITY Tissue transplantation and cell transplantation carry risks of disease transmission. This risk is significantly reduced, and the quality and safety of the tissue assured, by careful selection

of donors on the basis of a number of criteria – their medical and behavioural history, a physical examination and testing of the donor for transmissible agents. Donations are only procured from non-remunerated donors from low-risk populations.

OUR DONORS Bone is not a life-saving tissue, but rather a life-enhancing tissue. Yet the use of such tissue must be made only after due consideration of the risks and benefits to the recipient. Although by the time a patient reaches the operating table a variety of detailed donor-infectious-disease screenings have been performed, a graft may still transmit an infectious agent as yet undetermined. This would also include a theoretical risk of Creutzfeldt-Jakob disease (CJD). Therefore the selection and screening of the donor and the donation are essential for the safety of the intended recipient and also to optimise the surgical outcome of the graft itself. At the bone bank, potential donors are identified and canvassed by us before their primary hip surgery. Those suitable are interviewed and their unconditional and explicit consent is taken for the donation of the femoral head and for the required serology screening tests. These tests include screening for hepatitis A, B and C, HIV, HTLV, and syphilis. A rhesus status is also recorded. The bank complies with strict donor selection guidelines to minimise any potential risk of transmission of an infectious agent to the recipient. A detailed history is taken in a face-to-face interview with each donor. The mandatory serology screening is taken at the time of retrieval of the bone and repeated at a follow-up review a minimum of six months later.

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BONE BANK

THE BONE DONATION PROCESS During total hip arthroplasty, the femoral head is the by-product of the surgery being performed. Where this tissue would otherwise be discarded as clinical waste it can be donated by people of any age as long as they fulfil donor selection criteria. At the time of this surgery an evaluation of the bone donation itself can be done to ensure that the retrieved bone is of an acceptable quality to be used in an allograft procedure. The bone is retrieved and packed under aseptic conditions and is then stored at ultra-cold temperatures in our bone bank freezers. This environment will, theoretically, allow storage of the bone for up to five years. In reality, due to demand, graft that has completed the testing process and been authorised for implant is issued for distribution long before that expiry date.

GRAFT UTILISATION Bone allograft is used to repair and restore bone loss. Most of the graft will be used during complex revision arthroplasty surgery – 85 per cent of the grafts issued are for hip revisions – and the remainder will be employed for a variety of different purposes, from primary arthroplasty surgery to spinal, tumour and fracture surgery.

Bone allograft does not require complex tissue-typing. A rhesus-appropriate graft is a sufficient match. Grafts are issued on a ‘named-patient’ basis so that full traceability can be maintained. Our three bone banks are each selfsufficient for all of our in-house graft requirements and any excess is distributed nationally to hospitals that do not have their own bone banks. Since the first grafts were issued in 1997 the banks have provided over 3,000 grafts to benefit more than 1,600 recipients throughout Ireland.

OTHER MUSCULOSKELETAL GRAFTS Cappagh Bone Bank is a living donor bank – there is no cadaveric musculoskeletal

tissue retrieval in Ireland. On occasions, patients require other grafts, such as structural bone-struts, segments of long bones, or tendon grafts. These are used in fracture, tumour or sports injury reconstructive surgery. The bone bank is licensed by the Irish Medicines Board to import these grafts from outside Ireland. We work closely with a large non-profit bank in the US to provide us with these musculoskeletal grafts. This American bank complies with all the inspections, authorisations and quality systems required to fulfil US, Irish and EU standards and legislation.

WITH MANY THANKS... A special word of gratitude must be paid to all of our donors for their altruism and for generously giving their consent and bone so very willingly to help someone else. Fiona E Clarke, BNS, RGN, RON, CTBS., Bone Bank Coordinator. Prof. J. Conor O’Keane, FRCPI, FFPath, RCPI Mr Darragh Hynes, FRCSEd, FRCSEd(Orth), Deputy Medical Director Ms Fiona Clarke, RGN, BNS, CTBS, Cappagh Bone Bank Co-ordinator/clinical nurse specialist Ms Caroline Power, RGN, BNS, CTBS, Cappagh Bone Bank Co-ordinator/clinical nurse specialist Phone: +353 (1) 8140 337 Email: bonebank@cappagh.ie

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DEXA BONE SCREENING

DEXA BONE SCREENING DEXA BONE SCREENING HAS BEEN CONDUCTED IN CAPPAGH FOR OVER 12 YEARS. ANNE SMITH, RADIOGRAPHY SERVICES MANAGER AT THE HOSPITAL, EXPLAINS HOW THE SERVICE WORKS.

“C

appagh National Orthopaedic Hospital has had a DEXA machine since 2000,” explains Anne Smith, radiography services manager at Cappagh. “They upgraded to a Lexxos in 2005 – this is the first bi-dimensional DEXA bone densitometer. It performs measurements at various sites of the spine, femur, forearm and total body in an acquisition time of less than 1.5 seconds. At each site, the Lexxos provides information on projected area, on bone

mineral content, and on bone mineral density.”

WHAT DOES IT DO? “The machine works by aiming two X-ray beams of different energy levels at the patient’s bones. The bone mineral density can be extrapolated from the rate at which the bones absorb each beam.” With referrals coming from rheumatologists, orthopaedic consultants, GPs and paediatricians, it’s clear that medical professionals are impressed with the Lexxos DEXA machine.

HOW DOES IT WORK? But what would they be referring patients to DEXA for in the first place? Smith says that predominantly they are asked to use DEXA to diagnose osteoporosis: “A DEXA scan is a non-invasive method and currently the most precise and widely used method of assessing [it].” The good news for those who don’t like medical examinations is that DEXA is pain-free and far less daunting than other medical scanner machines. Unlike a standard MRI, the patient is not enclosed so issues of claustrophobia are instantly overcome.

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DEXA BONE SCREENING

The entire process is designed so as not to impinge on the patient’s comfort in any way. “The scan takes about 10 minutes and the patient’s height and weight is measured. Patients may be asked to remove any metal, such as belts or body piercings. They will be asked to lie still on the machine during the scan. An electronic arm will slowly travel over the area to be scanned.” And then you’re done.

WHO DOES IT WORK FOR? Cappagh is well known and highly regarded for its medical imaging

technology. According to Smith, they are the only DEXA unit to have a paediatric application – this draws in referrals from Crumlin, Temple Street and the Central Remedial Clinic. After being diagnosed at Cappagh – with the machine offering a reading of normal, osteopenia or osteoporosis – they can return to their own doctor who will discuss the results and recommend treatment. The DEXA also enables monitoring of the bone degeneration. Cappagh is, in this way, offering people a greater degree of control over their condition.

CONTACT INFORMATION Ms Anne Smith Radiography Services Manager Phone: +353 (1) 8140 431 Email: ann.smith@cappagh.ie

HOURS OF SERVICE MRI Department Monday – Friday: 8.00am – 4.00pm X-Ray Department Monday – Friday: 8.00am – 5.00pm

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PHYSIOTHERAPY

MOVEMENT & MOBILITY: PHYSIOTHERAPY SERVICES AT CAPPAGH HOSPITAL THE CAPPAGH HOSPITAL PHYSIOTHERAPY DEPARTMENT DRAWS ON A WEALTH OF EXPERIENCE WITH A TEAM OF 14 FULLY QUALIFIED MEMBERS OF THE IRISH CHARTERED INSTITUTE OF PHYSIOTHERAPISTS. THE TEAM HAVE DEVELOPED THEIR SKILLS AND EXPERTISE IN MUSCULOSKELETAL CARE IN HOSPITALS IN IRELAND, THE UK, THE UNITED STATES AND CANADA. The mission of the Cappagh National Orthopaedic Physiotherapy team is to help people live full lives through enabling movement and peak mobility. The key aspects to our success with patients are:

PRE-ASSESSMENT Before surgery patients attend our preassessment clinic (PAC) for multidisciplinary assessment and intervention including ‘prehabilitation’ to ensure each patient is physically fit and prepared for surgery as much as possible.

INPATIENTS A physiotherapy inpatient service is provided Monday to Friday and on Saturday mornings. Following surgery all patients are assessed and undergo a rehabilitation program under the care and supervision of an experienced chartered physiotherapist. On discharge from Cappagh, patients requiring continued treatment are referred onto our outpatient physiotherapy clinic or their local physiotherapy service.

OUTPATIENT CLINICS A physiotherapy outpatient service is provided Monday to Friday. Referrals are accepted from all consultants attached to Cappagh Hospital as well as from the new MSK triage service. Patients can also continue their outpatient physiotherapy service when they are discharged from Cappagh Hospital following surgery. The benefits of physiotherapy in an orthopaedic setting • Physiotherapy improves the recovery rate of patients who have undergone surgery. Research is currently being undertaken in Cappagh Hospital to quantify the scale of this benefit. • Physiotherapy facilitates self management by the patient, which empowers them in their healing and recovery process. • Physiotherapy facilitates peak movement and peak mobility for the patient so that they can live independent lives and are not as dependent on community support and resources.

At Cappagh National Orthopaedic Hospital, we pride ourselves on being the hospital to which you would refer your friends and loved ones, due to the level of care and expertise we offer. This is evident from the referrals we receive from our consultants to take care of their family members. In the words of one hip replacement patient to a member of the physiotherapy team: “you didn’t just help me be more mobile, you changed my life”.

CONTACT INFORMATION Ms Jill Long Physiotherapy Manager Phone: +353 (1) 8140 411 Email: jill.long@cappagh.ie In-Patient Department Phone: +353 (1) 8140 462 Out-Patient Department Phone: +353 (1) 8140 349

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LABORATORY SERVICE

UNDER THE

MICROSCOPE LABORATORY MANAGER MARESE MULLINS EXPLAIANS THE SERVICE PROVIDED BY THE LAB AT CAPPAGH HOSPITAL.

n the laboratory, our function is to effectively support all cases which come through the hospital. Our facility is a designated Blood and tissue establishment and is licensed by the Irish Medicines Board and hence operates under the terms of the EU Blood/Tissue Directive. We currently have nine medical scientists employed.

The laboratory at Cappagh Hospital is divided into four sections: • Biochemistry: Diagnostic clinical biochemistry uses biochemical knowledge and techniques to assist in the diagnosis of human disease, to follow its progress and to monitor the effect of treatment. • Blood transfusion: This specialty covers the investigations required to ensure compatibility with donor blood products when required for transfusion. Such investigations include blood grouping and irregular antibody

identification, and the screening and cross-matching of donor blood with patients’ blood samples. • Haematology: This specialty deals with disorders of blood, blood cells and the bone marrow. There is a consultative service for the diagnosis, treatment and follow-up of haematology and coagulation disorders and an oral anti-coagulant monitoring service. • Microbiology: This specialty deals with the investigation of infection and infectious diseases caused by pathogens. Pathogens could be bacteria, viruses, fungi or parasites. It provides a consultative service for the diagnosis, treatment and follow-up of infectious diseases, an anti-microbial usage and monitoring service, and control of the use of antibiotics. It also provides environmental monitoring for theatre, auto-transfusion, blood transfusion and

The laboratory also works closely with relevant consultants at the hospital in microbiology, pathology and rheumatology. bacterial testing for the bone bank. We have our own quality services department and work very closely with other blood and tissue related elements of the hospital, such as haemovigilance and the bone bank facility, respectively. The laboratory also works closely with relevant consultants at the hospital in microbiology, pathology and rheumatology.

CONTACT INFORMATION Ms Marese Mullins Laboratory Manager Phone: +353 (1) 8140 386 Email: marese.mullins@cappagh.ie Ms Beverley Kristiansen Quality Systems Manager Phone: +353 (1) 8140 456 Email: beverley.renyard@cappagh.ie

HOURS OF SERVICE Monday – Friday: 8.00am – 5.00pm

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SAME DAY ADMISSIONS THE CHALLENGE OF IMPLEMENTING A CHANGE IN PRACTICE: DAY OF SURGERY ADMISSIONS/SAME DAY ADMISSIONS (SDAs) 2008 • Admitting patients as SDAs was a nurseled initiative which started in Cappagh in April 2008, originally to reduce the inpatient length of stay and increase efficiencies in bed utilisation. • To start the process one patient each week was admitted as an SDA. These patients were selected after being telephone triaged and were only the uncomplicated ACL reconstruction cases. • Initially it was felt across the hospital that admitting patients as SDAs was unrealistic and unachievable, so communication with all stakeholders was key at this stage and throughout the process for successful implementation of the initiative. • At the same time huge changes across all disciplines were taking place to accommodate this change in practice, including changes in department opening times.

2009 • Gradually, patient numbers increased to one patient on each consultant surgeon’s theatre list; these patients were all seen in the Pre-Assessment Clinic and were deemed suitable by the consultant anaesthetist for SDA; they were never first on the theatre list. • But it was still a challenge for all concerned to have patients who were admitted as SDAs ready for theatre on time because although the patient numbers were still relatively small, they were admitted to all the wards across the hospital. This meant that time was wasted for the phlebotomy and medical staff locating these patients. The nurses also had a short timeframe to meet with the patient and complete their preparation.

smae day chart.pdf

2010

multidisciplinary bed meeting. – They were telephoned by a nurse at a convenient time for the patient to commence their nursing admission. – the bed manager met daily with the ward managers to allocate beds to these patients in a designated area of each ward, but due to demands on beds this was not always possible.

2011 • As a result an 18-bedded ward – St Mary’s Ward – was opened as an SDAs’ unit in March, allowing the process to be centralised in one area. All SDA patients are admitted to St Mary’s Ward and are prepared for and brought to theatre from there. Post-operatively they are allocated beds elsewhere in the hospital. • In June, a HSE directive stated that 75 per cent of all inpatients had to be admitted as SDAs by year end. • Consultant surgeons allowed their patients who were first on their theatre lists to be involved. • In order to expedite the process, especially in the mornings, patients living in the greater Dublin area were asked to come in to St Mary’s Ward at a time that suited them prior to their admission date so that their nursing admission could be completed and bloods and X-rays reserved as required. This is particularly useful for patients who are first on the theatre list or patients with a past history identified in the Pre-Assessment Clinic that may cause a delay on the morning of theatre, for example blood antibodies and warfarin therapy. 16/08/2012

2012 • Admitting all patients on their theatre day has now become the normal practice in Cappagh, reducing patients’ length of stay by one day at a cost saving of €233,416 in 2011. • The nursing staff in St Mary’s Ward have streamlined the process with time. They also have greater input into the order of the theatre list and as a result larger patient numbers can now be accommodated.

PLANS FOR THE FUTURE • To continue and maintain the current numbers of patients admitted as SDAs. • To continue to provide a high standard of care to the patient. • To maintain St Mary’s Ward as the SDA unit with some modifications: – increase storage available for patients’ charts – increase the number of telephone hands-free sets for nursing use – increase the number of computer terminals available for use • To audit patient satisfaction levels regarding this change in practice. • To further streamline the hospital IT system to reduce repetition when gathering patient information. • To increase the numbers of patients admitted within six weeks of being passed fit in the Pre-Assessment Clinic.

Thanks to all departments for their help in the implementation of this initiative in Cappagh.

16:29:15

Percentage of all SDA’s

• To allow for greater efficiencies in the process – staff in the Admissions Department started admitting patients according to their place on the theatre list. – patients who were able walked to theatre, reducing delays – patients who were suitable for admission on their theatre day were discussed and highlighted at the weekly

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CONSULTANT DIRECTORY

CONSULTANT DIRECTORY CONSULTANT ORTHOPAEDIC SURGEONS Professor John O’Byrne Adult – Joint Replacement / Sports Injury Mr. Denis Collins Adult – Joint Replacement Mr. Paul Curtin Adult – Joint Replacement Mr. Niall Hogan Adult – Joint Replacement Mr. Conor Hurson Adult – Joint Replacement Mr. Paddy Kenny Adult – Joint Replacement Mr. Peter Keogh Adult - hip and knee arthroplasty/ musculoskeletal infections Professor Kevin Mulhall Adult Joint Replacement Mr. Shea O’Flanagan Adult Upper Limb Mr. Darragh Hynes Adult Upper Limb Mr. Kieran O’ Shea Adult Upper Limb Mr. Hannan Mullett Adult Upper Limb Professor Robert Flavin Adult – Foot & Ankle Mr. Paul Moroney Adult Foot & Ankle

Mr. James Walsh Adult Foot & Ankle

CONSULTANT RHEUMATOLOGIST

Mr. Keith Synnott Adult – Spinal/Joint Replacement

Dr. Geraldine McCarthy Dr. Conor McCarthy Dr. Donough Howard Dr. Grainne Kearns

Mr. Seamus Morris Adult – Spinal Mr. Sean Dudeney Adult Tumour/Joint Replacement Mr. Gary O’Toole Paediatric/Adult – Tumour/Joint Replacement Ms. Noelle Cassidy Paediatric/Adult – Spinal/Joint Replacement Mr. Paul Connolly Paediatric/Adult – Spinal/Joint Replacement Professor Damian McCormack Paediatric/Adult – Spinal/Joint Replacement Mr. Michael Donnelly Adult – Joint Replacement

CONSULTANT ANESTHETISTS Dr. Frances Conway Dr. Nick Eustace Dr. Conor Hearty Dr. Patrick Higgins Dr. Miriam Langdon Dr. Kim Hunter Dr. Avine Lydon Dr. Maire McCarroll Dr. Brendan McGarvey Dr. Brid McGrath Dr. Frances O’Donovan Dr. Geraldine O’Leary Dr. Cormac Redehan

CONSULTANT PATHOLOGIST Dr. Conor O’Keane

CONSULTANT HEMATOLOGIST Dr. Peter O’Gorman

CONSULTANT RADIOLOGISTS Professor Steve Eustace Dr. Eoin Kavanagh

CONSULTANT GERIATRICIANS Dr. Joseph Duggan Dr. Dermot Power Dr. Marie O’Connor

SPORTS MEDICINE Dr. Pat O’Neill Dr. Noel McCaffrey

CONSULTANT MICROBIOLOGIST Dr. Banu Dinesh

CONTACT INFORMATION Cappagh National Orthopaedic Hospital, Finglas, Dublin11 Main Hospital Phone Number: Tel: +353 (0)1 8140 400 Fax: +353 (0)1 8140 327 Email: feedback@cappagh.ie

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PATIENT INFORMATION

PATIENT INFORMATION ACCOMMODATION Medical and nursing needs determine bed allocation. This means you may not occupy a particular bed space in a particular ward for the duration of your hospital stay. The hospital is a public hospital and has a small number of private and semi-private beds. If you have private medical insurance, you will be accommodated in a private or semiprivate bed if one is available. Parents Accommodation The hospital has a limited amount of accommodation for parents (only) who wish to stay close to their children. Please notify the ward manager if you require accommodation. A nightly charge of €15 applies in respect of the accommodation. The daily rate is charged pro rata. External Accommodation Special room rates for Cappagh patients and Cappagh patients’ families are available at the following hotel: www.ardmore-hotel.com Car Parking There is a large public car park with multiple spaces for disabled parking available. Car park charges are as follows: • First hour = €2.00 • One to five hours = €5.00 • Five hours to 24 hours = €10.00 The pay station is located in the main hospital entrance conservatory. Security The hospital is monitored by CCTV cameras and security personnel both internally and externally 24 hours a day. Visiting Arrangements Visiting hours are strictly as follows: • 2.00pm – 4.00pm daily • 6.30pm – 8.30pm daily Special arrangements exist for visiting paediatric patients. These visiting times will be strictly enforced.

The hospital reserves the right to restrict visiting on the basis of health and safety, patient welfare and infection control.

ADMISSION & DISCHARGE INFORMATION Your visit to the Pre-Operative Assessment Clinic (PAC) Some of our patients are required to attend our Pre-Operative Assessment Clinic (PAC) approximately two to eight weeks prior to major surgery in order that they are passed fit for procedure. This is carried out on an out-patient basis. If you need to attend PAC, you will receive the following: • A medical questionnaire relating to your past and current medical history, which must be returned to PAC as this will speed up progressing you to surgery. • A consent form allowing us to request medical information from other hospitals you may have attended in the past. This must also be returned to PAC. • A leaflet on telephone triage, a facility which allows patients to be assessed at home. • On receipt of the completed medical questionnaire, a nurse will telephone you to go over the information you have supplied and clarify any areas that are uncertain. • Following this phone call, you will be sent a date for attendance at our PAC clinic, if required. Notification of Admission for Surgery We will give you notice of your admission by letter, approximately three weeks before you are due to be admitted. When you receive the admission date, you must phone the Admissions Department no later than two weeks prior to your date of admission to confirm you will be attending as allocated. Some of our patients are required to attend our Pre-Operative Assessment Clinic (PAC) approximately two to eight weeks prior to major surgery in

order that they are passed fit for procedure. Please phone the Admissions Department on (01) 814 0414 or (01) 814 0452 after 12 Noon and leave a message stating your name, telephone number, patient number and date of admission, indicating if you will or will not be attending on the allocated date. Failure to confirm your appointment will result in you being removed from the waiting list. Preparation For Your Visit • If you develop a cold, flu, sore throat or cold sore prior to admission, please contact the Admissions Department on (01) 814 0414 or (01) 814 0452 as early as possible. • If you are diabetic and on insulin or oral hypoglycaemic drugs, please do not take your hypoglycaemic medication on the morning of surgery until reviewed on the ward by the medical staff. Please bring your insulin with you. • If you are having a general anaesthetic DO NOT EAT or DRINK anything, even water, after 12 midnight – do have a late supper prior to 10pm the night before admission. • Shower/bath the evening before your admission and remove nail varnish, false nails, ALL make up and any body piercings. If you are taking any of the following drugs: warfarin, plavix, nu-seal aspirin, HRT, oral contraceptive pill, methotrexate, arava, kineret, humera, remicade and have attended the Pre-Operative Assessment Clinic (PAC), please consult the information sheet given to you at the clinic. If you are taking any of the above drugs and have not attended the Pre-Operative Assessment Clinic (PAC), please contact the hospital at 01-8140400 and ask to speak to the medical registrar for advice regarding medicine management. • Do not discontinue your medication

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PATIENT INFORMATION without consulting your information sheet given to you at PAC and/or consulting the medical registrar. • Please take all other prescribed medications at the times prescribed for you. • If you are having major joint or spinal surgery, please see your dentist for clearance of any dental problems and forward a dental certificate to the PreOperative Assessment Clinic. This is to reduce your risk of infection. Major joint or bone surgery will be cancelled if you have dental problems. • If you are, or suspect you may be pregnant, please inform the Admissions Department as your surgery will have to be deferred.

MEDICINES It is the policy of the hospital to use patients’ own drugs during your hospital stay. This is done to improve the safety and quality of your care in hospital. It ensures that: • All your drugs are immediately available and no break in treatment occurs • A complete and accurate drug history can be obtained • The drugs you are taking in hospital are the same as always and they will look familiar to you and no change in effectiveness is seen • Drug errors can be reduced through reduced number of transactions • Any drugs that have been stopped for medical reasons can be disposed of, with your permission, to avoid accidental use. There is a locked press fitted beside your bed for the storage of your own medication. Your drugs will not be used for any other patient and they will be returned to you on the day you are being discharged.

ADMISSION CHECKLIST On admission you will need: • One month’s supply of prescribed medications in their original labelled containers • A copy of any relevant MRI scans or X-rays, which you may have to request from the hospital which referred you to Cappagh • Night clothes • Mid calf-length dressing gown • Rubber-soled or flat footwear • Personal toiletries • Hand and bath towels • Walking aids/stick • Ladies – tracksuit or loose fitting skirt/

shorts • Gentlemen – tracksuit or loose fitting trousers/shorts. • Anything else you use on a daily basis – e.g. glasses or hearing aid. • Book or magazines • Medical card if you have one • Details of your private health insurance, if any – VHI/Quinn/etc. • If your treatment is as a result of road traffic accident, please bring your solicitor’s details with you. • Please shower/bath prior to admission, remove nail varnish and all jewellery/body piercings. • Details of next of kin and a second contact telephone number • Please note that on admission to the hospital you will be advised of your discharge date; this will allow you to make arrangements for your discharge.

WHEN YOU ARRIVE AT CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL • Please check in at the admissions office at the exact time stated on your admission letter. • You will be asked to confirm details such as your name, address, telephone number, next of kin, religion and family doctor (GP) • In-patient and day case patients under 16 years of age must be accompanied by a parent/legal guardian who will be requested to sign the consent form. • Your permission will be sought to allow the Hospital Charitable Trust to forward details of fundraising events or activities to you. This is voluntary and should you not wish to do so, it will in no way affect your care in the hospital. • You will then be admitted to your assigned ward.

WHAT HAPPENS WHEN I AM BEING DISCHARGED? • Prior to admission, you should plan appropriate arrangements with relatives and friends for support following your discharge from Cappagh National Orthopaedic Hospital to your home after your operation. • Your GP and local health centre will be able to assist you in arranging suitable home help if this is necessary. Please contact them before your admission to Cappagh National Orthopaedic Hospital. • If a follow-up outpatient appointment is required, it should be sent to you within

three weeks. If not received, please contact the Medical Records Department on (01) 814 0432. • Patients are expected to leave the hospital by 11am on day of discharge.

DISCHARGE CHECKLIST • Have you got transport to your home? • If you have a wound, what care is needed? • Have you stitches that need to be removed? • If you are already receiving care or services at home, does the service provider know you have been discharged? • If there are any problems when discharged, who do you contact? • Has your own medication been returned to you? • Have you got a prescription for any new medication? Do you know what your medication is for, how often and for how long you should take it? Have you someone who can get the medication for you? • Have you got all your belongings? • Have you got a letter for your doctor? • Do you need an outpatient appointment or follow-up care? • When can you return to work and normal activities? • Do you need a medical certificate for your employer?

ON DISCHARGE FROM THE DAY WARD • If your discharge is from the day ward, it is mandatory that you are accompanied home by a responsible adult and remain in the company of a responsible adult for 24 hours after your procedure. • You must not operate machinery (such as cars, bicycles or power tools) or make important decisions for at least 24 hours after. • Alcohol (even beer) is prohibited for 24 hours after anaesthesia or sedation. • You may resume a normal diet – start with clear fluids until your stomach has settled.

OUTPATIENTS DEPARTMENT • Following discharge, patients are reviewed in the Outpatient Department or in their original referring hospital. • If you do not receive notice of your appointment within three weeks, please contact the Medical Records Department on (01) 814 0432. If you cannot attend for your appointment,

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PATIENT INFORMATION please ring (01) 814 0401 or (01) 814 0408 as soon as possible to cancel the appointment and reschedule.

CATERING SERVICES The Hospital Restaurant is open to visitors and patients. Restaurant Opening Hours Monday to Friday inclusive: • Breakfast 7.30am to 11.15am • Lunch 12.00pm to 2.30pm • Afternoon tea 2.30pm to 3.00pm There is a 24 hour vending room beside the restaurant with a selection of hot and cold foods, hot beverages, soft drinks and confectionery available.

MAIL SERVICE There are facilities for the postage and delivery of mail while in the hospital.

PATIENT ACCOUNTS MEDICAL CARD/PRIVATE HEALTH INSURANCE If you have a medical card, please bring it with you. If you have private health insurance please bring details with you.

COMPULSORY IN-PATIENT CHARGE FOR NON-MEDICAL CARD HOLDERS There is a compulsory in-patient charge, up to a maximum stay of 10 days in any consecutive 12 months, for patients who do not have a medical card. If this compulsory charge has been paid in full, or in part, to any other hospital within the previous 12 months, please bring evidence of payment.

INSURANCE FORMS AND MEDICAL CERTS

suggestions for improvements which can be made, so please do not hesitate to let us know. Comment cards are available on all wards.

PERSONAL BELONGINGS The hospital management does not accept responsibility for the loss of any personal items. Patients are encouraged to send personal property including valuables, jewellery and important documents home with relatives. Only retain small amounts of money (just enough for day-to-day use).

LOST PROPERTY Enquire to main hospital reception regarding any lost property.

SPECIAL NEEDS We aim to meet the needs of people with special needs/disabilities. To help us do this, please notify nursing administration in advance of any requirements needed.

TELEPHONES/MOBILE PHONES TELEPHONES Patients and visitors have bedside access to public payphones on all wards. The phones in the reception Area take callcards and credit cards. A cordless phone is available at ward level for patients on bed rest.

MOBILE PHONES Mobile phones emit signals which can interfere with medical equipment and so may cause harm to other patients. Mobile phones may therefore only be used with the permission of ward staff.

Please ensure that all relevant insurance forms are completed prior to discharge. If you intend to claim social welfare benefit while in hospital, please bring your PPS number with you. The attending doctor will issue a medical certificate on request.

PASTORAL CARE Holy communion is distributed weekly at the hospital oratory. A volunteer Catholic chaplain is on site twice per week; arrangements can be made for other religious denominations.

PATIENT COMMENTS We hope your stay in will be as comfortable as possible. Hospital staff are always pleased to hear any comments or

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Cappagh

National Orthopaedic Hospital

Cappagh National Orthopaedic Hospital

Cappagh National Orthopaedic Hospital, Finglas, Dublin 11 | Tel: 353-1-814 0400 | Fax: 353-1-814 0327 | www.cappagh.ie

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