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ANNUAL REVIEW 2013
PATIENTS FIRST
WELCOME
TO THE
MATER
PRIVATE
ANNUAL
REVIEW
2013
CHIEF EXECUTIVE'S INTRODUCTION
Welcome to our Annual Review of 2013. This report is a snapshot
of the quality of care provided at the Mater Private and it reflects
our desire for a more open sharing of information on the quality
of healthcare delivered in Ireland.
Our Radiology Group also had a busy year. The Mater Private’s
specialist breast cancer centre saw over 1,000 patients in
2013, a 12% increase on the previous year. In addition we
entered the cancer prevention arena by providing cancer
awareness services to the Irish Midwifes and Nursing
Organisation (IMNO) and to companies such as Dell and
Hewlett-Packard. Over 3,400 individuals received information
on cancer prevention directly in their place of work and
screening was made available for at risk individuals.
In 2013 the hospital received two external recognitions of
quality, of which we are very proud. Firstly the World Health
Organisation ranked the Mater Private No 1 in Europe for
Hand Hygiene Excellence. As hand hygiene is recognised
as the single most important factor in preventing the
spread of infection, this is a most welcome achievement.
Secondly, we were presented with the “Guardians of
Excellence” award following our adoption of the US based
Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS). This is a patient experience survey,
that is now mandatory in the US, and it demonstrates
our commitment to putting the patient at the centre
of everything we do.
We always try to listen to our patients and their feedback
and act accordingly. One piece of patient feedback that
we acted on this year was from oncology patients, who
identified a lack of space, privacy and natural light in
the Day Oncology environment. In our 2013 building
improvements programme, a new Day Oncology suite was
developed and it opened in early 2014. The unit is a bright,
open space, full of natural light and with views of the city.
Importantly there is now a significantly more space for
treatment and consultation.
In cardiovascular care we are seeing a trend towards older
patients with more complex disease. These patients are
higher risk and it means that our consultants are constantly
seeking more minimally invasive ways to treat them. The
innovation in treating totally blocked coronary arteries as
well as new ways to deal with cardiac valve disease are
dealt with more fully inside. And in November, we opened
a fully integrated Diabetes Centre as part of the Heart and
Vascular Centre because diabetic patients have such a high
risk of cardiovascular disease.
On the innovation front, our ophthalmology team were the
first and only hospital on the island of Ireland and only one
centre of only 7 centres in Europe, to implant a miniature
telescopic device in one eye behind the iris to treat end-stage
age related macular degeneration (ARMD). For patients it
gives them the opportunity to increase their independence.
I am proud of what we achieved in 2013 and I hope you
find our Annual Review interesting.
Yours sincerely,
Mr.Fergus Clancy
CEO, Mater Private
3
ANNUAL REVIEW 2013
4
CONTENTS
01/ QUALITY & PATIENT SAFETY
06
02/ HEART & VASCULAR CENTRE
16
03/ CANCER CENTRE
28
04/ ORTHOPAEDIC & SPINE
38
05/ OPHTHALMOLOGY
48
06/ EAR, NOSE & THROAT
56
07/ RADIOLOGY
60
5
ANNUAL REVIEW 2013
✓
constantly delivering
the best achievable
outcomes for patients
✓
proactively identifying,
managing and
eliminating risks
✓
clear accountability
for quality, safety and
patient satisfaction
✓
continually improving
skills, care processes
and outcomes
✓
6
listening to “the
Voice of the Patient”
01
QUALITY & PATIENT SAFETY
We continuously measure outcomes and monitor
performance to support the delivery of safe and
effective care.
7
ANNUAL REVIEW 2013
INTRODUCTION
At the Mater Private Hospital the patient is at the centre of the care we deliver.
We provide safe and effective care, in an environment of the highest quality
and deliver exceptional outcomes.
In line with the goals of Joint Commission International
(JCI) all treatments are designed to ensure that the patient
is afforded the best possible care. The data in this review
supports our commitment to national and international
standards, while demonstrating positive outcomes.
In 2013, the Mater Private continued to focus on safe
and effective care by documenting clear evidence based
objectives, congruent with our mission to provide high
quality care and to continuously improve our performance.
Our structured approach to governance throughout the
organisation ensures patient safety is an essential part
of our processes.
Leadership walkarounds are an important aspect of the
culture of safety. They offer insight into the processes and
demonstrate our senior leadership’s commitment to patient
safety. We recognise that there is always more that we can
do. With this in mind, we continue to implement and expand
innovative patient safety and quality improvement efforts.
Measures to achieve this have included:
• d
esigning safer systems of care to reduce
preventable harm
• accelerating
the implementation of improvements
to reduce waste in our delivery of care
• listening
to our patients and our staff in order
to continuously improve
• strengthening performance measurement
to demonstrate our outcomes.
We focus on improving the coordination of care throughout
a patient’s entire hospital stay and strive to further engage
patients and their families in the care process.
In 2013, we were acknowledged by Press Ganey with the
'Guardians of Excellence' Award following our adoption of
the US based Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) in 2012. In addition patient
feedback through comment cards, surveys and patient
forums give us valuable experience into patient experience.
Thorough scrutiny of this feedback along with honest selfassessment allows us to focus on continuous improvement
and address any qualitative issues that arise.
For us it is very important that we deliver exceptional
outcomes to the patient. There are many measures to
evaluate outcomes, one of which is that patients who
leave the hospital do not have to be readmitted. At the
Mater Private our 30 day readmission rate is less than
1% compared internationally with rates of 8-15%.
Consistent with the goals of all Joint Commission
International accredited hospitals, quality and patient
safety filters through the entire organisation. It requires the
entire team working together towards shared goals and
being supported with on-going education, training and
professional development.
Finally of noteworthy mention are the successes we
celebrated organisationally in 2013. All underpin delivery
of safe effective care. They include being Ranked No.1 in
Europe for Hand Hygiene Excellence by the World Health
Organisation (WHO) re-accreditation of our laboratory, the
successful achievement of ISO in our technical services
catering departments.
Yours sincerely,
Ms. Melissa Lanigan
Acting Director of Quality
Mater Private, Dublin
8
QUALITY & PATIENT SAFETY
THE SYSTEMS APPROACH –
8 STEPS TO PATIENT SAFETY
In 2013 we adopted the ‘Systems Approach’ to patient safety in the Mater
Private Hospital.
This approach, recommended by the Institute for
Healthcare Improvement (IHI)*, is based on the experience
of senior leaders in healthcare, who place patient safety and
quality as a strategic imperative within their organisation.
The process involves 8 specific steps against which we
evaluate and measure our performance. The insight and
learnings we gather are used to improve the care we offer
to our patients.
*IHI are a US based organisation focused on
improving health care worldwide www.ihi.org
Redesign
systems and
improve
reliability
08
As a result of this approach, a number of improvements have
been identified throughout the organisation:
• Incident
Management Reporting System upgrade
• Patient Safety Week established
• Weekly tracking and review of safety data and
recorded incidents
• Increased library of quality and clinical measures
• 'Failure Mode Effects Analysis' on chemotherapy
administration
• Hospital-wide "Quality Improvement Initiatives" champions
01
Address strategic
priorities, culture
and infrastructure
Engage key
stakeholders
Align system wide
activities and
incentives
07
02
ENVIRONMENT
OF PATIENT SAFETY
Support staff and
patients/families
impacted by
medical errors
06
03
Communicate and
build awareness
Track/measure
performance
over time,
strengthen
analysis
05
Establish,
oversee, and
communicate
system-level aims
04
9
ANNUAL REVIEW 2013
DELIVERY OF CARE
The care we deliver in the Mater Private is measured in many ways using best
in class standards and benchmarks. We continuously assess performance and
outcomes. We share successes and learnings to improve the care we deliver.
Performance
Measured Care
Safe Care
Care in the
Mater Private
Effective Care
Patient
Centred Care
SAFE CARE
PERFORMANCE MEASURED CARE
• Surgical
site hospital acquired infection rates reduced
from 1.2% to 0.8%
We use a range of evidence based clinical standards and
measures, to benchmarks our performance. As a case in
point, we benchmark ourselves against HIQA standards
in the delivery of Cancer Care.
• Hospital
acquired pressure ulcers reduced from 0.85
per 1,000 bed days to 0.53
• Unscheduled returns to theatre down from 0.9% to 0.8%
• Reduced
levels of injury to patients from falls with 77%
not sustaining injury
• Clinical
communication improvements with safe
surgery checklist, intentional rounding by staff and
leadership rounding
• Managing
average length of stay safely to reduce
possibility of Health Care Associated Infections (HCAI)
e.g. robotic prostatectomy length of stay (LOS) 2.6 days
• Every
new patient diagnosed with breast cancer and
deemed urgent following the consultant surgeon's
assessment at the clinic had further testing to include
mammography or ultrasound completed at the first visit
• 1 00% of breast cancer patients received surgical
intervention within 20 working days of the
multidisciplinary meeting (MDM)
• 100%
of breast cancer patients received chemotherapy
on time
• 100%
of breast cancer patients received radiation
therapy on time
• We
exceed the cancer waiting time targets for HIQA/
NCCP (National Cancer Control Programme)
10
10
QUALITY & PATIENT SAFETY
EFFECTIVE CARE
PATIENT CENTRED CARE
• 6-8
weeks following lumbar surgery, patients ranked
their level of disability as moderate compared to severe
prior to surgery; some patients even ranked it as minimal
We are continuously listening to patient feedback in many
ways and at different times
• 100%
of patients undergoing cardiothoracic surgery
received antibiotic and embolism prophylaxis
• Comment cards
• 100%
of patients received antibiotic prophylaxis prior
to surgery for prostate cancer
• Patient forums
• 100%
of patients undergoing surgery for gynaecological
cancer received venous thromboembolism (VTE)
prophylaxis
• Less
than 1% readmission rate within 30 days compared
internationally with rates between 8-15%
• Effective
pain management for oncology patients,
ranked higher than other international hospitals
HCAHPS Oncology Pain Management Results 2013
• HCAHPS
• Departmental surveys
• Complaints process
1 in 3 patients surveyed in relation
to their experience in 2013
We don't just listen to feedback; we actively listen, learn and
act on it.
Waits and delays – patients undergoing heart catherisation
were delayed on average 2.5 hours. Causes other than
emergencies were identified and addressed, reducing
patient waits by >50%.
100
80
60
40
Pain Management
Mater Private
Reduced patient
waits by more than 50%
All Database
Large Peer Group Database
Cancer
Data Source: Press Ganey Database
11
ANNUAL REVIEW 2013
INTERNATIONAL BENCHMARKING
The Mater Private was the first hospital in Europe to adopt the US based Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey tool.
The use of HCAHPS is mandated by the US government and over 13 million patients
worldwide submit their feedback to this survey.
HCAHPS CARDIAC SURGERY
98% of patients who underwent Cardiothoracic Surgery would recommend the Mater Private Hospital to others given the positive
experience they had. For patients the management of their pain following surgery excelled relative to our peers, with our patients scoring
this area at 91%.
100
80
60
40
Rate hospital
0-10
Mater Private
Recommend
the hospital
All Database
Communication
with nurses
Response
of hospital staff
Communication
with doctors
Hospital
Environment
Pain
Management
Large Peer Group Database
HCAHPS GENERAL SURGERY
In the vast area of General Surgery we perform higher on all measures compared to international counterparts and specifically compared
to the top 10 US hospitals as a defined group.
100
80
60
40
Rate hospital
0-10
Mater Private
12
Recommend
the hospital
All Database
Communication
with nurses
Large Peer Group Database
Response
of hospital staff
Communication
with doctors
Hospital
Environment
Pain
Management
QUALITY & PATIENT SAFETY
HCAHPS ONCOLOGY
Patients rate our performance in Cancer Care very positively relative to the top US Cancer Care Centres. Communication with Nursing
staff scores 87%. Pain Management for the second year running outperforms the feedback for top international hospitals.
100
80
60
40
Rate hospital
0-10
Mater Private
Recommend
the hospital
All Database
Communication
with nurses
Response
of hospital staff
Communication
with doctors
Hospital
Environment
Pain
Management
Large Peer Group Database
Through HCAHPS and other feedback, patients identified a lack of space, privacy and natural light in the Day Oncology environment as
negatively effecting their experience. In response, a new suite was developed as part of our building improvements programme. The new unit
opened in early 2014 complete with natural lighting, views of the city and significantly more space for treatment and private consultation.
HCAHPS ORTHOPAEDIC
Pain management is an important measure of orthopaedic patients, as less pain enables early mobilisation and so improved outcomes.
Our patients score us positively in terms of pain management. .
100
80
60
40
Recommend
the hospital
Mater Private
Communication
with nurses
Response
of hospital staff
Communication
with doctors
Pain
Management
All Database
13
ANNUAL REVIEW 2013
HAND HYGIENE EXCELLENCE
Mater Private Ranked No.1 in Europe for Hand Hygiene
Excellence by the World Health Organisation (WHO).
The ‘WHO SAVE LIVES: Clean Your Hands’
annual global campaign encourages and
supports hospitals to focus on promoting
and improving hand hygiene. The Hand
Hygiene Excellence Awards recognises
these efforts.
Following selection as one of the six
highest ranking finalists from hundreds
of entrants across Europe, the Mater Private
Hospital underwent Inspection by the WHO
panel and emerged as the top performing
hospital in Europe.
This award underlines our commitment
to hand hygiene in particular as a part
of our infection control and prevention
programme. The WHO expert panel said
they were impressed by the continuous
and collective actions taken by the Mater
Private to ensure patients' safety through
excellence in hand hygiene. This award
followed the Mater Private topping a
14
National Hand Hygiene Compliance
Audit in late 2012, following an audit
of 44 acute hospitals.
Hand hygiene is recognised as the single
most important factor in preventing the
spread of infection and plays a key role in
delivering safe patient care. The human
hand is the primary cause for the spread of
infection in hospitals, kitchens and among
the public at large. Health Care Acquired
Infections (HCAI’s) infect 8-10% of hospital
in-patients in the western world and up to
20% of patients in the developing world.
At the Mater Private hand hygiene is
central to infection prevention and
control. We have a rigorous training and
assessment programme in place which is
mandatory for all our staff. We continue
to carry out monthly audits of hand
hygiene compliance, ensuring our ongoing
commitment to hand hygiene.
QUALITY & PATIENT SAFETY
20 DAYS
12 HOURS
58 MINUTES
(492 hours) of hand hygiene
technique training
142 mls
of Hand Rub
251 mls
of Hand Soap
used per patient stay
Hand hygiene is recognised
as the single most important
factor in preventing the
spread of infection
15
ANNUAL REVIEW 2013
16
16
02
HEART & VASCULAR CENTRE
Our team of 22 cardiologists cover the full spectrum of
cardiac conditions with a high degree of sub-specialisation
among the team. Patient are treated and managed with
the expertise relating to their specific condition.
17
ANNUAL REVIEW 2013
INTRODUCTION
Our success is built on teamwork. Our multidisciplinary clinical teams have
been established over many years, working together to deliver seamless,
co-ordinated and specialist care to each and every patient.
own home. Additionally, since November 2011 our cardiac
services are available to patients in need of urgent care
24 hours a day, 365 days a year.
Patients are at the heart of everything we do at the Mater
Private Heart and Vascular Centre. We treat people of all
ages, from paediatric to those well into their nineties and
from all over the country.
From the moment they arrive, our patients become part
of a community of people who, for more than 25 years, have
benefited from expert diagnosis, treatment and long-term
care. We are all dedicated to patient care, from the very first
contact a patient has with us.
We believe that one of the main frustrations which patients
experience is delay in accessing care. Over the last 4 years
we have made this a major focus for the Heart and Vascular
Centre. We have restructured cardiology clinics so that
no new patient needs to wait more than 10 days to see a
cardiologist. We have opened clinics in Navan, Drogheda
and Sligo to enable patients to see our team closer to their
18
18
The increasing incidence of diabetes in the last 20 years and
the fact that adults with diabetes are two to four times more
likely to have heart disease than those without diabetes led
us to open a Diabetes Centre in November 2013. Diabetic
patients require integrated and coordinated care over a
number of specialties and the new Diabetes Centre team
of endocrinologists, diabetic educators, dieticians and
nurse practitioners work closely with cardiology, vascular,
nephrology and ophthalmology teams to provide patients
with that integrated care.
The purpose of the centre is to encourage patients to
receive early specialist care and education, getting them
on the right track with their diabetes management from
the start. Day to day patient care will then be managed
by their primary care physician with full access to our
multidisciplinary team as required.
Yours sincerely,
Mr. John Hurley,
Chairman
Mater Private Heart & Vascular Centre
HEART & VASCULAR CENTRE
22%
of premature deaths
(under age 65) are from
Cardiovascular Disease
10,000
patients (approximately)
die each year from
Cardiovascular Disease
in Ireland
Cardiovascular Disease
is the most common
cause of death in
Ireland, accounting
for 36% of all deaths
19
ANNUAL REVIEW 2013
CARDIOVASCULAR
CENTRE OF EXCELLENCE
The Heart and Vascular Centre is a national leader and tertiary referral
centre in the prevention, evaluation and treatment of cardiovascular disease.
The centre offers patients advanced diagnosis, innovative
treatments and comprehensive management by an
expert consultant team. The specialties of cardiology,
cardiothoracic surgery, diabetes and vascular surgery
are integrated with and fully supported by an array of
disciplines such as radiology, microbiology, anaesthetics
and intensive care medicine.
The Heart and Vascular Centre is fully integrated within
the Mater Private Hospital, offering the reassurance of
having all specialties under one roof and the support
of a critical care department.
Clinical teams at the Heart and Vascular Centre care for
patients with a wide range of complex cardiac conditions,
which may be congenital, inherited or acquired later in life.
Over the past 5 years we are increasingly treating older
and more complex patients, not surprising given our
range of expertise, subspecialty and integrated support.
We are seeing an increase in the patient’s age and disease
complexity. Patients presenting with multi-vessel disease
have more than doubled in the last 5 years, now accounting
for 42% of all angioplasties.
ANGIOPLASTY PATIENTS
CARDIAC RHYTHM PATIENTS
Average Age
Average Age
65yr
67yr
66yr
68yr
Increased by
8 years since
2009
2008
2010
2012
2009
2013
2013
Disease Complexity
Complex Ablations
Angioplasty patients presenting with multi-vessel disease
Accounting for two-thirds of all ablations carried out
in 2013
42%
18%
2
3
of all ablations
in 2013
2009
20
20
2013
HEART & VASCULAR CENTRE
ACCESS TO CARE
Over the last three years over 3,000 patients have been
transferred to our care from other hospitals. The three main
access points to the hospital for patients are consultant
clinics, outreach clinics and 24/7 Urgent Cardiac Care.
The number of patients attending consultant clinics has
increased by 37% since 2010. Outreach Clinics and the
24/7 Urgent Cardiac Care service were introduced in 2011
significantly improving access options for our patients.
Patient Attendance 2010 v 2013
Innovative, minimally invasive PCI procedures are associated
with significantly lower risk to the patient compared to
cardio-thoracic surgery. One of the innovative approaches
developed over the last few years has been catheter based
treatment techniques for Chronic Total Occlusion (CTO)
– total blockages of the coronary artery.
The diversity and specialty of our team results in us being
able to provide patients with access to more treatment
options. The CTO interventional programme was
introduced in the Mater Private in 2011 and since then
88 patients were treated in 2012 and 135 in 2013.
Such procedures enable us to open up the possibility
of treatment to older and higher risk profile patients,
who otherwise may have limited treatment options.
18k
16k
14k
12k
CARDIOTHORACIC SURGERY
10k
8k
2010
2013
Consultants Clinics
Outreach Clinics and 24/7 Urgent Cardiac Care
Over the last three years over
3,000 patients have been
transferred to our care from
other hospitals
In 2013 the Heart and Vascular Centre performed 412
cardiac surgery procedures. Coronary Artery Bypass Grafts
(CABG) accounted for 39%, with valves representing
another 41% and 20% being made up of other
cardiothoracic procedures.
Cardiothoracic surgery patient profile
24 PATIENTS – 80yrs +
AVERAGE AGE – 66yrs
HYPERTENSION – 71%
DIABETIC – 23%
ISCHAEMIC HEART DISEASE
Innovative minimally invasive procedures enable
us to open up the possibility of treating higher risk
profile patients.
Mortality rates
STS 2012
Mater Private
2013
Isolated CABG
2.0%
0.3%
CABG + Valve
2.5%
0.6%
Percutaneous Coronary Intervention (PCI) is a treatment
procedure to open blocked coronary arteries and restore
blood flow to the heart tissue without open heart surgery.
21
ANNUAL REVIEW 2013
CARDIAC RHYTHM DISORDERS
HEART FAILURE
The Mater Private Heart and Vascular Centre is
home to the country's largest Electrophysiology
Centre using specialised approaches to diagnosing
and treating a wide variety of arrhythmias.
Heart failure is the final common pathway of many
cardiac conditions and a major challenge facing
cardiovascular medicine in the 21st century. Heart
failure is not one disease; rather it is a syndrome
with a wide range of causes and an equally wide
range of treatment options.
Patients with cardiac rhythm disorders require highly
individualised care. Our dedicated electrophysiology cath lab
is equipped for state-of the-art electrophysiology procedures
and is available 24 hours a day. This enables our specialists
to treat challenging arrhythmia conditions – such as those
causing the heart to slow down too much for which a
pacemaker may be fitted, or those causing the heart to beat
in a disorganised manner which can often be treated with
cardioversion or ablation.
Cardiac arrhythmias can be diagnosed using non-invasive
procedures or invasive procedures. Our specialists offer the
latest diagnostic procedures for all cardiac arrhythmias.
~1,000 Ablations & Cardioversions
1-in-6 Pacemakers & 1-in-4
ICDs nationally are deployed
in our cath labs
We operate a physician-directed heart failure nurse
specialist-implemented heart failure disease management
service. We are a High volume ICD and Cardiac
Resynchronisation Therapy (CRT) centre for sudden death
prevention and improvement of heart failure symptoms
respectively. Biventricular ICDs help prevent cardiac death
and assist in the management of heart failure. Over 25%
of all devices implanted in 2013 were bivent devices.
Over the last 2 years almost 900
patients have attended our heart
failure nurse and heart failure
disease management clinic
Patients with Heart Failure have access to:
• 5 heart failure specialist cardiologists
• Heart failure nurse specialist
• Evidence based patient education
The Mater Private has been treating children with a wide
variety of tachycardias since 2006. Working with Our Lady’s
Hospital for Sick Children over 150 ablation procedures
have been carried out in the last 5 years. Radiofrequency
ablation offers a non-surgical treatment option where
previously most children were controlled with long term
drug treatment or some underwent open heart surgery.
+150 Paediatric Ablations
in the past 5 years
• Individualised follow up to optimise treatment, manage
symptoms and prevent acute episodes
• High volume device implantation
• C
omplex structural interventions, novel options
for patients with severe LV dysfunction/advanced
heart failure
• P
ercutaneous Transluminal Septal Myocardiac Ablation
(PTSMA) for selected patients with hypertrophic
cardiomyopathy
• 24/7 access
• Palliative care for end-stage disease
• Full cardiac transplant work-up
22
HEART & VASCULAR CENTRE
VALVE & STRUCTURAL HEART
The Heart Valve Programme at the Mater Private provides a multidisciplinary
team of experts managing complex and common valve diseases.
In this programme, cardiology and cardiothoracic teams
work together to:
To date, the 30 day mortality rate for patients undergoing
TAVI is 5%, comparing favourably with published data.
• F ully diagnose and understand a patient’s valve
condition
• D
etermine if a heart valve is repairable or needs
replacement
• D
etermine the right time to repair or replace a valve
for a patient
All referred patients are assessed and discussed by the
multidisciplinary valve team so that all treatment options
are fully considered before deciding the best plan for the
patient. This ensures the patient benefits from the best
opinion and clinical expertise.
The Mater Private remains the
largest private hospital for treating
valvular diseases of the heart. In
2013, 168 patients were treated
surgically for valvular disease
Our interventional cardiologists are leaders in catheterbased approaches to valve disease and perform a range
of procedures, including:
Valve surgery
accounts for
• Mitral and aortic valvuloplasty for stenosis
40%
• Closure of paravalvular leaks
• Transcatheter aortic valve replacement (TAVI)
of all open
heart
surgery
• MitraClip for mitral regurgitation
Valve Procedure Volumes (2011-2013)
250
200
150
100
50
itr
aC
lip
M
TA
VI
ry
ur
ge
ry
Va
lve
S
Mater Private
2013
Isolated
Aortic Valve
Replacement
2.6%
0%
Isolated
Mitral Valve
Replacement
1.4%
0%
STS 2013 data not available at time of production.
Do
ub
le
ur
ge
ry
rg
e
+V
alv
eS
Su
BG
M
lat
ed
Soc of Thor
Surg 2012
Iso
CA
itr
al
tic
Ao
r
lat
ed
Iso
Va
lve
Va
lve
S
ur
ge
ry
0
Mortality Rates
Valve Surgery
23
ANNUAL REVIEW 2013
STRUCTURAL HEART
Congenital heart disease is a type of defect in one or more
structures of the heart or blood vessels that occur before
birth. Congenital heart defects occur while the foetus is
developing in the uterus. They affect 8 to 10 out of every
1,000 children. Congenital heart defects may produce
symptoms at birth, during childhood and sometimes
not until adulthood.
The structural heart team at the Mater Private treat some
of the most common congenital heart disorders affecting
adults. These include:
• A
trial septal defects. An atrial septal defect (ASD) is a
hole in the septum, or muscular wall, which separates
the heart’s two upper chambers (atria).
• P
atent Foramen Ovale. PFO is a defect in the septum
(wall) between the two upper (atrial) chambers of the
heart. Specifically, the defect is an incomplete closure
of the atrial septum that results in the creation of a flap
or a valve-like opening in the atrial septal wall.
• P
atent Ductus Arteriosus. PDA leads to abnormal blood
flow between the aorta and pulmonary artery, two
major blood vessels that carry blood from the heart.
95 structural heart procedures
were carried out at the Mater
Private in 2013
Structural heart procedures at the Mater Private Heart
& Vascular Centre include:
Patent Foramen Ovale (PFO) Closure: This is a minimally
invasive catheter based procedure where the hole in the
heart is closed using a device called the Amplatzer® PFO
Occluder. The procedure takes from 30 minutes to two
hours, and patients are often able to leave the hospital the
same day or after an overnight stay, returning home with
minimal restrictions on normal physical activity
Atrial Septal Defect Closure: This is also a minimally
invasive catheter based procedure where an ASD closure
device is allowed to expand its shape to straddle each side
of the hole in the heart. The device remains in the heart
permanently to stop the abnormal flow of blood between
the two atria chambers of the heart. Two main types of ASD
closure devices are currently being used are the Amplatzer®
Septal Occluder System and the HELEX® Septal Occluder.
Left Atrial Appendage: Is a treatment for patients at risk
of developing clots in the left atrium. This catheter based
procedure seals off your Left Atrial Appendage using the
Watchman device and prevents the LAA from releasing
clots. This can reduce your risk of stroke and eliminate the
need to take blood-thinning medication.
24
HEART & VASCULAR CENTRE
VASCULAR SURGERY
The vascular team provide comprehensive state of-the-art diagnostic and therapeutic
interventions for the entire spectrum of vascular disorders; from medical management
to minimally invasive endovascular therapy to conventional open surgery.
Treatment takes place in both theatre and our dedicated
vascular laboratory, opened in 2012.
The most common vascular disease treated at the Mater
Private are Abdominal Aortic Aneurysm, Peripheral Vascular
Disease and vein disorders (including varicose veins).
ENDOVASCULAR ANEURYSM REPAIR
(EVAR)
FEMORAL POPLITEAL BYPASS
Peripheral Vascular Disease (PVD) is generally associated
with blocked arteries of the legs. The blockage most often
is the result of a chronic build-up of hard fatty material
(atherosclerosis or hardening of the arteries) into the inside
lining of the arterial wall of the legs. Femoral popliteal
bypass is an open surgical procedure that bypasses the
blocked portion of the artery using a piece of another
blood vessel.
Abdominal endovascular aneurysm repair (EVAR) is a
minimally invasive endovascular procedure which is
an alternative to major open surgery for the repair of
abdominal aortic aneurysms. Instead of open surgery,
access to the aorta is achieved through small incisions in
the groin through which catheters are passed and then
used to place a stent with a specifically designed liner
to reinforce the weakened part of the aorta. EVAR has
significant benefits for older patients as it leads to faster
recovery with fewer complications than open surgery.
25
ANNUAL REVIEW 2013
PATIENT CENTRED ACCESS TO CARE
Over 6,000 calls were received by our team of Cardiac Nurses on our urgent
cardiac care phone line 1800 247 999 in the last 12 months.
24/7 URGENT CARDIAC CARE
LOCAL ACCESS CLINICS
As part of our commitment to putting patients first in
November 2011 we extended access to the Heart and
Vascular Centre to 24 hours a day, 7 days a week.
Over 5,000 patients attended for urgent assessment
or treatment over the last 2 years.
Dedicated Cardiology Outpatient Clinics in Drogheda,
Navan, Mullingar, Sligo and Limerick saw over 1,500 patients
in 2013. Patients typically attend the clinics for either a nonurgent cardiac consultation or for a follow-up consultation
post-procedure.
15% of patients accessed
UCC after hours
People can call our cardiology nurse specialists on our
Urgent Cardiac Care number 1800 247 999 and have access
to our full range of services at any time. In 2013 over 2,700
people used this service.
26
The clinics provide a wide range of non-invasive testing
including Echocardiography, Carotid Ultrasound, Stress
Testing, ECG, Holter and Blood Pressure Monitoring.
Mater Private Clinics at
Drogheda, Navan, Mullingar,
Sligo and Limerick saw over
1,500 patients in 2013
HEART & VASCULAR CENTRE
INTEGRATED CARE
The Mater Private Diabetes Centre
opened in October 2013 to
provide a Consultant delivered,
integrated diabetes care service
Adults with diabetes are two to four times more likely to
have heart disease or a stroke than adults without diabetes.
Cardiovascular care plays an important role in the
management of Diabetic patients and as such the newly
established Mater Private Diabetes Centre has close links
and strong integration with the Heart and Vascular Centre.
Heart disease and stroke are the No. 1 causes of death
and disability among people with type 2 diabetes. In fact,
at least 65 percent of people with diabetes die from some
form of heart disease or stroke.
The Diabetes Centre ensures patient’s receive specialist
care in one coordinated and integrated setting, with the
aim of getting them on the right track with their diabetes
management from the start.
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Delivering integrated care enables us to ensure that
the patient is firmly at the centre of everything we
do, no matter what their diagnosis.
The Diabetes Centre acts as an organisational hub
for patients, facilitating access to specialist services in
diabetes management, endocrinology, cardiovascular,
ophthalmology and nephrology, coordinating patient
care under one roof.
ist
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D ia
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Services
27
ANNUAL REVIEW 2013
28
03
CANCER CENTRE
The Mater Private is the leading private cancer centre
in Ireland. Every patient is treated with the highest
quality, innovative care while recognising that each
patient is an individual.
29
ANNUAL REVIEW 2013
INTRODUCTION
I am delighted to provide you with an update on the activities of the Mater
Private Cancer Centre in 2013. Our Cancer Centre is the busiest and most
comprehensive private cancer centre in Ireland providing excellent patient
care in our Dublin hospital and our Radiation Oncology unit in Limerick.
A further cause for celebration during the year was the
opening of the Clatterbridge Clinic which is a private centre
operated by the Mater Private in the Northeast of England.
The clinic is based on the Wirral outside of Liverpool and
provides radiotherapy and chemotherapy treatments. The
Mater Private is the first Irish hospital to run a private unit
in an NHS trust and won the right to do so as a result of a
competitive tender.
The Mater Private Cancer Centre is staffed by an expert
group of Consultants across the full range of specialties
including Radiology, Pathology, Surgery, Medical Oncology,
Radiation Oncology and Palliative Care. In 2013 our
expertise was enhanced with a number of additions to
our team including Cathy Kelly Medical Oncology, Karen
Redmond Thoracic Surgery, Mitchell Barry Breast Surgery,
Paul Hegarty Urology and Helen Hegarty Urology. Our
Consultant group is assisted by a dedicated team of
nursing, allied health professionals and support staff. The
aim of all of the team is to provide the highest quality care
to each patient ensuring the best outcomes of treatment
but also to recognise that each patient is an individual with
personal and emotional needs.
In 2013 we were focused on providing services to support
the personal needs of our patients both during and after
their cancer treatment. We hosted a number of “Moving
On” programmes to assist patients with their adjustment
to living life after their treatment is completed. Information
and support equips cancer survivors to enjoy a healthy
and full life.
In the cancer centre we also pride ourselves on providing
new and innovative technologies and in 2013 we treated
our 100th prostate cancer patient with High Dose Rate
(HDR) brachytherapy and we continue to be the only centre
in Ireland providing this treatment.
30
30
The Mater Private embarked on an extensive building
programme during 2013 to improve the physical facilities
of the hospital for our patients. By the end of the year we
were ready to open a new day unit for patients receiving
chemotherapy that is more spacious and improves the
treatment experience for patients. Other improvements
include a refurbished radiology department and waiting
area, where our patients regularly attend for scans. Our
building programme continues into 2014 and we will make
further improvements to our patient facilities.
I look forward to leading the Mater Private Cancer Centre
into 2014 and beyond and am committed with my team
to continuing to provide innovative services that improve
patient outcome and wellbeing.
Yours sincerely,
Dr. Michael Maher
Chairman
Mater Private Cancer Centre
CANCER CENTRE
EXPANSION
The Clatterbridge Clinic – Expansion into the UK.
The Clatterbridge Clinic is a joint venture between the
Mater Private and the Clatterbridge Cancer Centre, one of
the largest UK cancer centres. Opened in June, it provides
chemotherapy and radiotherapy to insured patients.
A state-of-the-art Truebeam linear accelerator provides
advanced technological treatment options. Patients
attending the Clatterbridge Clinic have access to highly
specialised cancer treatments – Proton Therapy and
Papillion Therapy. Proton Therapy in used to treat eye
cancers and we are the only site in the UK to offer Proton
Therapy. Papillion is a form of contact radiotherapy for early
colorectal cancers.
Since opening the clinic has provided over 1,000 radiotherapy
treatments and over 200 chemotherapy treatments.
Truebeam linear accelerator
Proton Therapy
1,000+ radiotherapy treatments
Papillion Therapy
31
ANNUAL REVIEW 2013
CANCER DIAGNOSIS
The Mater Private is established as the leading private cancer centre in Ireland.
The Mater Private Cancer Centre provides comprehensive
care for the full range of cancer types including solid
tumours and blood cancers. The most frequent cancer
types treated in the Mater Private are prostate cancer in
men and breast cancer in women.
Research has shown that contact with the arts, such as
music and theatre, has a positive impact on the healing
process for cancer patients. In 2013 we hosted 10 events for
patients undergoing treatment including music, art, poetry
and drama readings. We were fortunate to be joined by well
known artists such as Roddy Doyle, Peter Sheridan and the
Shannon Colleens for these events.
Solid tumours 2013
300
250
200
150
100
50
0
Prostate
Breast
Gynae
Lung
Colorectal
CANCER PREVENTION
In 2013 focus shifted to the role we could play in the
prevention of cancer. An initiative was established with
a number of organisations to provide cancer awareness
programmes, focusing on education and screening.
The Irish Midwifes and Nursing Organisation and
companies such as Dell and Hewlett-Packard participated
in this initiative. Over 3,400 individuals received information
on cancer prevention directly at their place of work and
screening was made available for at risk individuals. This
programme identified a number of individuals with a
cancer diagnosis who required further treatment.
PATIENT EXPERIENCE
The patient is at the forefront of everything we do in
the Cancer Centre and as such we aim to support each
patient throughout their treatment journey with us. In
2013 we held 3 ‘Moving On’ programmes for patients who
32
have completed their cancer treatment. The Moving On
programme is run over seven weeks and assists patients
to return to a lifestyle that does not involve their cancer
treatment. The programme includes everyday topics such
as diet, exercise, managing fatigue and stress management.
The cancer treatment journey is sometimes a traumatic
experience for a patient and their families. To assist those
who are experiencing difficulties we have introduced a
professional psychology service to compliment the support
already provided by our nursing and social work staff. In
2013 63 patients and their families availed of this service
which assisted them deal with the challenges of living with
a cancer diagnosis.
Our Palliative Care service remains an important part of the
support we offer patients. The service provides support to
those who are both living with cancer and at the end of life,
who need management of their cancer related symptoms.
In 2013 the Palliative Care service carried out over 600
patient reviews with patients receiving both medical and
nursing intervention.
The Mater Private was the first private hospital to be
accepted to the hospice friendly programme and to comply
with the standards for patients who are at the end of life.
The achievements of the programme in the Mater Private
Hospital during 2013 include:
·The establishment of an End of Life steering committee
which oversees the adherence to the Quality Standards
for End of Life care in Acute Hospitals
·Education and training sessions on end of life issues
including the Final Journeys programme for staff from
all disciplines
·Attendance at 3 hospice friendly network meetings
throughout the year
CANCER CENTRE
BREAST CANCER
We benchmark our breast cancer services against the standards established by HIQA
in 2008 and continue to meet and exceed the requirements of these standards.
In 2013 over 1,000 patients attended our Specialist Breast
Centre for assessment of suspicious breast symptoms; a
12% increase on the number of patients attending in 2012.
Our specialist breast centre boasts state of the art
mammography and ultrasound equipment and is staffed
by a team of specialty trained Radiologists, Pathologists
and Surgeons who are aided by a team of Radiographers,
Specialist Breast Nurses and Administration Staff.
Patients urgently triaged and diagnosed at a cancer
centre should be discussed at multidisciplinary
meetings (MDM) within 10 days of first attendance
100%
The Specialist Breast Centre is focused on ensuring that
patients can get their results in an accurate and timely
manner and if required, proceed to treatment rapidly.
Access to Triple Assessment
5 days
Assessment to Surgery
17 days
90%
Mater Private
HIQA std
All patients who generate a histopathology report
should be discussed at MDM
100%
ays
5d
12 d
ay
s
90%
5 d a ys
Access to Triple Assessment
Diagnosis to MDM
MDM to Surgery
Mater Private
HIQA std
100%
of appropriate patients
received Adjuvant Chemotherapy
within 8 weeks
33
ANNUAL REVIEW 2013
PROSTATE CANCER
The first centre in Ireland to introduce the template biopsy diagnostics
procedure and the only centre to offer all types of surgical and radiation
therapy treatment for prostate cancer.
At the Mater Private we continue to consolidate our
position as Ireland's leading prostate centre, offering
the widest range of treatment available in any centre
in Ireland. We are the only centre to offer all types
of surgical and radiation therapy treatment.
In 2013 we were the first centre in Ireland to introduce the
template biopsy procedure for the diagnosis of prostate
cancer. This technique has a number of advantages over the
standard transrectal biopsy method as it allows for a higher
number of samples to be taken, increasing the chances of
identifying a lower grade prostate cancer and also it causes
less side effects.
Innovation drives our relentless
focus to deliver a greater range
of treatments to all our patients
RADIOACTIVE SEED IMPLANTATION
We host the most advanced radiotherapy treatments
for prostate cancer. We were the first centre in Ireland
to provide radioactive seed implants for low risk prostate
cancer and have carried out 740 cases in the last 10 years.
Our outcome data for these patients compares favourably
to that of other centres.
5 Years Post
Seed Implants
Mater Private
International
Overall Survival
Rate
98.1%
72.6% University
of Washington
Seattle
85% University
Medical Centre
Utrecht
Data for 2004-2014
HIGH DOSE RATE BRACHYTHERAPY
ROBOTIC SURGERY
In 2013 we carried out over 180 robotically assisted prostate
cancer surgeries making us the largest surgical cancer
centre in the country. Patients travelled from all over the
country to avail of this innovative surgical technique and
the advantages it can offer to recovery, which include a
shorter hospital stay, less blood loss and a quicker return
to normal activities.
MULTIPARAMETRIC MRI
This year we have commenced multiparamtric MRI
including dynamic contrast imaging for the diagnosis of
prostate cancer. Multiparametric Contrast MR imaging is
used to guide template transperineal biopsy and transrectal
biopsy, where indicated.
34
In 2008 we commenced the first high dose rate
brachytherapy programme for patients with prostate
cancer in Ireland and continue to be the only centre
offering this treatment. In 2013 we treated 34 patients
with this technique. Patient numbers for this service will
grow in 2014 as the treatment has been recognised as the
gold standard for many intermediate risk prostate cancer
patients in addition to high risk patients.
NEW INNOVATION
In 2014 we plan to introduce a number of new treatments
for prostate cancer including the injection of Xofigo 223
which is a radioactive isotope that has been shown to be
beneficial in some types of advance prostate cancer and
High Intensity Frequency Ultrasound which is used to treat
localised prostate cancer.
CANCER CENTRE
CANCER DIAGNOSIS
Accurate and timely diagnosis is vital to the provision of cancer care.
CANCER GENETICS
In 2013 the Mater Private actively participated in National
Quality Assurance Programmes designed by the Royal
College of Physicians to enhance cancer diagnosis in
Ireland; specific programmes have been developed for
histopathology, radiology and endoscopy. In the Mater
Private expert teams of Pathologists and Radiologist lead
our cancer diagnosis services.
Our genetics service was the first of its kind in
Ireland. Extensive coverage concerning Angelina
Jolie being positive for the BRCA gene led to
significant interest regarding the role of genetics
in the development of cancer.
PATHOLOGY
218 patients and their families attended our genetics clinic
and were assessed by our specialist genetics consultant
and nurse counsellor.
During 2013 our team of Pathologists and medical scientists
assessed tissue samples from over 8,000 patients. Our
turnaround times compared favourably to the standards
established by the National Quality Assurance Programmes.
Sample Type
National
Benchmark
Mater Private
Small Biopsy
80% available
in 5 days or less
97%
GI Endoscopic
Biopsy
80% available
in 5 days or less
100%
Cancer
Resection
80% available
in 7 days or less
100%
RADIOLOGY
Our team of 11 sub-specialty trained Radiologists provide
a comprehensive range of services including CT, PET/CT,
MRI, Nuclear Medicine, Mammography, Ultrasound and
Interventional Radiology. Cancer patients avail of these
services to diagnose their disease and to monitor the
progress of the any treatment.
As the national leaders in the field we also undertake
research to advance the field of oncology genetics. The
results of four research projects initiated and supervised by
Dr. Gallagher in the Mater Private Hospital were presented
at the American Society of Clinical Oncology meeting in
Chicago in June 2013. The projects focused on the genetics
of ovarian cancer, cervical cancer, and colorectal cancer.
One of the team working at the Mater campus earned a
prestigious ASCO Merit Award for her work focusing on the
role of telomere length in the initiation of colorectal cancer.
MULTIDISCIPLINARY MEETINGS
In 2013 the care and treatment of almost 1,800
patients was discussed at multidisciplinary
meetings (MDMs) relating to solid tumour cancers.
The review of diagnostic information by a multidisciplinary
team is the cornerstone of confirming cancer diagnosis and
planning the appropriate treatment.
Tumour site specific MDM meetings take place across the
Mater Campus on a regular basis, enhancing the patient
care and management with sub-specialist input, opinion
and discussion on individual cases.
In 2013 there were over 50,000
individual patient visits to our
Radiology department
35
ANNUAL REVIEW 2013
CANCER TREATMENT
CHEMOTHERAPY
106 patients treated as part
of a clinical trial
In 2013 we delivered close to 7,000 chemotherapy
treatments to 500 patients with a cancer diagnosis; this
represented a 10% increase on the previous year. This
service is led by a team of specialist oncologists and
haematologists who are assisted by a dedicated group
of nursing and other health professionals.
We are dedicated to providing access to chemotherapy
clinical trials to increase treatment options for our patients
but also to advance the understanding of cancer treatment.
In 2013 we opened six new trials to patients to increase
the total number of trials available to patients to 28.
RADIOTHERAPY
The Mater Private provides radiotherapy at 2 sites nationally,
offering patients access to wider range of radiotherapy
treatment and expertise.
Radiotherapy treatment
centres in Dublin and Limerick
Our services are located at the Mater Private in Dublin and
at the Mid-Western Radiation Oncology Centre in Limerick.
26,000 external beam
treatments
We offer state of the art treatments to patients including
Intensity Modulated Radiation Therapy, Imaged Guided
Radiation Therapy, 4 Dimensional CT planning and
Volumetric Modulated Arc Therapy.
Intensity Modulated
Radiation Therapy
Imaged Guided
Radiation Therapy
4-Dimensional
CT planning
Volumetric Modulated
Arc Therapy
The excellent care provided by our radiation therapy team
was acknowledged when our Limerick team were selected
as finalists in the Medray sponsored Department of the
Year award.
We strive to ensure that patients access radiation treatment
in a short a timeframe as possible. In 2013 our access to
treatment was measured in Limerick versus the National
Cancer Control Programme framework.
Standard NCCP Standard:
90% of patients should commence on treatment within
15 days of being ready for treatment.
Mid-Western Radiation Oncology Centre:
98% of patients commenced on treatment within 15 days
of being ready.
36
CANCER CENTRE
37
ANNUAL REVIEW 2013
38
38
04
ORTHOPAEDIC AND SPINE
Our strength lies in the knowledge, innovation, expertise
and exacting standards of our team. For patients our goal
is to enhance their mobility and quality of life.
39
ANNUAL REVIEW 2013
INTRODUCTION
I am pleased to update you on the developments and activities in orthopaedics
and spine during 2013.
This was a busy year for spine procedures. There was an
11% increase in the number of patients who underwent
spinal fusions.
The Mater Private Orthopaedic and Spine service has
undergone significant positive changes in the last 12
months, supporting our committment to providing clinical
excellence and putting patients first. Patients are the most
important aspect of our healthcare practice. We provide
our patients with unparalleled, respectful and high-quality
service. Through care and education we focus on the
enhancement of mobility and quality of life for our patients.
A key priority for us is that we provide treatment consistent
with national and international guidelines.
Our strength lies in the knowledge, innovation, expertise
and exacting standards of our Consultants. Our team
of 14 expert Consultants are assisted by a Multidisciplinary
team of nursing and health professionals who are dedicated
to supporting the patient through their journey in the
Mater Private.
In 2013 we were pleased to welcome Mr Seamus Morris
Consultant Orthopaedic and Spine Surgeon to our team.
40
It was a very successful year in terms of patient outcomes
and the development of patient services. We lead the way
in the private hospital sector, being the first to implement
an Enhanced Recovery Programme for joint replacement
patients. This programme is a new model of care, putting the
patient at the heart of their own recovery. Positively it results
in a shorter hospital stay and a more rapid recovery allowing
patients to return to normal daily activities sooner. The
setting up of this programme required the enthusiasm and
positive collaboration of the whole multidisciplinary team.
It was this spirit of cooperation which achieved the optimal
outcome for patients. This initiative was hugely successful,
as you will read further on in our report.
In the coming year we will open a Rapid Access service
for Orthopaedic and Spine patients. This will enhance
patient’s access to our services and patients will be seen
in the clinic within 10 working days. We also look forward
to welcoming our new colleague Mr James Cashman to
our team of Consultants.
Yours sincerely,
Mr. Keith Synnott
Keith Synnott F.R.C.S.I., (Tr & Orth)
Consultant Orthopaedic Surgeon
Clinical Lead Mater Private Orthopaedic
& Spine Service
ORTHOPAEDIC & SPINE
INTEGRATED MULTIDISCIPLINARY TEAM
The Orthopaedic and Spine team at the Mater Private cross a wide spectrum
of disciplines and specialties.
Our department includes 14 Consultant Surgeons,
Anaesthetists, Clinical Orthopaedic Nurse co-coordinator,
dedicated Pain Nurse specialist, experienced Theatre
Nurses and Assistants, senior Clinical Nurse Managers in
orthopaedics, a Rehabilitation Team led by senior triage
qualified Physiotherapists, outpatient Rehabilitation and
Sports Physiotherapists, Occupational Therapists and a
dedicated Orthopaedic ward with an experienced care team.
We work in cooperation with the wider Mater Campus
and benchmark ourselves against international centres
of excellence. We have established links and comparable
standards of care with our colleagues in the Rothman
Institute, Philadelphia. Clinicians and hospital management
share goals to ensure continuous improvement in the
service delivered to our patients and in 2013 as we strived
to consistently ‘get it right’ from the patients perspective.
With the wealth of experience amongst our team, the
conditions treated under the umbrella of orthopaedics and
spine is immense and encompasses the whole spine, upper
limb including hand and lower limb including foot and ankle.
In 2013 we continued to be committed to putting our
patients first by providing clinical excellence with best in class
outcomes, embracing the changes required to deliver a world
class patient experience. Patient Related Outcome Measures
(PROMS) are in place for Orthopaedic and Spine patients.
Radiology
Consultant
Surgeons
Anaesthetists
Administration
Social
Work
Orthopaedic Nurse
Co-coordinator
MULTIDISCIPLINARY
CARE
Pain Nurse
Specialist
Nursing
Occupational
Therapy
Theatre
Physiotherapy
41
ANNUAL REVIEW 2013
OPTIMISING PATIENT OUTCOMES
In benchmarking ourselves against other National and International Centres,
the Mater Private comes out strongly in terms of positive outcomes for patients.
JOINT REPLACEMENT
+2.3% increase in Joint
replacement surgery
ALOS Primary Total Hip Replacement
37%
26%
21%
16%
Some of the indicators we benchmark our performance
against include mortality rates, readmissions to theatre,
infection rates and average length of stay (ALOS).
ALOS primary total knee
replacements down 10%
ALOS primary total hip
replacements down 27%
≤ 4 days
5 days
6 days
≥ 6 days
ALOS Primary Total Knee Replacement
32%
27%
There was a 70% reduction in the number of patients
who developed venous thromboembolism (VTE) in 2013,
building on a 36% reduction in the previous year.
The number of wound related blisters reduced notably,
by 60% to 2.01%, which is significantly below the current
international incidence of between 10% and 35%.
Standardisation of care processes and the implementation
of clinical audits supported early recognition of
complications, effectively reducing complications
in 2013, delivering excellent results on key measures.
42
21%
20%
Improvements in the patient mobilising early and exercising
comfortably with confidence, has played a significant role
in reducing complications and improving outcomes.
≤ 4 days
5 days
6 days
≥ 6 days
ORTHOPAEDIC & SPINE
SPINAL SURGERY
With the implementation of clinical audits, we regularly
track a range of measures, which enable us to ensure
we are delivering optimum outcomes.
650+ spine surgeries
The upward trend of spinal fusion procedures over the past
number of years continued with an 11% increase in the last
12 months.
The procedures performed included lumber and cervical
discectomy, decompression and single and multi level
spinal fusions. Interdisciplinary team collaboration ensures
our patients continue to receive the highest quality care
based on national and international best practice adopted
to suit our patient population.
The positive outcomes in 2013 for all spine patients are
underlined by our zero mortality rates and reduced pain
scores post-operatively.
A major success of 2013 was achieving a 58% increase in
the number of patients reaching their target length of stay
(2 days) for Discectomy and Decompression procedures.
71% of patients now go home in 2 days.
Lumbar Decompression – Discectomy
Antibiotic Prophylaxis prior to Surgery
99.8%
Antibiotic Discontinued within 24 hrs
97.3%
Unscheduled admissions to ITU
1.3%
Inpatient Falls causing Injury
– Single Level – 0%
Post-op LOS ≤ 2days
71%
45%
2012
2013
Inpatient Falls causing Injury
– Multi Level – 0.8%
Mortality
0%
11% of patients were
discharged Day 1 post-op
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ANNUAL REVIEW 2013
MULTIDISCIPLINARY TEAM MEETINGS
(MDT)
Multidisciplinary Team meetings are held with participation
from a wide cohort of the healthcare team resulting in a
number of positive impact initiatives being put in place.
• A
n Integrated Care Pathway for Lumbar Spinal Fusion
surgery patients ensuring consistency of care.
• R
educed number of blood transfusions by taking
corrective action for patients with low haemoglobin
levels prior to surgery and by extending the use of
post operative cell salvage.
• T he Pain Nurse, Anaesthetics and Surgeons
implemented changes which improved post operative
management of pain, nausea and vomiting.
• T he patient’s journey from admission to theatre
improved as a result of more efficient scheduling
and patient flow.
POST-OPERATIVE REHABILITATION
2013 saw the development of a post-operative
Rehabilitation Programme for back and neck patients.
Current research into clinical best practice shows that best
outcomes for post-op spinal fusion patients occur when
a psychomotor approach to physiotherapy treatment is
utilised. Based on the STarT Back programme, patients
are evaluated and any psychomotor aspects which are
preventing the patients achieving their goals towards full
independence are identified.
It is well recognised that some patients, having suffered
back pain for a period of time before surgery, are afraid
to bend post-surgery as bending increased their pain
prior to surgery. This fear of bending acts as a barrier
to postoperative physical rehabilitation.
Our Clinical Specialist Physiotherapist tackles both
physical and non-physical drivers of pain directing
treatment towards the whole person rather than the
individual symptom. In addition to this, the physiotherapy
team designs individualised, patient specific exercise
programmes to support rehabilitation.
This process focuses on putting the patient in the driving
seat and enabling them to work towards new goals to
improve mobility, flexibility and strength.
This new treatment approach
was used for all post-op spinal
fusion patients, over 500 of
whom attended for outpatient
review in 2013
44
ORTHOPAEDIC & SPINE
ENHANCING RECOVERY
ENHANCED RECOVERY PROGRAMME
(ERP)
In 2013, based on the experience of international centres
of excellence, we implemented a pilot programme
for a new mode of care for joint replacement patients
– Enhanced Recovery.
The Enhanced Recovery Programme (ERP) is a
multidisciplinary and goal based approach which
encourages the patient to become an active participant
in their recovery process and rehabilitation. The goals are
to minimise the physical and mental stress of surgery
through preparations and participation so that patients
return to normal daily activities as soon possible.
The ERP demonstrates the benefits of establishing shared
goals between Clinicians and Management. It has been
embraced by the entire team involved in the patient
journey, resulting in positive changes to clinical practice
and patient experience.
JOINT SCHOOL
The Joint School is a key component of the enhanced
recovery programme. The aim is to prepare patients for
surgery, to ensure that they are as fit as possible for surgery
and ready to be an active participant in their care.
Patients learn how to prepare for surgery and for recovery.
They meet with members of the entire team who take the
patient through the surgery, anaesthesia, physiotherapy,
recovery and pain relief.
The Joint School has been hugely successful in encouraging
and enabling patients to become active participants in their
care. This preparation and involvement is removing the
fears and anxieties many patients experience prior
to surgery.
Surgeon
ENHANCED RECOVERY PROGRAMME
Physiotherapy
Team &
Occupational
Therapist
Pre-assessment Clinic
Joint School
Admission on Day of Surgery
Anaesthetist
Pain
Specialist
PATIENT
& COMPANION
Integrated Patient Care Pathway
Post-operative Rehabilitation
Nursing
Team
Social
Worker
Pain Specialist
Nursing Team
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ANNUAL REVIEW 2013
A new model of care – embracing change to improve patient outcomes
A number of process changes were implemented
as part of the ERP programme, delivering notable and
welcomed changes.
Timing and frequency of nursing and physiotherapy
intervention adapted to start rehabilitation within
24 hours of surgery.
Pain
Joint range of movement
Muscle strength & higher scores for gait & balance
'Joint School' preparation helped reduced cognitive
confusion in the elderly following hip or knee replacement.
Post-op sleep disturbances
Pain
Opioid requirements all of which can impair
cognitive function
11% more patients were discharged to their own homes
during the ERP pilot when compared to the 2012 prior to
the introduction of ERP.
Hospital stay
Mobilisation within hours of surgery as a result of
anaesthetic protocol changes and ‘Joint School’ preparation.
Discharge Destination
Significantly reduced rates of urinary catheterisation
72%
A multimodal analgesia strategy was implemented,
moving away from opioid based analgesia.
28%
80%
20%
Decreased side effects (e.g. nausea/vomiting)
Reduced pain scores
Convalescence
2012
Home
2013
COMMENTS FROM OUR PATIENTS
The impact of ERP & Joint School as described by our patients:
"I feel twice as far on in my recovery now compared to
my previous hip replacement with regard to my walking
and everything in general"
"I was so scared I had put off the surgery for so long,
after the surgery I just couldn’t believe how good my
new hip was"
"Joint school was brilliant, psychologically to be told
'you’re not sick' had such an impact I feel, the last time
I had my hip operation I didn’t get dressed for 3 weeks!"
"I was in town with my daughter the week after
I left the hospital and was off all sticks by week 5"
"The joint school gets you focused and prepared,
I picked up a lot of very useful information"
"Brilliant help, advice and care, the encouragement
especially helped me"
46
"Joint school was excellent and very informative as
within a week of seeing the consultant I had the
operation so the joint school really helped me"
ORTHOPAEDIC & SPINE
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ANNUAL REVIEW 2013
48
48
05
OPHTHALMOLOGY
Our goal is protecting and restoring vision. Rapid access
to assessment and treatment by an integrated care team
plays a key role in limiting sight loss or impairment.
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ANNUAL REVIEW 2013
INTRODUCTION
It is with great pleasure that I present an update from the Eye Centre at the
Mater Private for 2013.
We continue to be the largest private ophthalmology
group in Ireland with 14 consultants, having added 3 new
colleagues this year, Ms Catriona Kirwan, Ms Brid Morris
and Mr Marc Guerin.
We cover all the subspecialties in Ophthalmology including
cataract, eye laser, retinal disease (medical and surgical),
neuro-ophthalmology, glaucoma, oculo-plastics/orbital
disease, low vision and paediatric ophthalmology. We are
all under the umbrella of the Eye Centre incorporating three
main strands, Eye Laser Centre, Retina Centre and General
Eye Centre. This allows us to provide clarity to our patients
when they attend any of us at the Mater Private. In all areas
our consultant team are supported by a dedicated team of
nurses, secretaries and administrative staff to ensure total,
supportive and smooth care. Our goal is protecting and
restoring vision.
We have continued to provide care for our patients and
in 2013 have performed in the region of 1,850 cataract
surgeries, 1,500 refractive surgeries, 2,600 injections, 180
vitreo-retinal procedures such as vitrectomy and have
assessed over 6,000 patients in our retinal centre.
In 2013 we were delighted to commence a number of
initiatives around eye care in Ireland. We were the first
unit outside the US to insert the Intra-ocular Magnifying
Telescope (IMT) commercially and are the only centre in
50
Ireland offering this surgical and rehabilitation programme
(Centra-SightTM). We implanted 3 devices in 2013. We also
commenced the novel eccentric vision training system
under Ms Catriona Kirwan to aid patients with low vision
needs through a non-surgical approach. Additionally,
we have commenced an in-house low vision service
to help our patients with a range of external low vision
aids. The Laser centre continues to be at the forefront of
technological advances in this country and commenced
the presbyopic laser treatment programme to help patients
overcome their need for reading glasses. The corneal team
led by Prof Michael O’Keeffe commenced the corneal
cross-linking programme for treatment of keratoconus (a
blinding corneal condition). We continue to acquire new
technologies to speed up or make more accurate the
assessments of our patients leading to better outcomes in
glaucoma, neuro-ophthalmic, cataract, retina and refractive
laser surgery care.
We have taken the opportunity, as the Mater Private have
increased paediatric activity at the hospital, to expand the
range of paediatric ophthalmic services offered here. Our
team of 4 paediatric ophthalmologists with support from
retina and neuro-ophthalmology offer the full range of
paediatric eye care now at the Mater Private.
For 2014 we are very excited about expanding the
innovations introduced in 2013. We plan to enhance the
Retina Centre rapid access service. Additionally, we strive to
continue to provide excellent, innovative, readily accessible,
quality care for all our patients.
Yours sincerely,
David Keegan
Consultant Ophthalmologist
Clinical Lead, Mater Private Eye Centre
OPHTHALMOLOGY
RAPID ACCESS TO CARE
More than half of all sight loss is avoidable. Rapid access to assessment
and treatment plays a key role in limiting sight loss or impairment.
At the Mater Private we offer a Rapid Access to specific
services where time is critical in managing sight
impairment. With the integration of multiple specialties
supported with a framework for rapid access to care,
we work to deliver the best clinical outcome for patients.
Patients Referred 2010-2013
7000
+35%
6000
5000
4000
RAPID ACCESS RETINAL SERVICE
This service is available for routine and urgent patients,
offering faster access to diagnosis and treatment for
conditions affecting vital vision and central vision.
Fast-track triage of urgent referrals prioritises patients
based on the severity of their condition.
3000
2000
1000
2011
2012
2013
Patients referred
Our team of 4 retinal specialists take a front line approach
to patient management as treatment and technology
evolve, ensuring the highest quality of care and best
practice. Our consultants are supported by nurse
photographers who provide advanced imaging using
state of the art imaging equipment.
One of the largest and most experienced eye laser
units in the country.
This service is easily and readily accessible for patients,
GP’s, Optometrists and Consultants, and we have seen
steady growth in patient numbers over the last 4 years.
This includes an increasing number of paediatric cases
with complex eye conditions.
Rapid Access to the Eye Laser Centre is available to patients
for whom an appointment for assessment can be booked
over the phone with no referral letter necessary. Our
doctors are contactable 24/7 for emergencies during the
critical post-operative period.
6000+ patients
+35%
RAPID ACCESS EYE LASER SERVICES
Over 20,000 refractive surgeries have been performed since
the centre was established in 1992. Thousands of satisfied
patients have come to recognise our commitment to the
highest standards of quality care provided by world leaders
in this specialty.
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ANNUAL REVIEW 2013
INTEGRATED MULTI-SPECIALIST CARE
Our dedicated multidisciplinary team (MDT) of nursing, allied health professionals
and support staff work in close collaboration with our Consultant group.
We strive to ensure the journey through our care and
treatment for each and every patient is of the highest
quality and results in clinical outcomes that have a tangible
impact on the patient’s quality of life.
Our patients are treated on site within the Mater Private
for all their visual needs whether they require medical
surgical or educational interventions. A broad spectrum
of care is provided to our patients ranging from simple
eye conditions to complex eye disorders.
Medical and surgical interventions range from traditional
methods to innovative new procedures incorporating the
latest technology available. The use of intraocular lenses
from the progressive telescopic implant to the more
common monofocal and mutifocal implant allow surgeons
to preserve the best possible vision for their patients.
SURGICAL SERVICES
A variety of surgical procedures are performed at the Mater
Private Eye Centre in 2013. These include Cataract surgery,
Corneal surgery including Corneal laser, Glaucoma surgery,
Retinal surgery, Strabismus surgery (eye muscles) and
Occuloplastic surgery (eyelids, orbit and tear ducts).
Refractive Surgery
Our Consultant Ophthalmic Surgeons offer bladeless,
wavefront guided customised laser treatments using
the most up to date Femtosecond and Excimer laser
technologies. We perform Laser surgery for short sightedness,
long sightedness, astigmatism and presbyopia (the need for
reading glasses). All short sighted patients are treated with
the most up to date technology of the Ziemer Femtosecond
laser for definite precision, and faster eye recovery.
52
For those unsuitable for laser surgery, we also perform
lens implantation. This type of lens is placed in front of the
natural lens, acting like a contact lens inside the eye.
1,500 surgeries; more than any
other centre in the country
This refractive service has a long track record in safety
and experience, offering the highest standards of care,
in particular in relation to post-operative care.
Cataract Surgery
Cataract surgery is one of the most commonly performed
eye surgeries.
Over 1,850 cataract
surgeries in 2013
The patient’s individual visual needs and lifestyle are always
considered when selecting an appropriate intraocular
lens. We are looking to achieve a high level of ‘spectacle’
independence for all patients where possible. Historically
cataract patients were offered a Monofocal lens designed
to improve their distance vision. Consultants at the Mater
Private now offer Multifocal lenses to suitable patients, in
addition to the conventional lens technology providing
correction for near and distance vision. This preserves
maximum vision, enabling patients to see without glasses.
A Biometry eye exam is necessary to calculate all intraocular
lenses. This process has dramatically changed in recent
years with the introduction of optical biometry devices.
The Eye Centre nursing team can perform this test within
minutes and without touching the eye in 90% of all cataract
patients, irrespective of previous surgical intervention.
OPHTHALMOLOGY
Almost 9 out of 10
patients never need
to wear distance glasses
Vitreo-retinal Surgery
Patients are referred to the Mater Private Hospital for all
surgical retinal procedures and we carry out macular hole,
epiretinal membrane, diabetic retinopathy, primary and
re-do retinal detachment surgery. Patients are also referred
to the Mater Private from other eye centres nationwide for
complex retinal surgery.
In 2013 our surgical retinal specialists performed over
180 vitreo-retinal operations for retinal detachment,
vitreous haemorrhage, trauma, macular hole and
epiretinal membranes.
The use of state-of-the-art, sutureless micro-incision
technology, offers significant benefits to the patient
including:
• Faster visual recovery
• Excellent patient comfort
• Better post-operative appearance
• Shorter surgical time
NON SURGICAL SERVICES
Some eye conditions (such as Glaucoma, Uveitis and
Macular Degeneration) do not require surgical
intervention but need continuous monitoring, evaluation
and appropriate treatment. The Mater Private Eye Centre
facilitates this monitoring process, providing accurate
testing using technology to its best.
Low Vision Aid Clinic
When conventional surgery or medical treatment is not
appropriate to address a sight limitation, we provide
patients with the support of a low vision specialist clinic.
This clinic focuses on techniques and technology which
can be used to enhance partial vision.
The degree and type of vision loss is assessed and evaluated
to identify options for the patient, which can include
low vision aids such as magnifiers, telescopes and video
magnifiers. The patients are trained and supported in the
use of these aids.
Training programmes assist patients with low vision to
use a healthier part of the macula to maximise their vision.
Intravitreal Injections
The number of eye injections for medical retina patients
has been increasing year on year and showed an increase
of 20% in 2013. Individualised patient treatment regimens
provide patients with sustained improvement in vision.
Clearly defined guidelines and protocols in using new
treatments allow us to suppress conditions affecting the
retina (AMD wet, diabetic eye disease and vein occlusion) to
help stabilise or improve vision. With correct administration
of intravitreal treatments many (70%) patients can recover
vision and at least 95% will stabilise their vision. In addition,
the rapid access service allows patients faster access to
diagnosis and treatment affecting the vital central vision.
Eye Injections – 5 Years of Sustained Growth
+20%
+41%
+60%
+43%
Specialist Diagnostic Equipment
Specialist diagnostic equipment such as, Visual Fields,
MAIA Microperimeter, OCT (optical coherence tomography),
Optos Camera, Fluorescein Angiography and Corneal
Topography deliver the best possible ophthalmic care
for all patients no matter what eye condition is presented.
2009
2010
2011
2012
2013
Patients referred
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ANNUAL REVIEW 2013
PERSERVING AND MAINTAINING VISION
INNOVATION
Avedro KXL Accelerated Cross-linking system
In 2013 our ophthalmology service continued to lead the
way in cutting edge technology. Consistent with our mission
to preserve, restore or enhance the gift of sight through
leading edge technology and innovative procedures.
The Avedro KXL Accelerated Cross-linking system is another
advanced piece of equipment introduced in 2013. This
technology has halved the surgical time which is more
comfortable for the patient.
Telescopic Implant
This system treats Keratoconus which is a condition
that affects the cornea during teenage years with rapid
progression. Treatment is most beneficial when done early
before the shape of the cornea becomes too abnormal.
Cross linking does not make the keratoconus better, but
prevents it from getting worse and may prevent the need
for corneal transplantation. The Mater Private has provided
this service for children referred from the Children’s
University Hospital and our four Paediatric Consultants
continue to work closely with this hospital to deliver the
best possible care to the children of Ireland.
The Mater Private Eye Centre is the first and only hospital
on the island of Ireland and only one centre of only 7 in
Europe, to introduce this innovative procedure which
involves the implantation of a miniature telescopic device
in one eye behind the iris to treat end-stage age related
macular degeneration (ARMD).
Smaller than a pea, the telescope implant uses microoptical technology to magnify central vision. Enlarging
images up to 3 times, it improves vision through the use
of magnification but it does not restore vision fully to the
level it was before ARMD.
For patients this offers the opportunity to increase their
independence and re-engage in everyday activities. It also may
help patients in social settings as it may allow them to recognise
faces and see the facial expressions of family and friends.
MAIA Microperimeter
An MAIA Microperimeter, the gold-standard in optometry
and ophthalmic equipment, was installed in 2103 to
support the new low-vision clinic. This is an invaluable
tool in the assessment of the macula.
The MAIA Microperimeter enables Consultants to diagnose
and treat patients who suffer with Age-Related Macular
Degeneration (AMD). It monitors retinal functional changes
and observes the effectiveness of treatment over time.
It offers multiple fixation targets, which helps patients
with central scotoma (loss of central vision) visualise the
target during the sensitivity test. This feature enhances
the identification of the Preferred Retinal Locus (PRL) and
decreases the examination time in patients with highly
unstable fixation.
The microperimeter has also been instrumental in a number
of studies which the hospital has undertaken on ocular
pathology, with further studies planned for the future.
54
Ultra-wide digital retinal scanning
Traditional ways of looking at the retina only show a small
part of the retina at one time. The Optomap® retinal exam
shows almost the entire retina at once. The Optos camera
was introduced to the department in 2013, as one of only
a few private facilities to use this ultra-wide technology.
It delivers dynamic, ultra-wide field, ultra-high definition
colour, red-free and fluorescein angiography.
Panoramic imaging
> 80% of the retina
captured in a single view
In 2013, 30% more patients were referred for fluorescein
angiography and 25% for retinal photography with the
optomap® camera.
The images are created by non-invasive, low-intensity
scanning lasers. To date we have captured over 20,000
images, allowing our patients thorough and detailed
assessments, enhancing diagnosis and treatment plans.
OPHTHALMOLOGY
Without optomap
With optomap ultra-widefield retinal imaging
15%
80%
RESEARCH
Inherited Retinal degeneration
We are committed at the Mater Private Eye Centre
to participate in collaborative research and drive
our own initiatives. We are involved in a number
of multicentre retinal studies.
Patients attended the retinal eye centre to be included
in the inherited retinal degeneration study under the lead
of Mr. David Keegan
The laser centre at the Mater Private Hospital has been at
the forefront of refractive laser research for 20 years and
continues to innovate with new approaches and studies.
The Luminous program
This is one of the largest observational studies in
ophthalmology and consists of two parts launched in 2011.
Over 30,000 patients are expected to enroll in over 80
countries worldwide looking at the efficacy and safety of
lucentis (anti- VEGF drug) in licensed indications in real time.
This study will describe the long-term safety and
effectiveness, treatment patterns, and patient reported
quality of life associated with ranibizumab treatment in
routine clinical practice for the medical retinal conditions:
Wet Age Related Macular Degeneration, Diabetic Macular
Edema and Retinal Vein Occlusion
This study, which is a collaboration with the Mater
University Hospital, the Royal Victoria Eye and Ear Hospital,
Crumlin and Temple street Children’s hospitals, is aimed at
developing the first complete Irish registry for inherited
retinal degenerations (IRD). Data collected will benefit
future patients with inherited retinal conditions and give
Ireland the opportunity to be part of the new and emerging
prospects of gene therapy, artificial retinas, stem cell
transplants and neuro-protectant drugs.
Multiple sclerosis clinical trial (contra indication
of a drug that it effects the macula)
Patients were referred from Beaumont Hospital and St
Vincent’s Hospital for a complete ophthalmic examination
with Ms Louise O Toole. This study was a 4 month, open
label, multi centre; single treatment arm design included
approximately 1,850 patients with relapsing MS.
The aim of the study was to evaluate the safety and
tolerability of fingolimod drug in patients with relapsing
form of multiple sclerosis.
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56
06
EAR NOSE & THROAT (ENT)
Caring for adult and paediatric patients with a comprehensive,
patient centred service. Our specialist team provide
assessment, medical and surgical treatment of the
ears, nose, throat and related head and neck structures.
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ANNUAL REVIEW 2013
EAR, NOSE AND THROAT (ENT)
OTOLARYNGOLOGY (EAR, NOSE AND
THROAT)
The team at the Mater Private is focused on the treatment
of ear, nose and throat conditions in adults and children. Our
Consultant ENT surgeons are experts in their field and tailor
treatments to the unique needs of each individual patient.
Subspecialty interests include head and neck masses,
paediatrics, rhinology, endoscopic sinus surgery and
congenital hearing loss.
In 2013 we treated over 500 paediatric patients with ENT
conditions. The paediatric service is provided by paediatric
ENT surgeons that are attached to the Children’s University
Hospital, Temple Street and supported by a team of allied
health care professionals to provide the safest possible
environment for children.
SELECTED ENT SERVICES
• Head and Neck Masses
CLINICAL SERVICES
Our Otolaryngologists provide comprehensive evaluation
and medical/surgical treatment of both adult and paediatric
patients with all otolaryngology conditions.
Waiting times for a Paediatric
Consultation at the Mater Private
are between just 2-3 weeks
•Audiology
• Voice Disorders
• Thyroid and Parathyroid
• Salivary Gland Disorders
• Ear Disorders
Procedure Activity Levels
513
380
338
299
237
195
40
2008
Tonsils & Adenoids
58
75
2009
Myringotomy
81
2010
73
2011
98
2012
125
2013
EAR, NOSE & THROAT
PATIENT EXPERIENCE
The patient experience is central to everything we do at the Mater Private. ENT patients in 2013 rated the hospital above it’s peer group across
all main categories. Particularly strong areas were pain management and communication with nurses.
HCAHPS Ear Nose & Throat
100
80
60
40
Rate hospital
0-10
Mater Private
Recommend
the hospital
All Database
Communication
with nurses
Hospital
Environment
Pain
Management
Communication
about Medicines
Large Peer Group Database
Data Source: Press Ganey Database
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ANNUAL REVIEW 2013
60
60
07
RADIOLOGY
A diverse range of multi-modality imaging and
technologically advanced techniques combined
with sub-specialist radiological opinion.
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ANNUAL REVIEW 2013
RADIOLOGY
The Mater Private Radiology Group provides sub-specialty expertise in order
to harness the full potential of contemporary imaging modalities for diagnostic
and therapeutic procedures.
A clinical imaging approach which prioritises the patient is
at the centre of our process. We provide a range of services
for elective and urgent care in the inpatient and outpatient
setting and across most clinical areas including the cancer,
cardiovascular and spinal care programmes.
Participation in peer review, multi-disciplinary meetings
(MDM), quality initiatives and dose reduction initiatives
ensure a constant evolution in the quality of care for
the patient. Our processes are now firmly based on fast
turnaround, paperless digital systems to optimise workflow
and the patient/clinician experience. All members of the
group are actively involved in education and research
nationally and internationally.
The whole radiology group contributes to the national
cancer control programmes through diagnostic expertise,
rapid access tissue sampling and follow up care. Research
initiatives require accurate and reproducible staging
systems which we employ. Command of multiple
modalities is brought to bear in diagnosis, therapeutics,
longitudinal care plans and palliative care where necessary.
Reduced Cardiac Computed
Tomography (CT) radiation
doses by over 50%
Reduced radiation dose in
oncological staging CTs by 30%
BREAST IMAGING
The Breast Symptomatic Unit at the Mater Private Hospital,
the Specialist Breast Centre, was opened in August 2008.
Five specially trained breast radiologists with national
and international experience, deliver advanced care to
patients attending, in a dedicated facility. The extended
multidisciplinary breast care team includes specialist
pathologists, surgeons, oncologists, radiation oncologists
and breast care nurses.
Each year the unit diagnoses and manages over three
hundred patients with breast cancer. This includes patients
attending following assessment or diagnosis at the Eccles
BreastCheck Unit (National Breast Screening Programme)
or another hospital.
The centre provides a range of clinics specially tailored
to the needs of the patients. These include Triple
Assessment Clinics where a woman may receive her clinical
examination, radiological investigation and, if necessary,
tissue sampling on the same day, reducing the delay to
diagnosis and further anxiety. The entire design of our
facility has sought to create a comfortable, non-intimidating
environment to minimise the stress experienced by
patients attending the Unit. This facility includes dedicated
consulting rooms, ultrasound suites and a digital
mammography unit with stereotactic biopsy facilities.
Triple Assessment Patients
1000
800
600
We are also fortunate to work closely with allied health
professionals in radiography, nursing, physics and care
assistants, where shared care pathways benefit patient
experience.
62
400
200
0
2011
2012
2013
RADIOLOGY
Recognising the significance of family history in the
diagnosis and management of patients with breast cancer
and their extended family, and as part of the development
of genetics in the Mater Private, Breast Imaging continues
to expand the breast MRI services. The volume of breast MRI
continues to increase year on year and all breast MRI studies
are double read.
The Unit has been actively involved in Breast Cancer
awareness programmes in partnership with the INMO,
Cornmarket Insurance, Dell, Hewlett Packard and others.
The Unit operates under strict HIIQA and NCCP guidelines.
Audit and quality control is vigorously adhered to and is
fundamental in helping improve our service.
GASTROINTESTINAL IMAGING
The Mater Private Radiology Group provides the full range
of diagnostic and interventional procedures related to the
abdomen and GI tract. This includes, but is not limited to,
Ultrasound (greyscale, colour and doppler), state-of-the-art
CT and MRI, Fluoroscopy and PET CT.
Our Radiologists are internationally recognised as leaders in
this field, have published widely on CT colonography and
have obtained grant funding to support its development.
Members of the group are on a wide range of national and
international colorectal cancer advisory committees.
The Mater Private Radiology
Group were the first to introduce
CT Colonography in Ireland
in 1999 and have a personal
experience of over 10,000 cases
As well as the full range of routine diagnostic cross-sectional
studies, specialised cross-sectional imaging techniques
provided include CT colonography in symptomatic,
surveillance and screening populations, Magnetic Resonance
(MR) enterography for evaluation of small bowel inflammatory
bowel disease, use of liver-specific contrast agents for liver
evaluation and intraoperative ultrasound for lesion localisation
and resection. This busy diagnostic service is complimented
by an active cross-sectional interventional practice facilitating
targeted lesion biopsy and targeted therapies including image
guided tumour radiofrequency and microwave ablation.
The Radiologists in the Mater Private work in close
collaboration with their colleagues in gastroenterology,
endoscopy, GI and hepatobiliary surgery, oncology, radiation
oncology and pathology to insure optimal patient care. This
multidisciplinary collaboration is greatly enhanced by the
running of a weekly GI Multidisciplinary Meeting where all
specialties meet to discuss best practice and patient care.
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ANNUAL REVIEW 2013
PET CT AND NUCLEAR MEDICINE
All cancer Multi-Disciplinary Teams (MDTs) feature
PET(Positron Emission Tomography)/CT imaging in diagnosis
and treatment for cancer patients. All PET CT studies are
reported on the day of imaging. Often complex comparison
with all prior imaging is made, making this "a line in the sand"
turning point in many patients’ management.
Nuclear medicine is a branch of medicine that uses small
amounts of radioactive material to diagnose and determine
the severity of a variety of diseases. The nuclear medicine
department is involved in the care of both inpatients
and outpatients.
In 2013 the department has recently increased its focus on:
PET CT – radiation CT doses
reduced by 40%
In early 2013 we collaborated
with the Northern Ireland NHS
to carry out PET/CT on over 100
patients. These were PET/CT of
the brain to diagnose dementia
• 3D spect imaging particularly in orthopaedic patients.
• P
erfusion imaging of transplant patients and patients
with pulmonary hypertension.
• T reatment of hyperthyroidism with iodine -131 therapy
for outpatients.
• P
roviding a facility to deliver Alpharadin (radium 223)
therapy for hormone resistant metastatic prostate
carcinoma. This is the first isotope therapy that has been
shown to prolong survival in this patient group.
CHEST IMAGING
The National Lung Cancer Screening Trial (New England
Journal of Medicine, August 2011) is the US showed a 20%
reduction in mortality in 55-75 years olds with history of 30
pack years smoking, who are screened by low dose CT scan.
The introduction of this service at the Mater Private was the
first and only of its kind nationally.
The service adopted a low dose lung screening protocol,
using Safire iterative reconstruction, the chest is now
scanned with doses about 1/8 of previous CT scans.
First Low Dose CT for lung
nodule detection in smokers
MUSCULOSKELETAL, SPORTS IMAGING
& INTERVENTION
The Mater Private Radiology Group provides all match day
radiology at the Aviva Stadium in collaboration with the FAI
and IRFU. We offer hospital based subspecialty sport and
orthopaedic imaging interpretation and musculoskeletal
intervention, including tumour biopsy and microwave
ablation, spinal selective and non-selective epidural
injections, facet joint injections and rhizotomy, peripheral
joint and tendon injections with ultrasound fluoroscopy
and CT guidance, percutanous vertebroplasty, kyphoplasty,
vertebral body stenting and sacroplasty.
64
RADIOLOGY
NEUROIMAGING
INTERVENTIONAL IMAGING
Specific subspecialty expertise in Neurovascular imaging
is provided at the Mater Private including (Computed
Tomography Angiography (CTA), Magnetic Resonance
Angiography (MRA) and High Resolution Carotid
Plaque imaging. Spectroscopy and Advanced Diffusion
applications are also provided with extensive Medical
Physics support and input.
Image guided procedures increasingly provide an adjunct
or alternative to conventional care pathways. Minimally
invasive technologies are now applied to provide vascular
access, perform diagnostic tests and increasingly to provide
symptom relief or deliver therapeutic agents. It is important
that we can provide a range of diagnostic and therapeutic
procedures to support new care pathways.
High resolution advanced Epilepsy Imaging is offered for
the investigation of seizure disorders. We have significant
subspecialty expertise in the imaging of patients with
stroke, dementia and movement disorders
WOMEN’S HEALTH
This is all in addition to routine MRI, CT, Nuclear Medicine
and PET/CT for the investigation of all neurological disorders.
CARDIOVASCULAR
Cardiac and blood vessel imaging (angiography) is a key
interest of the MPH radiology group. CT, MRI, Doppler
and conventional subtraction angiography techniques
have been applied to a range of congenital and acquired
conditions complimenting efforts in the cardiology, vascular
surgery and cardiothoracic surgery departments.
Cardiac CT has been applied to coronary plaque and vessel
imaging as well as structural challenges of valvular and
myocardial disease. Newer techniques have been applied
for Transcatheter Aortic Valve Implantation (TAVI) and PVI
planning. Radiography and physics have worked together
on radiation dose reduction technology. Using prospective
gating and Safire dose reduction by 60 % achieved with no
loss of image quality.
A wide range of diagnostic and interventional radiology
services for Women's Health are provided by consultant
radiologists with a sub-specialty interest in gynaecological
and pelvic imaging.
The broad range of multimodality diagnostic services
include endovaginal ultrasound for the assessment of
complex gynaecological pathology including ovarian
malignancy (including familial screening),pelvic pathology
and abdominal conditions complicating pregnancy,
dynamic Magnetic Resonance Imaging (MRI) and endoanal
ultrasound for the evaluation of Pelvic Floor Dysfunction
(incontinence) and Magnetic Resonance Imaging for the
staging of gynaecological malignancies.
The interventional services include uterine artery
embolisation (fibroid disease), ovarian vein embolisation
for pelvic congestion, diagnostic hysterosalpingography
and fallopian tube catherisation for the evaluation and
management of sub-fertility. The services are provided in
close association with a team of Consultant Gynaecologists
based at the Mater Private and at the Rotunda Hospital.
First Radium 223 (Xofigo)
licensed for non-clinical trial
use in Mater Private Hospital
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ANNUAL REVIEW 2013
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QUALITY & PATIENT SAFETY
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ANNUAL REVIEW 2013
Mater Private Hospital,
Eccles St., Dublin 7
68
T: 01-885 8888
www.materprivate.ie