ST JAMES'S HOSPITAL
Annual Report
1983
CONTENTS PAGE
Introduction
(iii)
Board and Management Officers
(iv)
Executive Committee
(v)
Medical Advisory Committee Project Team - New Hospital Project
(vi)
Design Team - New Hospital Project
(vii) (v i i i)
Auditors, Bankers etc. f
Establishment o St. James's Hospital
(ix)
General Services Catering and Housekeeping
3
Einance
... 5
Laundry
7
Personnel
8
Medical Services Accident and Emergency
12
Department of Anaesthesia
13
Department of Endocrinology
15
Cardiology
18
General Medicine
19
Professorial Unit of Medicine, Gastroenterology & Nutrition
21
Geratric Medicine
25
Haematology
27
Oncology
28
Pharmacology and Therapeutics
30
Radiology
32
Respiratory
38
•
(i)
Surgery
41
Occupational Therapy
43
Pharmacy
46
Physiotherapy
48
Nursing Services
53
Pathology Laboratory Services
60
Biochemistry
62
Haematology and Blood Transfusion
64
Immunology
67
Clinical Microbiology
68
Technical Services, Planning and Development
71
Appendices — Statistical Analyses/Publications Appendix A - Publications
76
Appendix B - Admissions
97
Appendix C - In Patient Statistics
98
Appendix D - Out Patient Statistics
99
Appendix E - Out Patient Comparisons
100
Appendix F - Theatre Statistics
101
Appendix G - Pathology Requests Analysis
102
Appendix H - Analysis of Income and Expenditure (i)
Pay Expenditure
104
(ii)
Non-Pay Income and Expenditure
105
(iii)
Income
106
(iv)
Pay Expenditure Graph
107
(v)
Non-Pay Expenditure Graph
108
(ii)
BOARD MEMBERSHIP/HOSPITAL MANAGEMENT PERSONNEL AS AT DECEMBER 1983 Board Membership
NOMINATED
BY
EASTERN
HEALTH
NOMINATED BY FEDERATED DUBLIN
BOARD
VOLUNTARY
HOSPITALS
Dr J D Behan (Chairman)
Dr E Casey
Cllr D Browne
Dr P A Daly
Cllr M Carroll
Mr W D Fraser
Mr F Donohue
Prof D O'B Hourihane
Mr T Keyes
Prof D I D Howie
Dr P McCarthy
Prof J S McCormick
Mr J J Nolan
Mrs M E Redman
Prof B O'Donnell
Mr G Shanik
Dr B Powell
Dr M Walsh
Cllr E Stagg
Prof D G Weir
(Vice Chairman)
Hospital M a n a g e m e n t Personnel Dr K M Aboud, Medical Administrator Mr P J Corcoran, Personnel Officer Mr P 0 D'Alton, Project/Technical Services Manager Mr W P Dunbar, Group Nursing Administrator Mr L Hogan,
Hospital Administrator
Mr F P Lawler, Accountant/Asst. Secretary Miss A McNeill, Deputy Matron Miss M Prendergast, Deputy Matron Mr V. E. N. Robinson, Chief Executive Officer (ill)
EXECUTIVE COMMITTEE MEMBERSHIP AS AT DECEMBER 1984
Dr K M Aboud, Medical Administrator. Dr J D Behan, Chairman, Executive Committee. Dr M Cullen, Chairman, Medical Advisory Committee. Mr P J D'Alton, Project/Technical Services Manager. Dr P A Daly, Hospital Board Member. Mr D J Dempsey, Chief Executive, F.D.V.H. Mr F Donohue, Hospital Board Member. Mr W P Dunbar, Group Nursing Administrator. Mr W D Fraser, Hospital Board Member. Dr P J Freyne, Mr L Hogan,
Vice Chairman, Medical Advisory Committee
Hospital Administrator.
Prof D I D Howie, Vice Chairman, Executive Committee. Mr T Keyes, Hospital Board Member. Mr J J Nolan,
Hospital Board Member.
Miss M Prendergast, Deputy Matron. Mr V E N Robinson, Chief Executive Officer.
(iv)
MEDICAL ADVISORY COMMITTEE MEMBERSHIP AS AT DECEMBER 1983 Dr K M Aboud Prof J Bonnar
Dr P W Keeling Dr A Kennedy
Mr G Shanik
Dr J P Branagan
Dr J Kirker
Dr D Shanley
Dr B Breslin
Dr R Kirkharn
Dr G Sheehan
Dr M Buckley
Dr V Lane
Mr R Stephens
Mr M Butler
Dr B Lawless
Prof E Sweeney
Dr E Casey
Dr W Clayton-Love
Dr E Tempany
Dr H Cassidy
Dr M Magan
Prof I 0 Temperley
Dr L Clancy
Dr E W Malone
Mr F Ward
Dr D Coakley
Dr S Martens
Dr M Walsh
Dr M Cullen
Dr B Maurer
Prof M Webb
Dr P A Daly
Dr 3 Mellor
Prof D G Weir
Dr J Dinn
Mr A E Wood
Dr D Dowd
Dr S K Miller Dr M P Molloy
Dr J Feely
Prof P T Moore
Dr C Feighery
Dr G Mullet
Mr G Fenelon
Dr T E Mulvihill
Dr J Fitzpatrick -
Dr M McCullagh
Dr P J Freyne
Mr M McHugh
Dr N Gallagher
Dr S O'Briain
Dr J Gately
Dr D O'Brien
Dr G Gearty
Dr J D O'Flynn
Dr J Goodbody
Dr R R O'Moore
Dr T D Hanratty
Dr G Owens
Prof T P Hennessy
Dr R Parker
Prof D O'B Hourihane
Prof J Prichard
Prof C Keane
Mr R Quill
(V)
Dr R Ryder
Dr M Young
PROJECT TEAM MEMBERSHIP AS AT DECEMBER 1983
1. Professor D I D Howie, Chairman. 2. Mr J J Nolan, Vice-Chairman. 3. Mr F Jackman, Chief Architec.tual Advisor, Department of Health. 4. Mr H Clifton, Principal Engineering Advisor, (C & S ) , Dept. of Health 5. Mr T Egan, Engineering Advisor CM h E ) , Department of Health. 6. Dr J Humphreys, Deputy Chief Medical Officer, Department of Health. 7. Mr B Ryan, Inspector Quantity Surveyor, Department of Health. 8. Mr J A Enright, Principal Officer, Department of Health. 9. Mr 0 Richardson, Chief Architect, Department of Education. 10. Mr J Dukes, Secretary, Higher Education Authority. 11. Mr D Shanley, Dublin Dental Hospital. 12. Mr T Cooper, Director of Buildings, Trinity College Dublin. 13. Mr P Mangan, Projects Officer, Trinity College Dublin. 14. Mr D J Dempsey, Chief Executive, F.D.V.H. — 15. Dr J S Prichard, Physician, St. James's Hospital. v
16.
Professor D O'B Hourihane, Dean & Dental Faculty, T.C.D.
— 17. Professor T P Hennessy, Surgeon, St. James's Hospital. (lip
Dr J D Behan, St. James's Hospital Board.
19. Dr K M Aboud, Medical Administrator, St. James's Hospital. 20. Mr V E N Robinson, Chief Executive Officer, St. James's Hospital. 21. Mr W P Dunbar, Group Nursing Administrator, St. James's/F.D.V.H. 22. Miss K Purcell, Nurse Planning Officer, St. James's Hospital. 23. Mr P J D'Alton, Project/Technical Services Manager, St. James's Hosp. ^ 2 4 . Mr M Walshe, Project Co-ordinator, St. James's Hospital.
(vi)
DESIGN TEAM/NEW HOSPITAL PROJECT
Design Architects Mr James O ' B e i r n e ,
B. A r c h . , M . R . I . A . I .
Mr D A H u t c h i s o n ,
M.B.E., R . I . B . A . , A . R . I . A . S . , B.A. A.
(Arch), I.
Hosp.
F.I.A., E.,
F.F.B.,
R.I.B.A.
Donaldson
Medallist.
Consulting Engineers (Civil & Structural) Mr E H C o o l e y , M. A.
( C a n t a b . ) F . I . C . E . , F . I . S t r u c t . E.
Consulting Engineers (Mechanical & Electrical) Mr B K R e i l l y , B . E . , C.Eng., F . I . E . I . , F . I . M e c h . E., F.C.I.B.S.,
A.M.
I n s t . F., M. C o n s . E . I .
Quantity Surveyors Mr J Nesbet, F.R.I.C.S. Mr B F Merry, F.R.I.C.S.
(vii)
Auditors
Craig Gardner & Co., Gardner House, Ballsbridge, Dublin A.
Bankers
Allied Irish Bank, Dame Street, Dublin 2.
Dublin Savings Bank,
(Patients Property Account)
Thomas Street, Dublin 8.
Insurance Brokers
Irish Public Bodies Mutual Insurance Ltd., 1/3 Westmoreland Street, Dublin 2.
L a w Agent
Mr Denis Greene, Solicitor, 11 Wellington Quay, Dublin 2.
(viii)
ESTABLISHMENT OF ST. JAMES'S HOSPITAL
Following publication of the report of the Consultative Council on the General Hospital Services (the Fitzgerald Report) in June 1968, the Minister for Health requested the former Dublin Health Authority and the voluntary hospitals concerned in Dublin to consider, with representatives of their staffs, how the recommendations made in regard to the re-organisation of the general hospital system in Dublin might be brought about.
Separate discussions took place
between the interests concerned in north and south Dublin.
Four hospital centres were recommended for development in the Fitzgerald Report, one of which was St. Kevin's Hospital in the south Dublin area.
The Minister made an Order (St. James's Hospital
Establishment Order 1971) under the Health (Corporate Bodies) Act 1961 setting up a body to manage and develop St. Kevin's Hospital. The new Board to manage and develop the Hospital has 20 members ten nominated by the Eastern Health Board (formerly the Dublin Health Authority) and ten by the Central Council of the Federated Dublin Voluntary Hospitals (representing the Meath, Adelaide, National Childrens, Dr. Steevens, Royal City of Dublin, Mercer's and Sir Patrick Dun's Hospitals).
To reflect the change brought about in the functions and management of the Hospital, it was renamed 'St. James's Hospital'.
The
association of the name St. James's with the surrounding area of tne Hospital goes back to early Norman times.
(ix)
The new St. James's Hospital Board leased the Hospital premises from the Eastern Health Board.
The lease became effective from
July 1, 1971 and the new Board assumed responsibility for the running of the Hospital on that date.
Through the joint participation in the new Board of Representatives of both parties concerned, the intention is to develop medical and surgical service and teaching facilities on the site, including services now provided in a number of the constituent Hospitals of the Federation.
The Board is at present undertaking the planning
and construction of new hospital facilities for in-patient and outpatient care with full supporting facilities (including medical teaching facilities).
The Hospital will have 750 acute beds and
400 geriatric beds when completed.
(x)
Hospital 3 and the Communications Centre in the foregroun
NO
Communications Centre.
CATERING/HOUSEKEEPING
Staffing
1 Supervisory Catering Officer 1 Catering Officer 1 Senior Assistant Catering Officer 5 Assistant Catering Officers 96 Kitchen Staff/Cooks/Waitresses 1 Supervisor of Porters 44 Porters 1 Domestic Supervisor 110 Domestics/Restaurant Assistants
The Catering Department experienced a busy year during 1983.
The
two main areas, the Staff Restaurant and the Main Kitchen operate a twelve hour day, seven days a week. Patients Approximately 770 patients recieved 2 full meals daily, a proportion have cooked breakfasts.
The addition of 3 dietitians in May 1983
has resulted in an appreciable increase in the number of special diets, 150 daily at a minimum.
In addition to in-patient meals, other areas supplied include the Day Hospital - 40 daily between Monday and Friday; day patients Hospital 6 - 3 6 daily; St. Martha's Hostel, Endocrine Onit, Meals on wheels - 15,500 supplied; Day Centre and White Friar Street 12,400 supplied; Night Shelter
Back Lane - 36,590 supplied; -3-
The Staff Restaurant supplied 276,200 meals, i.e. breakfasts, lunches and teas.
Additional service supplied to coffee bars,
staff restaurant and Hospital 7, night meals for nursing and attendant staff, Post Graduate Centre, F.D.V.H., and Trinity Medical School and Eastern Health Board.
Catering for seminars, lunchtime meetings and other gatherings, Poth educational and social has always been a feature of our operation.
The Catering Department supplied in the region of one million meals in 1983.
FINANCE DEPARTMENT
Revenue Allocation 1983
Following the difficult financial year 1982, it was apparent that funding would again be restricted in 1983, and the revenue allccation for that year, notified In November 1982, was at £22,980,000, more than 97- short of the Hospital's estimate of recuiremeots.
As a.
result of a Government decision to discontinue charges to patients for out-patient attendances, and not to introduce charges for patients in public wards, the allocation was revised to £23,240,000. This allocation Included full provision for the costs of the Central Pathology Laboratory, which provides services not only to the Hospital itself, but also to all the hospitals of the Federated Dublin Voluntary Hospitals group and to certain Eastern Health Board institutions.
The Department of Health indicated that in order to avoid exceeding the allocation level approved for the year, it would be necessary for the Hospital to Identify and implement cost saving measures and advised that the Hospital should review its situation and determine where adjustments needed to be made so as to ensure that the limits of the approved allocation would be observed.
Throughout
the year financial data were furnished to the Department and periodic meetings were held with Officers from the Department's Finance Unit to monitor financial out-turns.
Mercer's Hospital closed at the end of May 1983 and, as a result, certain additional services were transferred to St. James's as were many of the staff of Mercer's Hospital.
-5-
Intensive negotiations on
the financial, as well as other Implications of this move took place in advance of the closure of Mercer's and additional funding for the transferred staff and services w as agreed with the department of Health.
Additional funding was also agreed in resnect of
certain pay awards which arose during the year.
Finance C o m m i t t e e Throughout the year the Finance Committee, under the Chairmanship of Mr T Keyes, kept the financial situation under review and advised the Board on the financial aspects of the Hospital's operations and various specific matters which arose for consideration.
The
following is the membership of the Finance Committee:Dr K Abouri
-
Medical Administrator
Dr J Pehan
-
Chairman Hospital Board
Dr M Cullen
-
Chairman Medical Advisory Committee
Mr D Dempsey
-
Chief Executive, F.D.V.H.
Mr F Donohue
-
Board Member
Mr L Dunbar
-
Group Nursing Administrator
Mr W Fraser
-
Board Member
Mr L Hogan
-
Hospital Administrator
Prof D I D Howie
-
Vice Chairman Hospital Board
Mr T Keyes
-
Board Member
Mr F Lauler
-
Accountant/Asst Secretary
Mr V E N Robinson
-
Chief Executive Officer
Analysis of Expenditure An analysis on a subjective basis of the pay and non-pay expenditure of the Hospital for 1983 is represented in graphical form in Aopendix H.
~6-
LAUNDRY
Staffing 1
Superintendent of Laundries
1
Senior Chargehand
5
Chargehands
39 6
Laundry Operatives Seamstresses
The total throughput for year ending 31st December 1983 was 1,365 tons, providing a service to St James's Hospital and Eastern Health Board institutions.
The 6001b Cherry Tree Washing Extractor, commissioned in December 1983 has performed very satisfactorily and helped to eliminate continuous overtime.
The equipment replacement programme will
continue this year with the replacement of two eighteen year old barrier/sluice machines.
-7-
PERSONNEL DEPARTMENT
Industrial Relations The closure of Mercer's Hospital was an important factor during the earlier part of 1983.
Negotiations with trade unions and staff
associations which had been initiated in 1982, on the translation of services to St. James's, were finalised and in June 1983 a total of 141 personnel/posts, comprising medical, nursing, para-medical, housekeeping and allied services, portering and clerical/administrative grades were transferred to St. James's.' On the closure of St. Ultan's Hospital, 3 additional ward sister personnel/posts were made available to St. James's with effect from 1st October, 1983. A major difficulty encountered during the year was the strike action by electricians from 7th to 13th September 1983 inclusive, in protest against the non-concession of a claim for travelling time.
The
electricians were supported in their action by all the craftsmen in the Hospital and some other technical services staff.
There was a
disruption of services mainly in the area of refuse collection and laundry which necessitated making alternative arrangements with external agencies.
The industrial relations machinery for dealing
with such matters was activated and following clarification by Dublin Corporation of an agreement within the Electrical Contracting Industry for payment of travelling time, (Dublin Corporation being the reference group for craftsmen in the Eastern Health Board/St. James's), the claim was conceded. Negotiations have been entered into and are continuing with the Local Government & Public Services Union regarding the filling of promotional posts in the clerical/administrative area and it is envisaged
-8-
that further discussions with the Union will take account of the broader issues of the future assimilation of staff at all levels from within the designated hospitals to St. James's. Having regard to the introduction/up-dating of computerisation systems in the Hospital, it is anticipated that an agreement regarding New Technology will be concluded with the relevant union in the near future.
Senior Appointments Administrative Officer
Mr James
McKeever from 31st March, 1983.
for assignment to security & allied matters Chief II Medical
Mr Gerard J O'Connor from 1st November 1983.
Laboratory Technologist Deputy Matron
Miss Ann M McNeill from 1st August 1983.
Midwifery Tutor
Mrs Katherine B Flynn from 1st February 1983.
Night Sisters
Mrs Mary E Jennings from 4th April, 1983 Mrs Anne M Smyth transferred from St. Ultan's Hospital from 1st October 1983.
Senior Dietitian
Miss Philomena Flood from 29th April 1983.
Senior Medical Social Workers
Mrs Jean Ahern from 1st April 1983 (for assignment to Sir Patrick Dun's Hospital) Mrs Rose Mary Grant from 9th May 1983.
Senior Pharmacist
Mrs Sile Trimble from 1st January 1983.
Senior Physiotherapists
Miss Anne M Jephson from 1st May 1983. Miss Helen Moore from 25th April 1983 Miss June A Ryan from 1st February 1983. -9-
Senior
Radiographer
Miss Miriam C Delaney from 1st June 1983.
Supervisor of Porters
Mr David Graham from 21st March 1983.
Theatre Sister
Mrs Dorothy V Hetherington from 1st November 1983.
Ward Sisters
Mrs Anne M Dixon from 9th August 1983. Miss Carmel Donnellan from 1st March 1983. Mrs Barbara Fitzgerald from 10th October 1983 Miss Bridget P Hughes, transferred from St. Ms A Stakelum, Ultan's from 1st October 1983. Miss Anne B Kelleher
from 1st June 1983.
Miss Margaret McKeown from 2nd May 1983. Miss Mary J McNamara from 1st December 1983. Miss Catherine O'Neill from 1st July 1983.
Resignations Matron
Miss N McCarthy from 1st May 1983.
Senior Medical Social Worker
Mrs
Fidelma O'Regan from 8th October 1983.
Senior Occupational Therapist
Ms Johanna Galloway from 12th November 1983.
Senior Physiotherapist
Mrs Jean E Taylor from 19th March 1983.
Ward Sisters
Mrs Anne Bell from 16th June 1983. Ms Margaret Henry from 24th September 1983. Ms Lena Murphy from 3rd October 1983. Ms Margaret McKeown from 1st December 1983.
-10-
Deaths Ms Josephine McNamara, Domestic (t ansferee from Mercer's Hospital), died on 12th September 1983.
Total staffing complements at 31st December, 1983 including additional increment from Mercer's Hospital -
1,815
Total clerical/administrative staff complement at 31st December 1983 171
-11-
ACCIDENT AND EMERGENCY DEPARTMENT
Staffing CONSULTANT
Mr F Ward
NON-CONSULTANT
1 Registrar
HOSPITAL DOCTORS
4 Senior House Officers.
The attendance figures continue to reflect the increased activity in the Department.
1981
-
37,495
1982
-
38,452
1983
-
41,330
Overall, 1982 showed a 2% increase in attendances over 1981, but 1983 had a 7% increase over the previous year. The increased numbers are putting a greater strain on space within the department.
Additional accommodation is also desirable to
properly accommodate receptionists, clerical staff and records which are vital to the proper functioning of the department.
-12-
DEPARTMENT OF ANAESTHESIA
Staffing CONSULTANTS
Dr J Goodbody Dr A Kennedy Dr R Kirkham Dr B Lawless Dr F O'Higgins
NON-CONSULTANT
1 Senior Registrar
HOSPITAL DOCTORS
2 Registrars 3 Senior House Officers
The Department of Anaesthesia in St. James's is combined to cover the two hospitals, Sir Patrick Dun's and St. James's Hospital. The number and type of anaesthetics have increased yet again over the past year coming to a grand total of approximately eight and a half thousand administrations.
The Department runs an Intensive Care Unit that provides tertiary care for many cases from various hospitals. are for long-term ventilation.
Many of these referrals
Two of the Consultant Anaesthetists
take a special interest in this Unit.
A pre-operative assessment clinic is still run and a limited 'pain service' is carried on.
-13-
Education/Training The Hospital is recognised for general professional and higher professional training and has membership of the Eastern Regional Training Scheme and participates in the National Training Programme for Senior Registrars.
Members of the Department lecture on the various Post Graduate Anaesthetic Courses as well as being examiners,in the Primary and Final F.F.A. examinations.
-14-
DEPARTMENT OF ENDOCRINOLOGY
Staffing 1
Consultant
Dr M J Cullen
1
Registrar
1
Senior House Officer
1
Intern
In addition one staff nurse is assigned specifically to deal with endocrine and diabetic patients.
The department provides a consultation service in Out-Patients with a diabetic clinic on Monday afternoons which has been growing at the rate of two new diabetics per week on average throughout 1983. This creates the need for a second diabetic clinic. mornings, an
On Wednesday
endocrinology clinic is held for all patients other
than diabetics.
In addition, the department carries out a regular
endocrine/diabetic ante-natal clinic in conjunction with Dr Hanratty, Consultant of Obstetrics and Gynaecology at 4.00 p.m. on Wednesdays by appointment.
This ensures that women do not have to attend on
two occasions at the Hospital if they are simultaneously diabetic and pregnant.
The in-patient facilities are catered for in Hospital 5 and during 1983, this has been a time of considerable change due to the extensive renovations and refurbishing carried out to accommodate the gastroenterology team to St. James's Hospital, and improve the facilities for the other medical teams.
This refurbishment is almost complete and
-15-
will then accommodate Endocrinology and Rheumatology.
The refurb-
ishment period has been a time of strain on all concerned - nurses, patients and doctors throughout the hard winter months when admissions pressure has been severest. remained amicable and morale high.
Relations have however
The Health Care Centre in the
Hospital 5 area which is used by all the physicians in the Hospital for day patients and day activities, diagnostic and therapeutic was also completed.
From the point of view of the Endocrinology depart-
ment, this has been important for diabetics who come for blood sugars, investigations, education and assessment, often avoiding admission to the Hospital.
In addition, it has been possible to carry out
investigative procedures such as hypothalamic pituitary function tests and thyroid aspirates in pleasant circumstances for both patients and medical personnel.
During the year, there has been
an opportunity to plan the re-development of a number of the beds in Hospital 5 Unit 3 for metabolic studies, suitable to endocrinology diabetic patients and it is hoped it will be possible to improve the service which is given through this means.
The department works closely with the endocrinology section of the Department of Biochemistry and relies heavily on the dedicated staff therein carrying out often unheralded, extremely sensitive and accurate measurements of hormones in human blood.
The good relations
which are shared with Professor Paddy Moore, Dr Clayton Love, Dr Rory O'Moore and Mr John Sweeney, Mr Aidan Cranny and all the members of the endocrine section of the laboratory services are also acknowledged.
A weekly Endocrinology Conference is held on Tuesdays from 1.00 p.m. to 2.00 p.m. which has been very popular throughout the year.
It
features an interdisciplinary approach involving nurses, laboratory -16-
personnel and clinical personnel in the study of endocrine problems in patients so that better understanding and treatment can be given to them.
This has helped greatly in co-operation and collaboration.
Research has been a continuing area in which a number of papers have been published during the year, both at home and abroad, on topics in the area of thyroid hormone metabolism, the clinical management of diabetes and congenital hypothyroidism.
Dr Cullen
attended the European Thyroid Association meeting in Madrid in July 1983 and reported on this to the Endocrinology Conference.
It has also been a very busy administrative year since the onus of being Chairman of the Medical Advisory Committee fell upon Dr Cullen and he would mention to prospective bearers of this job that there is a considerable workload attached to it which however has been at all times a pleasure to perform.
-17-
CARDIOLOGY DEPARTMENT
Staffing CONSULTANTS
Dr M Walsh Dr B Maurer Dr G Gearty
NON CONSULTANT
1 Registrar
HOSPITAL DOCTORS
2 Senior House Officers
The numbers attending for in-patient and out-patient services continue to increase.
The number of patients requiring the services
of the Cardiac Department, such as electrocardiography, stress electrocardiography, 24 hour Holter monitoring and echocardiography, continue to increase also.
Cardiac catheterization of St. James's patients continues to be carried out in R. C. D. H. for several years
The major problem, as it has been now
is the inability of the surgical services at the
National Open Heart Centre, Mater Hospital, to cope with the demands for necessary operations
in adults with heart disease.
There seems
to be no prospect of this problem being solved in the immediate future, and it may well be that we will have to consider sending some of our patients abroad.
-18-
GENERAL MEDICINE Staffing CONSULTANTS
Dr M P Buckley
NON
1 Registrar
CONSULTANT
HOSPITAL
DOCTORS
1 Senior House Officer 1 Intern
Services In addition to the general medical service presently provided, it is proposed to establish a sleep disturbance clinic in the near future.
Out-Patient Clinics Tuesday
9.00 a.m. to 1.00 p.m.
Thursday
2.00 p.m. to 5.00 p.m.
Friday
2.00 p.m. to 5.30 p.m.
Activity Analysis 1982
983 434
Admissions
413
Discharges
332
413 364
3Q
33
27
51
76
128
New Patients
222
343
517
Return Patients
821
1071
1733
1043
1414
2250
Deaths
394
OUT-PATIENT CLINICS Number of Clinics
TOTAL
19-
Endoscopy Room — Hospital 5.
20
PROFESSORIAL UNIT OF MEDICINE, GASTROENTEROLOGY & NUTRITION Consultants:
Dr. P.W.N. K e e l i n g , M.D., M.R.C.P., M.R.C.P.I. Dr. D.G. Weir, M.D., F . R . C . P . I .
Non Consultant Hospital Doctors 1 Senior Registrar 2 Lecturer/Registrars 2 Senior House O f f i c e r s 1 Lecturer/Scientist
Timetable: Monday p.m. Chronic Inflammatory Bowel & Liver Disease Clinic Wednesday a.m. General Medical and Gastroenterology Clinic Friday a.m. General Medical and Gastroenterology Clinic
Introduction The Professorial Unit and Department of Gastroenterology moved from Sir Patrick Dun's Hospital in September 1983.
The facilities available
include 36 medical beds, 3 medical out-patient clinics, one of which is entirely used for the management of patients with Inflammatory diseases of the liver (active chronic hepatitis, primary biliary cirrhosis, etc.) and of the bowel (Crohn's disease and ulcerative colitis).
The two general medical and gastroenterology clinics ensure
general medical follow-up for our patients and for assessment of all new patients.
E n d o s c o p y Services Adjacent to our in-patient beds, our endoscopy unit is in full flight. All forms of endoscopy are available; upper G.I. endoscopy, colonoscopy with polypectomy, dilation of oesophageal strictures with endoprosthesis, injection of oesophageal varices, small intestinal -21-
biopsies, endoscopic retrograde cholangiopancreatography, sphincterotomy and extraction of common bile duct stones.
In addition, a new satellite
unit of the main X-Ray Department is available in Hospital 5 for outpatients.
This will provide immediate barium meal, barium enema,
intravenous pyelograms, oral cholecystography and more invasive procedures for the Department of Gastroenterology.
Furthermore, a
procedure room is also available for out-patient skin, muscle, bone and liver biopsies.
Nutrition Unit Our Department of Nutrition will be fully active by the middle of 1984 with the appointment of Dr. Michael Gibney, Lecturer/Scientist and a third Lecturer/Registrar.
This unit will ensure that the nutri tion
problems of the patients seen in the Departments of Gastroenter ology and General Medicine will be assessed and treated by a very act ive nutritional team.
Research The Sir Patrick Dun Research Laboratory is now fully utilised.
It has
brought together a large number of basic scientists and physicians. Consequently, there is a very active research programme in the Department of Medicine, Gastroenterology and Nutrition. The research can be divided into three main areas:
folate metabolism
in health and disease, the effects of malnutrition on the immunocyte and immunological abnormalities in patients with chronic liver and bowel disease .
-22-
Clinical Trials The Department of Medicine is heavily involved in the management of peptic ulcer disease.
Presently, we are assessing four new
pharmacological compounds which seem promising.
-23-
DEPARTMENT OF GERIATRIC MEDICINE
Staffing CONSULTANTS
Dr D Coakley Dr 3 j Flanagan
NON
CONSULTANT
HOSPITAL
DOCTORS
2 Registrars 2 Senior House Officers 3 Interns
Services The department is organised along modern lines with acute admission/ assessment beds, rehabilitation and continuing care beds.
There is
a strong community orientation with regular meetings between the staff and liaison public health workers.
The visiting nurses
attached to the unit assess nearly 2,000 patients in their homes every year.
There are two Consultant Physicians in the Department and they are supported by a team of junior doctors, nurses and paramedical staff which include social workers, physiotherapists, occupational therapists, attendants and secretarial staff.
The philosophy of
the Department is that of a team approach to patient care.
There is an active Day Hospital attached to the unit where patients receive medical treatment and also are treated by the rehabilitation staff.
The Day Hospital functions as a 'hospital without beds' for
elderly patients.
Both Consultants run regular out-patient sessions every week. -25-
The
admission units are now in upgraded wards.
Although this meant an
actual drop in bed numbers the admission figure for the year was higher than previous years.
Activity In 1983, a total of 1,082 patients were admitted to the department and there were 844 discharges.
A total of 215 new patients were
seen at the Day Hospital and there were 6,271 return attendances. In 1983, a total of 1,376 patients were seen at the out-patient clinics.
Special Interests Research In the department has continued to develop. two full-time research registrars.
There are now
They are studying hypertension
in the elderly and Alzheimer's disease.
The department is also
developing an interest in bone disease and infection in the elderly A research project is currently being undertaken on respiratory infections in the elderly in collaboration with the Microbiology.
department of
There are also a number of projects of a biophysical
nature under way with a research engineer working full-time in the department for the past year.
Teaching The department is involved in both undergraduate and post graduate teaching.
Medical, physiotherapy, nursing and occupational therapy
students receive practical experience and teaching in the unit.
-26-
HAEMATOLOGY DEPARTMENT
Staffing CONSULTANTS
Prof I J Temperley Dr S McCann
NON CONSULTANT
1 Registrar
HOSPITAL DOCTORS
2 Senior House Officers
The Clinical Haematology/Oncology Unit sited mainly on Top Floor, Hospital 1 has developed substantially during 1983.
During the
year, the Unit was strengthened by the decision of Dr Peter Daly to devote his main energies to St. James's as Clinical Oncologist and by the appointment of Dr Shaun McCann as Haematologist to the Hospital with an emphasis on clinical haematology.
The Unit has
recently been recognised by the Department of Health as a Regional Centre.
During the year, the number of patients admitted for
treatment
for acute leukaemia has continued to grow and preparations were made to house a bone marrow transplant sub-unit.
The Unit is
grateful to the Department of Health for financing necessary structural changes and an increase in staff.
The Bone Marrow for
Leukaemia Trust has raised almost IR£500,000 for this venture. The efforts of the organisers
and all those who have helped in
this venture is greatly appreciated.
Medical students from the United States continue to visit the Unit for 'electives'.
-27-
DEPARTMENT OF ONCOLOGY
Staffing CONSULTANT
Dr P A Daly
NON-CONSULTANT
1 Registrar
HOSPITAL DOCTORS
1 Senior House Officer 1 Intern
Services It was determined, following the closure of Mercer's Hospital in May 1983, that the care of Oncology patients would be undertaken within a unit shared with Haematology in Hospital 1 Top and Middle Floors.
Through the Mercer's closure, an improved level of nursing
junior, medical and other categories of staff was achieved.
This,
along with structural alterations made to Hospital 1 Top Floor and the provision of basic requirements, such as office space and a unit secretary has meant that the care offered to patients in the broadest sense has improved dramatically.
Internal arrangements
are such that all Haematology/Oncology patients are cared for continuously by nurses with specialised training and by junior house staff who are familiar with these patients and their problems. There is valuable input from paramedicals, notably a medical social worker, dietitian and physiotherapists.
Weekly case conferences
ranging from patient care through histology meetings and a meeting concerning psychological factors, held in conjunction with the medical social worker and psychiatrist are held.
-28-
The use of the Day Ward facility in Hospital 5 on Monday, Wednesday and Friday afternoons has meant that there can be greater throughput of patients with a reduced need for patient admissions. Nonetheless, activity in all spheres has greatly increased (see statistics).
In the coming year, it is hoped to forge closer links
with the Department of Haematology and to seek that the Haematology/ Oncology Unit be recognised as a regional unit on completion of Phase 1C of the New Hospital Project.
Statistics Year
In-Patient
Out-Patients Department
1980
168
201
335
1981
213
306
A87
1982
167
326
350
1983
A15
A22
612
-29-
Day Ward/Chemotherapy.
PHARMACOLOGY AND THERAPEUTICS Staffing CONSULTANT
Professor John Feely
NON CONSULTANT HOSPITAL DOCTORS
1 Registrar/Lecturer
Services This Department was established at the end of 1983 and provides outpatient and in-patient facilities for the management of patients with drug related problems (e.g. inadequate response to therapy, adverse reactions and drug interactions).
Advice on drug use in at
risk groups (e.g. elderly, liver and kidney disease patients) will be complemented by the measurement of plasma drug levels.
The
Department has also established a Hypertension Clinic directed at helping in the
initial assessment and in the management of the
complicated hypertensive patient.
Development In addition to the development of the above services, the Department seeks to improve the safety, efficacy and economy of drug therapy through post graduate education.
Research The Department is involved in collaborative studies on the clinical pharmacology of drugs used in gastrointestinal, cardiovascular and endocrinological disorders.
Out-Patient Clinic Friday Afternoons.
-30-
New Radiology Services - Hospital 5.
DEPARTMENT OF RADIOLOGY
Staffing Radiologists:
Dr E W Malone Dr M P Molloy Dr P J Freyne Dr S Miller Dr J Gately Dr N O'Connell Dr M Ennis
Dr J F Malone - Chief Physicist (Temporary) Dr M O'Connor - Senior Physicist
(Temporary)
1 Superintendent Radiographer - Grade II 1 Superintendent Radiographer - Grade I k Senior Radiographers 11 Basic Grade Radiographers
Services The Department of Radiology has continued to provide a diverse range of diagnostic services.
In addition to the general diagnostic
disciplines available, certain developments have been achieved within the various disciplines. Nuclear Medicine The recent innovation of Radio-iodine treatment of certain thyroid disorders for Dr M Cullen, Consultant Physician and Endocrinologist -32-
at St. James's Hospital in conjunction with the medical physics services continues.
The availability of this service is of major
benefit to the relevant patients of this Hospital.
Similarly
detailed studies of cardiac function and status on data obtained both in St. James's and in the Royal City of Dublin Hospital continues to be made with major benefits to the cardiac services.
Workload of Nuclear Medicine Facility The overall volume of general nuclear medicine work being carried out has continued to increase.
The addition of a second radiographer
to this area arising from the closure of Mercer's Hospital has been a very welcome development and has permitted the continued expansion of work in this area.
Angiography In this area the programmes of Digital Angiography and other innovations such as Angioplasty and Streptokinase infusion referred to in previous reports continued to evolve.
The Digital Angiography
procedures used selectively has proven of major benefit.
In
particular many examinations can now be carried out on out-patient basis which otherwise would have required hospital admission.
With regard to Angioplasty, this recent but well proven new technique permitting dilatation of narrowed arterial segments by means of Balloon Catheter has been further developed and has proven of major benefit in many cases carried out by Dr Martin Molloy, Consultant Radiologist.
-33-
Similarly Streptokinase infusion, a technique whereby a slow infusion over a number of hours of the enzyme Streptokinase to dissolve recent obstructing clot formation, has continued to meet with success.
The continuation of these innovations together with the increasing level of Angiographic reauirenents imposes a near impossible burden on the single Vascular/Special procedure room which is shared with general Radiography.
The need for a specially dedicated additional
Vascular Radiography Room is increasing.
Ultrasound The service continues to make a major contribution to the diagnostic ability of the Department.
It is proposed to replace the existing
unit and investigations are underway to acquire a suitable replacement. Microfilming/Archival Storage The project of miniaturising archival x-ray films and reports for storage has proven very successful.
The amount of microfilming
carried out to date has permitted continued absorption of current films into existing filing space.
The work of preparing examinations
for microfilming however has proven more time consuming than estimated.
The continuation therefore of a full-time staff member
dedicated to this work is under consideration.
Activity/Statistics/Growth The growth in Hospital activity and new consultant appointments has increased demand on services, placing considerable pressure on existing facilities. -34-
The development of an additional x-ray screening room in the new Hospital 5 Day Care Centre is expected to confer initial assistance, but it is anticipated that this will be speedily overtaken by the work which would be generated within that unit by its new incoming consultant staff.
The growth of activity is clearly shown in the following comparative figures. Total Examinations
YEAR
(i.e. x-ray, untrasound and nuclear medicine) 22,695
1978
31,000
1979
37,433
1980
42,679
1981
45,233
1982
48,997
1983
Comparative figures relating to individual aspects of the departments' work for the years January to December 1981, 1982 and 1983 as follows:
Examination
1981
1982
1983
34,126
37,525
40,622
3,050
3,015
3,224
396
679
817
Ultrasound
1,616
2,161
2,280
Nuclear Medicine
1,614
1,853
2,054
Routine/General Contrast Examinations Special Examinations
The figures given above relate only to examinations performed and do not reflect the true level of demand on services from both within and outside the Hospital of a further twenty-five to thirty-five per cent. -35-
Necessary Requirements Additional requirements necessary to meet the consistently growing demand on the various elements of service, pending the development of the New Hospital X-Ray Department in three to four years include: Additional Radiographer Staff A documented need for five additional radiographer posts has been compiled.
Additional R o o m s and Equipment Submissions in respect of an immediate need of two additional x-ray rooms and major replacement items of equipment, e.g. x-ray units and ultrasound equipment are being considered.
The need
for major replacements therefore will have to be faced in the immediate future. It is suggested that such replacements should be phased into and in advance of the programme of commissioning the Department of Radiology of the new St. James's Hospital.
Radiologist Staffing Application has been made to the Department of Health for permission to utilise funding currently available for some vacant consultant radiologist sessions for the appointment of non-consultant doctors in the department.
Initial application is for two post fellowship
radiological registrars.
A further application for the establish-
ment of two trainee senior house office posts related to the Faculty of Radiologist Trainee Scheme has also been made.
36-
Conclusion As Hospital activity increases so demand on Radiological services grows.
Without the necessary levels of expansion of staff, equip-
ment etc it is not possible for the Department of Radiology to meet this demand.
It is hoped that some of the desired changes and
improvements can be made during 1984.
-37-
RESPIRATORY DEPARTMENT
Staffing Consultants
Dr Luke J Clancy Dr Doreen Dowd Dr M Nolan (Locum) Professor J S Prichard
Non Consultant
1 Senior Registrar/Lecturer
Hospital Doctors
1 Registrar/Lecturer 1 Senior House Officer 2 Interns
Bronchoscopy Service With the opening of the Health Care Centre, the Bronchoscopy Service transferred to that location from the Day Ward in Middle Floor, Hospital 1.
This has resulted in some change in timing.
Dr Clancy's session continues on Wednesday morning.
Professor
Prichard's session has moved to Thursday afternoon.
The Kveim innoculation and biopsy service is now carried out through the Health Care Centre.
The availability of x-ray screening facilities
has enabled the bronchoscopy service to be developed to include transbronchial biopsy under direct vision.
It is also planned in conjunction
with the radiologist to extend the biopsy service to include precutaneous lung biopsy.
-38-
Respiratory Function Laboratory The Respiratory Function Laboratory was commissioned and was operational on a limited scale during this year.
This is due to
the hard work of a Research Fellow in the department, Dr Paul Cotter who helped during this year, in getting the service off the ground.
A respiratory function technician has been approved by the Department of Health and there will be an appointment early in 1984. Laboratory is under the direction of Dr Doreen Dowd.
The
The close
working relationship with the Royal City of Dublin Hospital continues with both Drs Clancy and Dowd, working in both hospitals.
Thoracic Surgery The appointment of Mr F Woods, who is working at St. James's and Royal City of Dublin Hospitals, has been a very important development to the Respiratory Department.
This has resulted in the initiation
of an Out-Patient Thoracic Surgical Clinic, but lung surgery has not restarted in the Hospital at present.
Senior Registrar Dr Joan Power took up her post as Senior Registrar in this Department in 1983.
She is the first holder of this appointment
.,
and, at present, the only substantial appointment at this grade working in this country.
Her post combines activity in St. James's,
Royal City of Dublin Hospital and Peamount Hospital.
It has also
allowed the development of links at community level to the Chest Clinic at Crumlin.
-39-
Out-Patient Clinics Dr L Clancy
-
Monday 9.30 a.m. Astham Clinic ('follow-up) Thursday 9.00 a.m. Chest Clinic
Professor Prichard
-
Monday 9.30 a.m. General/Respiratory
Dr D Dowd
-
Wednesday 9.30 a.m. Respiratory Clinic
Activity Analysis
Out-Patient Clinics Attendance
YEAR
DR
CLANCY
PROFESSOR
PRICHARD
DR
DOWD
1981
1421
1254
—
1982
1550
1161
—
1983
1540
1218
65
1981
578
524
—
1982
438
522
—
1983
344
422
—
IN-PATIENTS
BRONCHOSCOPY
CLINIC
1981
364
277
—
1982
491
344
—
1983
488
289
—
-40-
DEPARTMENT OF SURGERY
Staffing CONSULTANTS
Professor T P J Hennessy, General Surgery Mr R D Quill, General Surgery Mr R Stephens, General Surgery Mr G Shanik, General/Vascular Surgery Mr M Butler, Urologist Mr J Fitzpatrick, Urologist Mr G Fenelon, Orthopaedics
NON CONSULTANT
1 Senior Registrar
HOSPITAL DOCTORS
2 Registrars 3 Senior House Officers 9 Interns
Services A full clinical service is provided in general surgery, vascular surgery, urology and traumatic orthopaedics.
Special interests
include, in general surgery, diseases of the oesophagus, protal hypertension, breast surgery and the surgery of colon cancer.
The vascular service provides particular expertise in the field of carotid artery surgery.
The Department of Urology provides a
comprehensive urology service and, with the Department of Gynaecology runs a clinic dealing with fertility problems.
The Accident and
Emergency Department, supervised by the Orthopaedic Surgeons, provides a major part of the accident and emergency service for the south city. -41-
Surgical services have continued developing, creating great pressure on operating theatre time, out-patients and beds.
The department
looks forward to the completion of Phase 1 of the New Hospital Development.
Research An active research programme is being pursued by the various surgical disciplines.
In general surgery, aspects of oesophagel cancer,
particularly in the aetiological area are being studied.
The non-
ivasive vascular laboratory combines an extensive diagnostic service with research into carotid blood flow and lower limb venous disorders Renal ischaemia is being studied by the Department of Urology and research into the healing of fractures has engaged the attention of the Orthopaedic Department.
Training The Hospital participates in both the pre-fellowship and higher surgical training programme under the aegis of the Irish Surgical Postgraduate Training Committee and the active programme of postgraduate surgical training is maintained which includes weekly surgical conferences, seminars etc.
-42-
OCCUPATIONAL THERAPY DEPARTMENT
Staffing 1
Senior Occupational Therapist
A
Basic Grade Occupational Therapists
The Occupational Therapy service is assessment and treatment through specific use of selected activities undertaken by those who are temporarily or permanently disabled by physical or mental illness, by social or developmental problems.
A programme is designed by
the occupational therapist to achieve optimum function and independence in working, social and domestic environments.
Methods of treatment include the areas of activities of daily living, aids and adaptations, work resettlement, assessment of mental impairment, splinting, upper limbs remedial activity, wheelchair assessment and training, advice to relatives, home visits and perception. Services The Occupational Therapists have to date concentrated the provision of the service in the Department of Geriatric Medicine.
The
Occupational Therapy service is not as comprehensive as would be desired due to a shortage of staff.
Unfortunately at present some
referrals cannot be dealt with and other referrals have not received the desired treatment and follow up care.
There are four attendants working in the Occuational Therapy department who mainly cover diversional groups in Hospital 2, 3 and 4.
-A3-
St. Joseph's College of Occupational Therapy The liaison between St. Joseph's College and the Hospital's Occupational Therapy Department continues satisfactorily.
Since
April 1983, the Hospital has postponed taking students.
Post-Graduate Courses and Lectures The following were attended by staff during the year:Bobath Course, Galway Bobath Course, Royal Hospital, Donnybrook Splint Making, St. Joseph's, Harold's Cross Splint Making, National Medical Rehabilitation Centre Hard Function Seminar, Hotel Victor, Association of Occupational Therapists in Ireland Treatnent Adaptation with Aphasic Patients, St. Anthony's Rehabilitation Centre Volunteer Stroke Scheme, National Social Service Board Effective Meetings, National Social Service Board The Occupational Therapists are members of the Occupational Therapists Geriatric Support Group.
Members present
papers which
are followed by further discussion.
The topics covered have
included:Assessment and Treatment of Mental Impairment In the Elderly Reality Orientation Assessment and Treatment of Perceptual Dysfunction Sensory Deficits in Adult Hemiplegia
Papers have also been presented in the Stroke Rehabilitation Seminars held in the Post-Graduate Centre of St. James's Hospital. The staff also lecture nursing students and have spent time with students of physiotherapy, speech therapy, dietetics and social work.
PHARMACY DEPARTMENT
Staffing
i chief I Pharmacist 1 Chief II Pharmacist A Senior Pharmacists 6 Pharmacists
The Hospital Pharmacy in 1983 reflected the ever changing face of St. James's Hospital over the past few years.
The increase in
patient numbers and acute patients in particular, introduced a new era within the Hospital and necessitated many new types of specialised treatment and medication.
Every department in the
Hospital was effected by this upsurge of activity and the Pharmacy naturally received its share.
Pharmacists, as a professional body are very much aware of the importance of patient care and individual specialised medication for each patient and its advantages in elementary cross infection. The range of drugs and especially expensive drugs has Increased dramatically with an inevitable rise in expenditure.
In answer
to this, a new system of individual dispensing to patients in Hospital 7 has been implemented.
Now it is intended to extend
this system to the remaining units in the Medical and Geriatric Hospitals.
-46-
New M.D.A. Registers have been introduced for controlled drugs throughout the Hospital to ensure greater security and safety on Hospital wards.
It Is planned to give a service to special units
who require additives to sterile solutions.
The units in mind are
Haematology Unit in Hospital 1 Top Floor Gastroenterology Unit in Hospital 5 and Hospital 7
Recently, a Drug Information Service has been established at St. James's Hospital with the aid of the Federated Irish Chemical Industries Group.
This Centre will supply information to our own
Hospital as well as all the Hospitals in the country.
Mrs June O'Shea is in charge of this Centre.
-47-
PHYSIOTHERAPY D E P A R T M E N T
Staffing 1
Superintendent Physiotherapist
7
Senior Physiotherapists
14 Basic Grade Physiotherapists 8 Attendants 3 Receptionists
Physiotherapy Services Referrals for physiotherapy services have continued to increase during the year 1983, as can be seen from the Statistical Analysis. The areas significantly effected have been the Out-Patients departments and the Geriatric Unit.
Out-Patient Departments The main source responsible for the increased referrals to the two departments has been the Accident and Emergency Unit and the Orthopaedic Clinic. One of the two physiotherapy staff transferred from Mercer's Hospital to St. James's Hospital was appointed Senior Physiotherapist to Casualty. This has been a distinct advantage as casualty and orthopaedic trauma patients can now be seen without delay. Also, student nurses in casualty are receiving instructions in simple procedures e.g. strapping etc for these patients. The medical staff are gaining an appreciation of the value of physiotherapy by a more direct communication with the physiotherapist.
-48-
Geriatric Unit The transfer of patients from Hospital A to Hospital 2 and the opening of the Rehabilitation Area in the middle floor of Hospital 2 has brought about an increase in the work load for the physiotherapists. The anticipated decrease in the number of patients in Hospital A requiring physiotherapy has not come about.
The physiotherapists
have now got 3 active areas to cover in Hospital A, Hospital 2 and the Day Hospital, without any increase in staff numbers.
Service has
been maintained by a re-distribution of the total physiotherapy staff facilitated by the closure of a unit in Hospital 5 Medical.
Medical Wards Although alterations have been underway in Hospital and Hospital 5 wiht a closure of some wards, the demand for physiotherapy services has not decreased as the number of patients requiring physiotherapy are up on those of 1982.
Developments A sub unit is now completed in Hospital 7 department which has proven an asset to both staff and students so providing them with a quiet area within the department to attend to patients records and reports.
During the year the Geriatric Unit acquired Bobath
plinths and a tilt table which are much appreciated when treating Hemiplegic patients in particular. Students The number of students from the Dublin School of Physiotherapy attending at St. James's at the one time remains at the same figure as last year - sixteen to twenty. -49-
The students now include the Maternity Unit as an area for clinical experience.
There has been an increase in the number of prospective
students attending St. James's for observation in the departments and other areas within St. James's.
In March, the Physiotherapy
Department was visited by the CSP Assessor from.London, who discussed with staff the methods of assessing students.
Financial Cutbacks The serious effect of the embargo on locum physiotherapists was pointed out in last year's report.
The effect of the total amount
of annual leave in any one year taken by all physiotherapy staff is that the department is short and in the complement by 2 full-time staff the whole year.
Added to this deficiency, is the annual leave
for attendants and for receptionists.
As stated last year the most
seriously effected areas are the Out-Patients departments with Inpatients receiving only scant coverage at times.
-50-
Post-Graduate Courses The following post-graduate courses were attended by members of staff:Upper Limb Mobilisation Course - Dublin School of Physiotherapy Mechanical Therapy of the Lumbar Spine - Dublin School of Physiotherapy Mobilisation of the Lumbar Spine - Dublin School of Physiotherapy 7th International Congress on Psychosomatic Obstetrics and Gynaecology - Trinity College Dublin Tutor on Maitland Peripheral Mobilisation Course Acupuncture Course, Dublin Electrotherapy Course - Post-Graduate Centre, St. James's Hospital Rheumatology Forum for Consultants - Paramedical Staff, Leeds University Respiratory Workshop - Westminster Hospital Problems with the Elderly - Post-Graduate Centre, St. James's Hospital Aspects of the Management of Cerebral Palsy - Central Remedial Clinic Dublin. Dr Cyriax's Spinal Techniques - Dublin School of Physiotherapy
-51-
Statistical Analysis Out-Patient Departments
1982
1983
A,589
5,842
24,470
36,066
2,526
3,103
20,515
29,272
No. of patients
1,014
1,096
No. of treatments
8,161
9,407
No. of patients
1,314
1,422
12,469
16,749
No. of patients No. of treatments
Geriatric Unit
No. of patients No. of treatments
Medical Wards
Surgical Wards
No. of treatments
-52-
NURSING SERVICES Staffing 1 Group Nursing Administrator 2 Deputy Matrons 6 Assistant Matrons 380 Ward Sisters/Staff Nurses 47 Student Midwives 185 Student Nurses 156 Attendants
One of the most significant factors in the Nursing and Allied establishments in St. James's Hospital is the large numbers of long serving members of staff in these categories.
This fact is even more
surprising when you consider the vast changes that have occurred in the past ten years or so, resulting in an almost complete change of use of large areas of the Hospital, particularly in the acute wards. These changes have meant in turn that the nursing staff have had to alter their approach and develop their skills to meet the new situation They have met this challenge and succeeded. about to commence
With the new Hospital
construction in 1984, there will be even more need
for nursing staff to equip themselves to meet the upheavals which will be caused by a major development on the campus and the continued expansion of acute services.
It will not be easy, but given the past
record, it is confidently expected that the Nursing and Allied staffs in St. James's will cope with the challenges.
Closure of Mercers Hospital Mercer's Hospital was closed in 1983.
This was a very traumatic time
for all the staff, but they coped very well with the upheaval and it is expected that they will settle at St. James's in their new working environment.
Because of the developments at St. James's, the -53-
experiences of the Mercer's staff will be repeated and undergone by many staff, both within this Hospital and in the designated Hospitals in the years to come.
It is hoped that the same degree of understanding
and co-operation achieved between all sides in arranging the closure of Mercer's Hospital will be maintained in the future. N e w and Upgraded Units It was very pleasing to have the upgraded Haematology/Oncology/Bone Marrow transplant ward reopened earlier this year and all staff are looking forward to the first bone marrow transplant being undertaken early in 1984.
The new Gastroenterology and Medical Day Care facility
also came on stream during the year.
The numbers and sophistication
of the procedures being undertaken in this Unit are increasing and becoming more complex almost daily, but the Unit is certainly providing value for money.
Towards the end of the year, investigations
in this unit were nearing 500 per month.
There is little doubt that
if the increase continues, the Hospital will have to review staffing levels, and given that the constraints in finance will continue, it will be difficult to meet increased activity with improved staff numbers.
Financial Constraints In spite of the economic constraints during 1983, the Nursing budget just managed to break even, but this was achieved mainly because certain wards in the Hospital were closed for upgrading for a large part of the year.
-54-
Courses/Seminars Although financial restraints bore heavily on the Hospital, it was found possible to send a number of nursing staff on post graduate courses and seminars such as Oncology, Coronary Care, Stoma Care, Nursing Management, Focus on the Elderly.
As well as there being
a great need for further training it is heartening to see the great interest amongst St James's nurses in developing their skills. It is a pity all training needs cannot be met. Two staff nurses from St. James's were given leave of absence to work in third world countries.
S/N Clare Chamberlain is with Concern in
Ethopia and S/N Mary A Bonfield is with Concern in Thailand.
A
number of other nurses are on leave of absence and have gone to the Middle East.
The effect of this is that temporary employment can be
offered to newly qualified nurses.
Senior Nursing Staff Appointments:Miss Anne McNeill, Assistant Matron St. James's Hospital took up her new appointment as Deputy Matron on 1st August 1983. Miss Anne Dunne, Assistant Matron transferred from Mercer's Hospital joined our staff as Assistant Matron on 26th July 1983.
Retirements It is appropriate to mention long serving members of staff who retired during 1983. MATRON WARD SISTERS -
STAFF
NURSES -
Miss Nora McCarthy Ms Anne Bell Ms Mary Henry Ms Lena Murphy Ms Kay Boland -55-
17 21 20 31 37
years years years years years
service service service service service
STAFF
NURSES -
ATTENDANTS
-
Ms Ms Ms Ms Ms Ms Ms Ms Ms Mr Ms Mr Ms Mr
Sheila Roe Elizabeth Kelly Mary Lloyd Anne Kay Mary Glynn Elizabeth Kelleher Margaret O'Donoghue Mary Manamon Helen Toomey Thomas A Barry Mary A Burke John Maguire Ada Cobb Frankie Byrne
16 15 8 15 14 13 14 21 18 38 10 21 15 35
years years years years years years years years years years years years years years
service service service service service service service service service service service service service service
The Board and staff of the Hospital wish them all good health and a long and happy retirement.
Nursing and Midwifery Education Approval has been received from the Minister of Health to establish a Group Nurse Training School incorporating St. James's, Dr. Steevens, Sir Patrick Dun's and Royal City of Dublin Hospital and to the appoint ment of a Group Principal Tutor.
The approval is on the basis that th
school will serve as a pilot project and its development will be monitored by the Department of Health.
This is a major step for
nurse education in Ireland and the confidence shown by the Minister in the Group is appreciated.
It is hoped that the post of Group
Principal Tutor will be filled during 1984. Mercer's Students Forty student nurses transferred to St. James's Hospital from Mercer's in June 1983 to complete their training.
The change for them was
difficult, but they have contributed positively to the standards of
-56-
patient care in the Hospital.
Their tutor, Miss Mary Moore also
joined our teaching staff and is very welcome. Miss Mary Leigh, Clinical Teacher successfully completed a tutors course at U.C.D. and is looking forward to a tutors post in the near future. The examination successes of our student nurses continues at a very high rate.
The one depressing factor is that with the almost virtual
standstill at staff nurse level, it is increasingly difficult to offer posts to newly qualified nurses.
This is a problem facing all nurse
training schools and one which must be addressed by the Department of Health and An Bord Altranais in the near future. In September 1983, Catherine Hennessy, Student Nurse (November '82 Group) attended the European Nursing Students Group Professional Conference and Annual General Meeting at the R.C.N. London. The School of Nursing organised many inservice training and orientation courses for trained nurses throughout the year.
On the social level,
our student nurses participated this year in the Inter Hospitals Concert and gained second place overall.
Midwifery January 1983 saw the introduction of a two year Midwifery Training Programme in response to the E.E.C. Midwifery Directives.
Ward Sisters
and Senior Staff Midwives are now actively involved in the education and assessing of students as laid down by An Bord Altranais. During 1983, forty nine student midwives completed their training and forty-eight being successful in An Bord Altranais examination.
-57-
Obstetric Secondment of Student Nurses The Maternity Unit continues
to provide an ongoing programme of
obstetric nursing experience, according to the E.E.C. Nursing Directives for student nurses from:St. James's Hospital Dr. Steeven's Hospital Our Lady's Hospital for Sick Children, Crumlin In all 153 student nurses benefited from this
experience during 1983.
The organisation of the obstetric programme is the responsibility of Mrs Katherine Flynn, Midwifery Tutor.
Continuing Education P r o g r a m m e Study sessions, lectures, debates on interesting topics are arranged for staff midwives in an effort to nurture their personal and professional development.
In October, St. James's Hospital hosted
the Annual Study Day for Ward Sisters from the Dublin Maternity Hospitals.
Staff Changes Mrs Katherine Flynn joined the staff of the School in January 1983, bringing to three the number of Midwife Teachers in post.
-58-
CD
Student Nurses - Finalists November, 1983.
PATHOLOGY LABORATORY SERVICES
The Central Pathology Laboratory under the St. James's Hospital Board is responsible for the pathology service to St. James's and to the Federated Hospitals.
In addition, it supplies a service to
a number of Eastern Health Board Hospitals. There are five departments within the Laboratory - Biochemistry, Haematology, Microbiology, Histopathology and Immunology. Each department has its own consultant, technical, clerical and portering staff.
The administrative unit within the laboratory
supervises the co-ordination between departments, the transport system and communications. Staffing 3.1 Clerical Administrative 122 Professional Technical 28 Non Nursing 16 Consultants 15 Non Consultant Hospital Doctors The desired development into computerisation has not yet been achieved.
The Laboratory has reached such a size and complexity
now that advanced computerization is essential for the smooth running of services, and particularly for the rapid reporting of results to outlying hospitals. It was difficult during 1983 to remain within our budget although several aspects of the work had to be curtailed and in particular development work had to be minimal. -60-
Publications
Appendix A
Increased Folate Catabolism in Mice With Ascitic Tumours CLINICAL SCIENCE.
1983, 65, 303-305
D. G. Weir, D. A. Kelly and J. M. Scott
Gliadin Antibody Levels in Screening Tests for Coeliac Disease BRIT. MED. J. 1984, 288, 69-71 D. G. Weir, C. O'Farrelly, J. Kelly and C. Feighery
-80-
Publications
Monocytosis:
Appendix A
A Feature of Alcoholic Liver Disease
LANCET. 1983, 2. 1492 D. G. Weir, U. McKeever, C. O'Mahoney, E. Lawlor, A. Kinsella, and C. Feighery.
Perspective Therapeutics, Peptic Ulceration. TERACOM. 1983, 7-8 D. G. Weir.
A Secondary Outbreak of Hepatitis B Among Contacts of Drug-Abusers in Dublin Ir. Med. J.
1983, 76, 205-209
D. G. Weir
A Family with Multiple Endocrine Neoplasia Type 1 Ir. J. Med. Set. 1983, 152, 99-103 D. G. Weir, M. Lucey and S. R. McCann
Massive Jejunal Diverticulosis and Sub-Acute Combined Degeneration of the Cord Ir. J. Med. Sci. 1983, 152, 289-291 D. G. Weir, K. Ward, A. Robinson and N. McMurray
Gliadin Antibody Levels:
A Serological Test for Coeliac Disease.
BRIT. MED. J. 1983, i, 2007-2010 D. G. Weir, C. O'Farrelly, J. Kelly, W. Wekkens, B. Bradley, A. Thompson and C. Feighery
-19-
Publications
Appendix A
The Role of Methionine in the Intracellular Accumulation and Function of Folates Proceedings of a Workshop on Folyl and Antifilyl Polyglutamates Ed. I. D. Goldman, B. A. Chabroer, J. R. Bertino, Plenum Press, N.Y. & London. 399-413 (1983) D. G. Weir
Inability to Increase the Mobilisation of Liver Folates During Folate Deficiency Suggesting That This and Other Organs Do Not Act As A Potential Folate Store For Marrow and Other Radidly Proliferating Cells D. G. Weir, J. M. Scott, A. Molloy, A. Smithwick, P. McGing Chemistry and Biology of Pteridines.
Ed. J. A. Blair, 1983.
Walter de Gruyter & Co., Berlin. N.Y.
Factors Affecting Folate Polyglutamate Biosynthesis in Rat Liver D. G. Weir, S. Keathing, J. M. Scott Chemistry and Biology of Pteridines Ed. J. A. Blair, 1983. Walter de Gruyter & Co., Berlin, N.Y. D. G. Weir
Isoenzymes of Human Liver Alcohol Dehydrogenase and Aldehyde Dehydrogenase in Alcoholic and Non-Alcoholic Subjects. Alcohol and Alcoholism 1983. 18, 219-225 D. G. Weir, K. Tipton. J. M. McCrodden and K. Ward
-78-
Publications
Appendix A
Isoenzymes of Alcohol and Aldehyde Dehydrogenase in Alcoholic and Non-Alcholic Patients GUT, 1983, 24, A483 (Abstract) D. G. Weir, K. Ward, J. McCrodden and K. Tipton
Blood Acetaldehyde Levels in the Relatives of Alcoholics European J. Clin. Invest. 1983, 13, A15. D. G. Weir, K. Ward, J. McCrodden and K. Tipton
Acute Folate Deficiency Does Not Increase the Rate of Liver Folate Release:
A Mechanism for Acute Megaloblastic Anaemia Following
Intensive Care Therapy GUT. 1983, 24, A497 D. G. Weir, A. Molloy, A. Smithwick, P. McGing and J. M. Scott
Inter-Relations of Rolates and Cobalamines.
Chapter in 'Nutrition
in Haematology' in the 'Contemporary Issues in Clinical Nutrition' series. Ch. 4, 121-142. D. G. Weir, J. M. Scott, Ed. 3. Lindenbaum, Churchill Livingstone Inc. N.Y.
Liver Function Tests of Practical Value Modern Medicine of Ireland. May 1983, 30-31 D. G. Weir, D. Kelly
-77-
DEPARTMENT OF GASTROENTEROLOGY
Publications
Appendix A
Colonic Cancer - Modern Medicine, July 1983 E. Cryan, P. O'Connor & P.W.N. Keeling
Alcohol and the G. I. Tract - Irish Medical Times, September 1983 D. J. Kelleher & P. w. N. Keeling
Oral Iron and the Bioavailability of Zinc B.M.J., 287, 1983 N. J. Meadows, S. L. Grainger, W. Ruse, P. W. N. Keeling, R. P. H. Thompson
Peripheral Blood Leucocyte Zinc Depletion in Babies With Intrauterine Growth Retardation. Arch, of Paediatrics, 178, 1983. N. J. Meadows, P. W. N. Keeling, R. P. H. Thompson
Adult Idiopathic Pulmonary Haemosiderosis:
A Comparison of Lung
Function Changes and the Distribution of Pulmonary Disease in Patients With and Without Coeliac Disease. Br. J. Dis. Chest. 282, 1983. P. H. Wright, M. Bruxton Thomas, P. W. N. Keeling, L. Kreel
-76-
Steam Distribution Major alterations and repairs have been carried out to the steam and condense distribution network throughout the Hospital complex which had a major reflection on the energy conservation programme introduced in 1983, and very successful cost savings are arising from this essential work which was carried out on a very effective cost evaluation basis.
G r o u n d Maintenance A very substantial improvement in the overall maintenance of the Hospital services was achieved over the period by the introduction of proper refuse recepticle units, the construction of refuse disposal bays and an overall reorganisation of the grounds maintenance personnel together with a reorganisation of the overall car parking policy on the site, which arises from the on-going major Hospital developments.
Rationalisation of Telephone Services Considerable progress has been made in pursuing the determined Hospital policy of discontinuing existing satellite telephone switchboard exchanges and centralising related services in the new Communications Centre.
Work has commenced
on effecting this policy with respect to
the Central Pathology Laboratory,
Trinity Medical School and Depart-
ment of Surgery, Hospital 6 and Eastern Health Board Department of Child Psychiatry.
It is anticipated that this exercise will be
completed by mid June 1984.
-75-
Minor Developments/Up -Grading P r o g r a m m e
Some of the more significant advances achieved, in progress or proposed under the Hospital's Minor Development/Up-Grading Programme include the following:D a y Care Centre — Hospital 5 The new Day Care Centre Extension to Hospital 5 Medical Wing has been completed and the facility is now fully operational.
Redevelopment of T o p Floor - Hospital 1 Redevelopment of the Top Floor of Hospital 1 to accommodate the Bone Marrow Transplantation Unit and the new Department of Oncology has been completed and it is anticipated that the first bone marrow transplant will take place in April/May 1984.
Maternity Unit Preliminary design and cost estimates have been prepared for the redevelopment of the Maternity Hospital to provide up-dated facilities for Obstetrics/Gynaecology.
Hospital 7 — Operating Theatres Preliminary design and cost estimates are at present being prepared for the redevelopment of the Operating Department at Hospital 7 to provide short term up-dated facilities to meet the ever increasing demands arising from the service being provided at St. James's Hospital.
-7A-
(a)
Radiodiagnostic Department
(b)
Operating Department
(c)
Intensive Care and Coronary Care Units
(d)
Out-Patients Department
(e)
Accident and Emergency Department
(f)
In-Patient Standard Wards [279 beds]
(g)
Burns Unit
(h)
Psychiatric Ward Unit
(i)
Geriatric Day Hospital Facilities
(j)
Central Sterile Supply Department
(k)
Medical Illustration Department
(1)
Day Ward Facilities
(m)
Maxillo-Facial Laboratory and supporting facilities
(n)
Temporary Concourse, Medical Records and other supporting facilities, i.e. Temporary central changing and central plating and dishwashing facilities together with central temporary cook/chill facilities.
The anticipated date for handover of the new facilities for commissioning purposes which will be on a phased basis will be 38 months from the date of commencement.
Phase II Detailed work has now been completed on the revised Brief and Schedules of Accommodation for Phase II of the Hospital development and 'a formal submission has been made to the Department of Health for approval to the Brief Amendments arising from that revision.
On the basis of
current programming, it is predicted that Phase II of the New Hospital Development which comprises the following facilities and is estimated
-Or
at £15 million will commence construction at the end of 1987 and will be completed by the end of 1990:(a)
Central Administration Facilities
(b) Central Concourse comprising shops, reception, waiting areas etc. (c)
On-Call Accommodation
(d)
Hostel Facilities
(e)
Central Staff Changing
(f)
Central Supplies Department
(g)
Restaurant
(h)
Medical Engineering Facilities
(i)
Pharmacy
(j)
Physiotherapy/Rehabilitation
(k)
Other Ancillary Facilities
Phase ID — Residential Accommodation Detailed work has been completed on Phase ID of the Hospital development which is the Residential Accommodation and work is presently proceeding to Stage A with the design programme.
It is anticipated
this will be completed in 1984, to allow the possible construction of the facility in 1985.
A similar position exists with regards to the
new Central Workshops facilities for the Hospital development. Work is also proceeding on the following minor developments which are essential to the overall programme:(a)
Temporary Social Works Department
(b)
Temporary Physiotherapy Department
(c)
Temporary Psychiatric Out-Patients Department
(d)
Temporary Pharmacy
(e)
Other Ancillary on-site works which arise due to the predicted demolition date of Hospital 3, being early 1986/7. 73
TECHNICAL SERVICES, PLANNING AND DEVELOPMENT
Major Hospital Development Phase IB Since the last Annual Report was presented, work on Phase IB has progressed on programme, and the new Ambulance Control Centre for the Eastern Health Board was formally handed over in July 1983, equipped, commissioned and operational by September, 1983.
The main Energy
Centre, which comprises the main electrical distribution centre, main water distribution centre, central incineration facilities and the steam and hot water generation plant for the whole Hospital complex is proceeding on schedule with a projected date for handover for final commissioning being November 1984.
Progress has also been made on the
staffing and commissioning aspects of the new Energy Centre and a formal submission is now being made to the Department of Health for the appointment of an Energy Services Officer.
Phase IC The Design Team have submitted the preliminary report on the tenders received for Phase IC and it is anticipated that following satisfactory negotiations for the Phase IC-East development, i.e. Psychiatric Hospital and Geriatric Day Hospital together with new provisions under the radiation protection requirements, that a formal submission will be issued to the Department of Health late in February 1984, with the intention of having the Contractor on site to commence the development in April 1984.
This phase of the Hospital development is estimated to
cost £25,500,000 for building works and comprises the following facilities :~?1-
o
Recreation Room - Ambulance Control Cent
Eastern Health Board - Ambulance Control Centre.
CLINICAL MICROBIOLOGY
It was confidently expected that with the dawn of the antibiotic era infectious disease would be rapidly conquered. proved to be unfounded.
This prediction has
Although certain infections have become
susceptible to chemotherapy, many others have become resistant to treatment.
Moreover, new infectious diseases have recently been
described.
Many of the techniques of genetic manipulation have
arisen directly from work done with bacteria.
The Clinical Microbiology Laboratory has contributed to these developments.
However, the prime purpose of the laboratory is the
clinical service which is of a standard comparable to the best laboratories in the United Kingdom.
Many of the newer techniques
recently introduced into the diagnostic microbiology laboratory greatly assist patient management.
Rapid methods of diagnosis
resulting in early treatment would be one example.
Better techniques
of microbial isolation result in more specific antibiotic treatment. Allied to these laboratory procedures is computerized reporting which means more rapid results for the clinician.
The fusion of the
Federated Dublin Voluntary Hospitals Microbiology Laboratory with that of St. James's has been extremely successful and givesa service of which the Hospital can be proud.
- h f> -
IMMUNOLOGY DEPARTMENT
The Immunology Department helps in the diagnosis and monitoring of a range of clinical disorders.
Antibodies directed against specific
tissue components are found in many diseases and help in the diagnosis of, for example, endocrine diseases (e.g. Hashimoto's thyroiditis); liver diseases (e.g. primary biliary cirrhosis); and neurological diseases (e.g. myasthenia gravis).
Patients with arthritis may suffer
from a variety of diseases including rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis:
the detection of particular
antibodies (e.g. rheumatoid factor, anti-nuclear antibody) helps classify these disorders.
Some patients have an increased susceptibility to bacterial and viral infections and the cause of this can be investigated in the laboratory by the estimation of immunoglobulin levels, and the function of complement, neutrophil and lymphocyte components.
Several graduate university students work in the laboratory and in the Sir Patrick Dun's Research Laboratory researching disease mechanisms in coeliac disease, alcoholic liver disease, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis and haemophilia. New tests are continuously being developed and recent additions include: an antibody test for the diagnosis of coeliac disease; the detection of unusual IgG antibodies (oligoclonal IgG) in multiple sclerosis; the use of monoclonal antibodies to help differentiate types of leukaemia; subtyping of antimitochondrial and antinuclear antibodies.
-£7-
The Haematology Department contains two other specialised units. Firstly, the Nutritional Anaemia Unit, involved in detecting vitamin deficiencies, which can cause severe anaemias.
This unit provides
a reference service for the detection of these deficiencies. Secondly, a comprehensive range of investigations is available for diagnosis of acquired and congenital haemolytic anaemias.
-6f-
Blood transfusion therapy has become more refined and sophisticated in recent times and the unit has to meet the increasing demands for specific component therapy, e.g. red cell concentrates for anaemic patients, platelet concentrates for thrombocytope patients, fresh frozen plasma for patients with coagulation disorders and plasma cryoprecipitates for haemophilia patients.
The increasing demands
for blood/red cell concentrates, which by their very nature have a short life span require us to use these vital products as efficiently as possible and we recognise that surgical, medical and nursing staff have a vital role to play in this regard.
Techniques for platelet auto-antibody detection have been developed recently despite restrictions on staffing levels.
Computerisation which is to be introduced shortly will improve certain aspects of the service, i.e. blood stock inventory control, patient record filing system and statistical information.
Like the routine haematology unit, the coagulation laboratory provides a comprehensive service to monitor the clotting functions in patients blood.
The coagulation unit provides the National Haemophilia Centre
with a laboratory reference centre and also provides full reference facilities for patients suspected of having an inherited or acquired coagulation defect.
The coagulation unit is now well established as
a national reference centre for the investigation of congenital bleeding disorders.
-65-
HAEMATOLOGY AND BLOOD TRANSFUSION
This Department has four major sub divisions in its service: routine haematology, coagulation, nutritional anaemia and haemolytic anaemia.
Routine haematology provides tests concerned with the cellular elements in the blood, both to general patients and to those with specific blood diseases. every day of the year.
Service is provided around the clock, During an average working day, tests are
performed on 550 - 700 patients.
This very high workload requires
the use of automated counting equipment.
It is hoped shortly to
purchase equipment which will automatically cope with the differential white cell count.
The routine haematology unit provides a compre-
hensive service both with cell counting and cytochemical diagnosis for the leukaemia unit which will soon become the new Bone Marrow Transplant Unit in St. James's Hospital.
The Blood Transfusion Unit is the largest hospital transfusion centre in the country, testing 15,000 specimens and crossmatching 40,000 units of whole blood and red cell concentrates annually. The following services are provided by the unit;
blood grouping
investigations and compatability testing, blood group serology for ante natal patients, serological testing of certain types of autoimmune disease and supplying treatment for haemophiliacs registering in the National Haemophilia Centre. day, seven day week basis.
H\
The unit operates on a 24 hour
A therapeutic drug monitoring service for certain antiepileptic, respiratory and cardioactive drugs is also in operation and this section is under active development and review.
The Department's computer (a DEC PDP-11/44) is on line to coordinate the major sections of Biochemistry.
End-of-day listings
by hospital, ward, consultant, etc are generated in mid-afternoon and individual patient reports for the charts are produced by the close of the day and distributed to St. James's and the Federated Hospitals.
Remote reporting takes place by transferring Biochemistry
results to the DEC computer at the Meath Hospital, which then prints the reports not only in the Meath, but also in the-Adelaide and in the National Children's Hospital.
This has led to a great reduction
in the number of phone calls between this group of Hospitals and the Department.
-63-
BIOCHEMISTRY DEPARTMENT
The Biochemistry Department is loosely divided into a number of sections.
The bulk of the routine estimations are handled in the
Automated Section, where up to twenty tests on each of approximately five hundred specimens are carried out daily on a 'Technicon' SMAC Analyser (Sequential Multiple Analyser Computerised).
The 'Stat. Lab.' deals with all emergency requests both by day and by night by a variety of analytical techniques.
The Endocrinology Laboratory is a most important section of the Department.
Within the last year, the range of work has been
broadened to include the following hormone assays - Gastrin, Androstenedione, Adrenocorticotropic hormone, and the Beta Subunit of Human Chorionic Gonadotropin.
Due to the nature of the work,
manual techniques which are labour intensive have to be used and this work has to be followed up by elaborate computerised calculations.
The section has an active interest in the study of
infertility problems and is currently engaged in research into the factors which influence the re-establishment of ovulation in breastfeeding mothers.
Close liaison is maintained with the Department of
Obstetrics and Gynaecology, and the Consultant Endocrinologists using the service.
The Department continues to operate a screening programme for inborn errors of metabolism, particularly those resulting in mental retardation and with special reference to amino-acid analysis.
-£2-
It has not been possible to install the necessary equipment in the satellite laboratories in the Meath and Sir Patrick Dun's Hospitals and it is hoped that the services provided from these will help in the management of patients who require urgent routine tests (where the result is required under one hour).
A continuing difficulty
has been the large volume of out of hours 'on call' work.
A
satisfactory method of reducing this work has not been found. There are so many specimens
to be dealt with before midnight that
there are five technicians working and we have a risk of a genuine emergency being taken in with a great
deal of other tests unless
staff are informed of the clinical urgency of the request.
The Laboratory continues to be a major centre for training technical, graduate and medical staff, and members of the C.P.L. have contributed substantially to the academic aspects of pathology within the Republic of Ireland during 1983.
In this connection, a list of the publications
during 1983 is listed in schedule.
During 1983, a total of 539,000 requests for tests were received in the Central Laboratory.
The sources and main categories of these
requests are described in the activity analysis (see appendix).
•61
GENERAL MEDICINE
Publications
Appendix A
Sleep And Hypnotics.
Hypnotics in Clinical Practice
The Medicine Publishing Foundation, Symposium Series, 7 May 1982.
Organophosphorus Poisoning I. M. J. Vol. 76, 3 March 1983. D. R. Hackett, M. P. Buckley
Infective Endocarditis:
An Emerging Clinical Problem?
I. M. J. Vol. 76, 4 April 1983. D. R. Hackett, M. P. Buckley
Adult Panhypopituitarism With Normal Stature Following Tuberculosis Meningitis in Childhood:
A Case Report.
I. M. J. Vol. 76, No. 8, August, 1983. C. J. Lanigan,
M. P. Buckley
-81-
DEPARTMENT OF GERIATRIC MEDICINE
Publications
Appendix A
Minute Eye Movement and Brain Stem Function D. Coakley
C.R.C. Press, Florida U.S.A.
Ultrasound:
Investigation of Choice for Elderly (1983)
Modern Medicine
28, 19.
D.E. Malone, D. Coakley
Art and Artefact in Diagnosis (1983) Geriatric Medicine 13, 28 B. West, D. Coakley
-82-
DEPARTMENT OF HAEMATOLOGY Publications
Appendix A
Relationship between Innmunogloculin Levels, Lymphocyte Subpopulations and Rai Staging in Patients with B-CLL Acta Haematologica 6H 217-223 1983 C. A. Whelan, R. Willoughy, S. R. McCann
Venous Access Using a Hickman Catherter. Irish Medical Cr (1983) 76, 35-36 D. J. Moore, J. Keating, F. Murray, S. R. McCann, D. G. Shanik
Successful Treatment of Invasive Aspergillosis in a Patient with Acute Leukaemia Ir. J % Med. Sci. 103-105 1983 D. D. Daly, A. Doherty, S. R. McCann High Dose Melphalan with Autologous Bone Marrow Transplantation in the Treatment of Metastatic Ewings Sarcoma. Irish Journal of Medical Science, 1983, 152, 160-164 S. R. McCann, M. Reynolds, R. Meldrum, B. Breslin, T. Walsh, I. J. Temperley and P. A. Daly
Hypercalcemia in Common All New England Journal of Medicine (Letter) 1982, 307, 1526 E. Lawlor, L. Coffey, R. Willoughby and S. R. McCann
Severe Hypomagnesaemia and Hypocalcaemia following Gentamicin Therapy Irish Medical Journal 76, 381, 1983. A. Watson, L.Coffey,
B. Keogh, S. R. McCann -83-
Publications
Appendix A
Use of M Amsa and VP 16 in the Treatment of Refractory Acute Leukaemia 13th International Congress of Chemotherapy 1983 S. R. McCann, P. Daly, I. J. Temperley,
Basophil Differentiation in Ph Postive Blast Cell Leukaemia Br J Haematol 54, 157-160, 1983 Emer Lawlor, S. R. McCann, Rena Willoughby, J. Dunne, I. J. Temperley
Lymphocytic Interstitial Pneumonitis (LIP) with Evidence of a B-Cell Lympho-Proliferative Disease Abstracts, International Society of Haematology, September Ath - 9th 1983 p. 315 D. Flanagan, L.Clancy, C. A. Whelan, C. A. Willoughby, R. Willoughby, R. Finn, E. Lawlor, S. R. O'Briain, S. R. McCann
Provision of Leucocyte - Poor Blood at the Bedside Abstracts, International Society of Haematology September Ath - 9th 1983. p. 178 Elizabeth McNamara, Shiela Clarke and S. R. McCann
A Pyruvate Kinase Variant with an Increased Affinity for Phosphenolpyruvate in an Individual with Congenital Non Sperocytic Haemolytic Anaemia. Clinical and Laboratory Haematology 1983.
5, 237-2A1
0. Smith, I. J. Temperley, K. Tipton and S. R. McCann
-8A-
Appendix A
Publications
The Evaluation of the Patient with a Suspected Bleeding of Thrombotic Tendency:
A Study of 290 Cases
Irish Medical Journal
76, 449, 1983.
J. D. Sweeney, H. Daly, E. Lawlor, S. R. McCann, I. J. Temperley
-85-
DEPARTMENT OF ONCOLOGY Publications
Appendix A
High Dose Melphalan with Autologous Bone Marrow Transplantation in the Treatment of Metastatic Ewing's Sarcoma. 152:
Ir. J. Med. Sci. 1983,
160-64
Sr. McCann, M. Reynolds, R. Meldrum, B. K. Breslin, T. Walsh, I. J. Temperley, P. A. Daly.
Osteonecrosis of the Femoral Head Following Treatment for Hodgkin's Disease.
Ir.J. Med. Sci. 1983. 152:
286-288
F. Murray, P. A. Daly, P. J. Freyne.
Alloimmunisation Prevents the Migration of Transfused Indium -IllLabeled Granulocytes to Sites of Infection.
Blood 1983, 62:
J. P. Dutcher, C. A. Schiffer, G. S. Johnston, D. Papenberg, P. A. Daly, J. Aisner, P. H. Wiernik.
Supportive Care for the Patient with Myelosuppression and Immunosuppression.
Ir. Med. Journal.
P. A. Daly
-86-
1983, 76:
466-470
354-360
PHARMACOLOGY AND THERAPEUTICS Publications NEW
Appendix A
DRUGS
A book compiled by the Department and published by the British Medical Journal based on a series of articles including:J. Feely, K. G. Wormsley. H 2 Receptor Antagonists-Cimetidine and Ranitidine. 1983 286:
J. Feely, P. DeVane, D. Maclean. Beta-Blockers and Sympathomimetics
1983 286:
1043-1047
D. Maclean, J. Feely Calcium Antagonists, Nitrates and New Antianginal Drugs 1983 286:
1127-1131
N. MacPherson, J. Feely New Insulins
1983
286:
1502-J 504
C. Patterson, .]. r eely Vitamin D Analogues Dlphosponates, Bromocriptine and Danazol 1983
286:
1625-1628
B. R. Ballinger, J. Feely, Antidepressants
1983
286:
1885-1887
N. Peden, R. Newton, J. Feely Oral Hypoglycaemic Drugs
1983
286:
-87-
1564-1567
695-697
DEPARTMENT OF RADIOLOGY
Publications
Appendix A
Glandular Epethelium With Particular Reference To Thyroid, 1983 in 'Cytotoric INsult to Tissue' p. 186-227 Eds:
C. S. Potten and J. H. Hendry, Edinburgh, Churchill-Livingstone
J. F. Malone, M. K. O'Connor and J. H. Hendry
Digital Fluoroscopy Using a Digital Video Interface and a Nuclear Medicine Computer 1984 British Journal of Radiology (in press) M. K. O'Connor, K. Maher, J. F. Malone et al
Development of a System for the Assay of Radiation Induced Transformation in Differentiated Thyroid Cultures 1983, in 'Proceedings of INt. Congress on
Radiation Research'
pp. C5-09 (INt. Assoc.
Rad. Res., Amsterdam) C. Mothersill, C. B. Seymour, M. Moriarty, J. F. Malone
An Investigation of the Optimum Culture Conditions for a Differentiated Culture of Sheep Thyroid Cells 1983 Acta Endocrinologica A. Murphy, C. Mothersill, M.K.O'Connor, J. F. Malone, M. J. Cullen and J.K.Taaffe
Initial Experience With The Implementation of an Audiometer Calibration Service, 1982, Associated of Physical Scientists in Medicine, A.G.M. Waterford
A.P.S.M. Bulletin, 1983, 3, 16
B. J. Murphy, J. F. Malone, K. P. Maher -88-
Publications
Appendix A
The Requirements for and Capabilities of Digital Image Processing Systems to Produce Fluoroscopic Difference Images, 1982. Association of Physical Scientists in Medicine, A. G. M. Waterford, A.P.S.M. Bulletin, 1983, 3, 18 K. P. Maher, J. F. Malone, M. K. O'Connor
Quantitative Evaluation of Renal Function Using Digital Subtraction Angiography, 1983, Fifth European Congress of Radiology, Bordeaux, Book of Abstracts p. 131 G. D. Hurley, K. P. Maher, D. Mclnerney, J. F. Malone
Digital Subtraction Angiography Using Conventional Fluoroscopic Equipment, Low Continuous Exposure and An Add on Image Processor 1983, Hospital Physicists Association 40th Anniversary Meeting, Newcastle. 1984 Physics in Medicine and Biology (in press) K. P. Maher, J. F. Malone, G. D. Hurley and D. Mclnerney
Radiation Induced Transformation of Primary Cultures of Differentiated Thyroid Cells 1983 Association of Radiation Research, Salford. 1984 Int. J. Radiation Biology (in press) C. Mothersill, C. B. Seymour, M. Moriarty, J. F. Malone
-89-
Publications
Appendix A
The Development of a System for the Assay of Radiation Induced Transformation in Differentiated Thyroid Cultures. 1983, Proc. 7th Int. Conf. Radiation Research, Amsterdam, Book of Abstracts, C, 509 C. Mothersill, C. B. Seymour, M. Moriarty, J. F. Malone
Evaluation of Left Ventricular Function by Digital Subtraction Angiography, 1983, Association of Physical Scientists in Medicine A. G. M. Cork A.P.S.M. Bulletin, 1984 (in press) M. K. O'Connor, P. Quigley, J. F. Malone
Dosimetry of 131j Labelled Monoclonal Antibody to Neuroblastoma 1983, Association of PHysical Scientists in Medicine, A.G.M. Cork A.P.S.M. Bulletin, 1984, (in press) B. J. Murphy, J. F. Malone, F. Breathnach, G. D. Hurley
Log Amplification for Quantitative DSA:
An Untested Assumption,
1983 Radiological Society of North America, Chicago. 1983 Medical Physics, 10, 128. K. P. Maher, M. K. O'Connor, J. F. Malone and G. D. Hurley
Digital Subtraction Angiography in the Evaluation of Extra-Cranial Vascular Disease, 1983, Irish Neurological Society, Galway, 1983, Irish J. Med Sci, 321 G. D. Hurley, K. P. Maher, D. Mclnerney and J. F. Malone
-90-
Publications
Appendix A
Experimental Investigation With A Digital Fluoroscopy System, 1983 Hospital PHysicists' Association A.G.M. Sheffield. 1983, Clin Phys. Physiol. Meas, A,98 M. K. O'Connor, K. P. Maher, J. F. Malone
-91-
DEPARTMENT OF SURGERY
Publications
Appendix A
The Relationship Between Technetium 99m Pertechnetate Gastric Scanning and Gastric Emptying British Journal of Radiology, 56, 817-822, 1983 M. K. O'Connor, R. O'Connell, F. B. Keane, P. J. Byrne, T. P. J. Hennessy
Pharyngolaryngectomy for Post Cricoid Carcinoma The Journal of Otolaryngology, 12:
A, p. 257-258, 1983.
W. Doyle-Kelly and T. P. J. Hennessy
Subcutaneous Left Colon Reconstruction Following Pharyngolaryngectomy Annals of the Royal College of Surgeons of England (In Press) T. P. J. Hennessy, M. P. Brady, and W. Doyle-Kelly
-92-
PATHOLOGY DEPARTMENT Department of Histopathology Publications
Appendix A
Hyper Insulism Associated with Pleomorphic Pancreatic Tumours Carcinoid or Carcinoma? Pathology Research and Practice 1983, 178, 152. D. S. O'Briain, P. Dervan, J. Kennedy.
Pituitary Immunoreactive Calcitonin - Like Material - Lack of Evidence for Cross Reactivity with Pro-Opiomelanocortin Metabolism 1983, 32:
686-96
R. F. Gagel, D.S. O'Briain, E. F. Voelkel, H. J. Wolfe, R. A. DeLellis, A. K. Lee, A. H. Tashjian Psammomatous Carcinoids:
An Uncommon Histologic Variant of
Duodenal Somatostatinomas Lab. Invest. 1983, 48, 19A Y. Dayal, D. S. O'Briain, M. J. O'Brien, W. G. Doos, R. A. DeLellis S. Reichlin, H. J. Wolfe
Epidermolysis Bullosa Acquisita with Pulmonary Tuberculosis: A Case Report, Clinical and Experimental Dermatology, 8(1983) 311-18 G. S. A. McDonald with Sarah Rogers, Catherine Larkin, Joan Mullaney and E. P. Collins
Bilateral Ovarian Carcinoma with Bilateral Uveal Melanomata Brit. J. Ophthalmol., in press with Joan Mullaney, D. Mooney and M. O'Connor
-93-
Department of I m m u n o l o g y Publications
Appendix A
The specificity of wheat protein reactivity in coeliac disease. Scan 3. Gastro. 18:
603-607 (1983)
C. O'Farrelly, C. Feighery, W. Hekkens, D. G. Weir
Alpha Gliadin and ELISA - A serological test for coeliac disease. Brit. Med. 3. 286:
2007-2010
C. O'Farrelly, 3. Kelly, W, Hekkens, B. Bradley, A. Thompson, C. Feighery, D. G. Weir
Murine Myeloma Cell Products -Effect on Murine and Human Cells. Folia Allerg et Immunol Clin. 30, 60. (1983) C. O'Farrelly, 3. McPartlin, A. Whelan, C. Feighery, D. G. Weir
Visual Evoked Responses and Immunoglobulins Abnormalities in the Diagnosis of Multiple Sclerosis Acta Neurol. Scand. 68:
90-95 (1983)
M. Hutchinson, E. A. Martin, P. A. Maguire,
D.
Glynn, M. Mansfield,
C. Feighery
Monocytosis:
A Feature of Alcoholic Liver Disease
Lancet ii, 1492, (1983) U. McKeever, C. O'Mahony, E. Lawlor, A. Kinsella, D. G. Weir, C. F. Feighery
Functional Immune Regulation in Alcoholic Liver Disease Gut, 24, A969 (1983) U. McKeever, C. O'Mahony, C. A. Whelan, D. G. Weir, C. Feighery -94-
Department of Microbiology Publications
Appendix A
Acetamide Broth for Isolation of Pseudomonas Aeruginosa from Patients with Cystic Fibrosis. Journal of Clinical Microbiology 1983, JJ, 1, 159. N. M. Kelly, F. R. Falkiner and C. T. Keane.
Mucoid Gram-Negative Bacilli in Cystic Fibrosis. Lancet, 26th March 1983, 705. N. M. Kelly, F. R. Falkiner, C. T. Keane, M. X. Fitzgerald, E. Ternpany
Gentamicin and Methicillin Resistant Staphylococcus Aureus in Dublin Hospitals.
Clinical and Laboratory Studies.
Journal of Medical Microbiology, 1983, j_6, 117-127. M. T. Cafferkey, R. Hone, F. R. Falkiner, H. Pomeroy, C. T. Keane.
Staphylococcal
Nasal Carriage in Medical Students with Varying
Clinical Exposure.
Journal of Hospital Infection, 1983, A, 75-79.
J. C. P. Kingdom, Susan M. Joyce, Fiona L. Bradley, W. Jauch, F. R. Falkiner and C. T. Keane.
Principles of Antibiotic Prescribing. No. 17.
Modern Drug Treatment Series,
Irish Medical Journal, June 1983. 76, 6, 293-296.
C. T. Keane.
-95-
Department of Microbiology
Publications
Appendix A
Severe I n f e c t i o n s Caused by M e t h i c i l l i n - R e s i s t a n t Staphylococcus Aureus.
European Journal of Clinical Microbiology, August 1983, 2, 4, 299-302 C. T. Keane and Mary T. Cafferkey
IgA Nephropathy in Association with Yersinia Enterocolitica. Irish Journal of Medical Science 1983, 152, 8, 311-312 D. Cusack, T. Martin, M. Schinittger, M. Cafferkey, C. T. Keane, B. Keogh
-96-
ADMISSIONS Appendix B
1979
1980
CARDIOLOGY
446
488
1,136
1,244
1,179
GERIATRICS
591
990
1,078
977
1,167
GYNAECOLOGY
244
196
225
230
257
G.U.
425
512
637
745
726
HAEMATOLOGY
670
564
546
424
301
3,561
3,790
3,565
3,551
3,435
710
707
746
554
536
2,755
3,347
3,547
3,155
2,627
NEUROLOGY
1
1
2
9
2
ONCOLOGY
11
145
237
158
317
ORTHOPAEDICS
790
947
1,291
1,280
1,378
PSYCHIATRIC
476
420
379
320
391
1,882
1,880
1,924
2,104
2,299
12,562
13,987
15,313
14,751
14,615
MATERNITY PREM.
UNIT
MEDICAL
SURGICAL TOTAL
IN-PATIENT STATISTICS 1983 -
-
1
MED.
ACUTE
BED
AVAILABILITY
128
BED
COMPLEMENT
183
AVAIL. OCC.
BED BED
VACANT
DAYS DAYS
TRANSFERS
IN
ADMISSIONS TRANSFERS
OUT
PATIENTS TREATED 1(Discharges & Deaths) 1% BED
UTILISATION
AVERAGE L T H . (Days)
STAY
TURNOVER INTERVAL (Days) j TURNOVER
RATE
46,720 38,064
A V A I L . BED DAYS
|
I
MEDICAL LONGSTAY
SURGICAL
PREM UNIT
121
130
30
75
178
135
130
30
87
179
10,950
27,375
64,970
MATERNITY
GERIAT
L. STAY
44,165
47,450
43,377
40,453 1
4,628
17,192
63,053
6,322
10,183
1,917
8,656
788
6,997
877
54
127
3,732
81
4,761
447
3
165
4,154
128
4,734
532
3,452
554
81.47%
98.22%
85.25%
42.26%
62.80%
97%
9
5
32
13
3
2
16
43
4
11
331
1.8
9
36
1
-
-
536
-
8 1.4 | 1 1 37 ,
-98-
95
3,435
-
718 243
OUT PATIENT SUMMARY 1983
CLINICS
NO. OF CLINICS
Cardiology Fertility Geriatric Gynaecology G. U. Haematology Maternity Medical Neurology Oncology Opthalmology Psychiatric Surgical Orthopaedic
96 52 101 53 98 50 331 723 51 52 93 455 239 199
SUB
TOTAL
IN PTS.
NEW PTS. 449
40
2 369
2,593
411
RETURN PTS
Appendix D
TOTAL
AVERAGE ATTENDANCE PER CLINIC)
289 293 447 86 2,951 3,281 178 16 252 282 1,695 999
2,626 469 1,087 887 1,245 1,114 20,770 10,945 392 406 505 6,343 4,710 4,453
3,075 469 1,376 1,180 1,692 1,200 23,721 14,266 570 422 759 6,994 6,405 5,452
32 9 14 22 17 24 72 20 11 8 8 15 27 27
1,218
55,952
67,581
26
Other Services Additional Attendances/Day Cases NO. OF CLINICS IN PTS. NEW PTS. OTH. HOSP. Med. Day Cases Surgical Cases A & E Attendances Chiropody Day Hospital Physiotherapy Speech Therapy X-Ray SUB TOTAL
TOTAL
848 603
517 298
29 215
418
8
RETURN PTS.
TOTAL
236 28
2,689 1,452 18,260 408 6,083 40,474 1,031 47,405
3,450 1,778 41,330 705 6,312 43,308 1,860 47,504
23,070 82 229 2,834 45
784 1,898
1,814
26,268
264
11,790
146,247
4,491
2,225
37,486
264
73,853
213,828
-99-
;
'
Appendix E OUT PATIENT COMPARISIONS NEW
PATIENTS
RETURNS
TOTAL
8,099
36,838
44,937
11% Inc
19,675
17,820
37,495
9% Inc
Maternity
2,375
21,742
24,117
5% Dec
Physiotherapy
1,873
20,579
22,452
3 5% Inc
1981 Out Patient Department Accident & Emergency
592
6,491
7,083
13% Dec
—
*42,307
42,307
13% Dec
TOTAL
32,614
145,777
178,391
% Increase/Decrease over 1980
20% Inc
7% Inc
9% Inc
8,722
38,268
46,990
4% Inc
22,398
16,054
38,452
2% Inc
Maternity
3,161
21,602
24,763
2% Inc
Physiotherapy
1,785
24,193
25,978
15% Inc
Psychiatric X-Ray Department
1982 Out Patient Department Accident h. Emergency
594
Psychiatric X-Ray Department
6,195
6,789
4% Dec
*44,362
44,362
4% Inc
TOTAL
36,660
150,674
187,334
% Increase/Decrease over 1981
12% Inc
3% Inc
5% Inc
Out Patient Department
10,469
40,502
50,971
8% Inc
Accident h Emergency
23,070
18,260
41,330
7% Inc
Maternity
2,951
20,770
23,721
4% Dec
Physiotherapy
2,834
40,474
43,308
661 Inc
651
6,343
6,994
3% Inc
—
*47,504
47,504
7% Inc
TOTAL
39,975
173,853
213,828
% Increase/Decrease over 1982
9% Inc
15% Inc
14% Inc
1983
Psychiatric X-Ray Department
Includes New Patients -100-
Appendix F
THEATRE STATISTICS
NUMBER
\
OF
OPERATIONS
1983
1982
General Surgery
2,233
1,876
Orthopaedic Surgery
1,244
1,042
Gynaecology
2A3
217
Urology
767
7A3
Ear, Nose & Throat
151
1A3
Vascular Surgery
656
596
6
3
5,300
A,6A5
A33
A30
Dentals TOTAL EMERGENCIES:
!
Included in Totals
-101-
;
CENTRAL PATHOLOGY LABORATORY A n a l y s i s of REQUESTS r e c e i v e d from E.H.B. H o s p i t a l s
Department
Haematology Coagulation
Year End
St. Brendans
St. Columcilles
Cherry Orchard
St. Ita's
1891
3732
5398
1252
112
191
124
64
9
151
6
1
Bl. Transfusion
St. L
8
B 1 2 & Folate
—
—
—
—
Biochemistry
2258
3978
2772
1567
— 15
Microbiology
1419
586
3626
645
7
1 1
— — 1
Histopatholgy Cytology Immunology Total per Hospital Hospital Total as | % of Grand Total
6 1 15
1
I
5711
17%
5
—
J
90
1 153
8729
12,085
25%
35%
-102-
9 3540 i
10%
31 9
CENTRAL PATHOLOGY LABORATORY A n a l y s i s of REQUESTS r e c e i v e d by C e n t r a l S e r v i c e s :
Year
St. James's
*RCDH
*SPDH
*AHD
*NCH
*Mercers
*DSH
*Meat
Haematology
Al,093
12,608
10662
13391
6095
4050
8109
1821
Coagulation
7,165
5,204
2032
1490
384
911
1062
260
Bl. Transfusion
7,295
1,456
931
1404
191
413
1694
297
B 1 2 & Folate
2,967
742
1039
1291
129
216
428
120
Biochemistry
58,565
17,023
13789
18409
3748
5097
13035
3167
Microbiology
38,768
10,295
9043
10755
14943
2808
11498
2222
Histopathology
3,645
1,175
1440
1994
286
331
1095
265
Cytology
2,869
1,141
708
561
19
178
295
52
Immunology
3,997
1,413
1112
1455
1145
394
667
145
166,364
51,057
40756
50750
26940
14398
37883
8352
31%
9%
7%
16%
;
DEPARTMENT
Total per Hospital Hospital Total as % of Grand Total
8%
9%
5%
3%
* Federated D u b l i n V o l u n t a r y H o s p i t a l s
Appendix H (i) ANALYSIS OF INCOME AND EXPENDITURE 1983 1983
1982
1,000
IRE X 1,000
Administrative
1,380
1,161
Medical and Dental
2,2.90
1,882
Nursing and Allied
8,097
7,261
Para Medical
2,552
2,308
Catering and Housekeepino
1,425
1,273
Maintenance
464
536
Others
208
Fees and sessions
-
188 1
IRE X
Pay Expenditure
16,416
14,610
Superannuation
567
Employer's P.R.S.I.
927
443 813
17,910
15,866
TOTAL
GROSS
REMUNERATION
-104-
Appendix H (ii) ANALYSIS OF INCOME AND EXPENDITURE 1983
1983
1982
IRE X 1,000
IRE X 1,000
Medicines
1,778
1,502
Pathological Expenses
1,520
1,375
Medical and Surgical Appliances
1,020
891
N o n - P a y Expenditure
X-Ray Expenses
234
228
Medical Equipment
212
123
Food
806
784
Heat, Power and Light
886
917
Cleaning and Laundry
453
335
Furniture, Crockery and Hardware
1.10
63
Bedding and Clothino
168
152
Maintenance
673
651
20
17
Transport and Travelling
128
ln9
Finance
1*3
149'
Office Equipment
48
36
Computer Services
133
95
Office Expenses
664
441
Sundries
102
77
o nan
7,945
27,008
? 1 P 11
Farm and Garden
TOTAL
GROSS
EXPENDITURE
-105-
Appendix H (iii)
ANALYSIS OF INCOME AND EXPENDITURE 1983
1983
1982
IR£ X 1,000 IR£ X 1,000 Income Payroll Deductions:
Emoluments
18
14
448
399
527
303
Other Incone
1,017
1,383
TOTAL
7.010
2,099
24,998
21,712
Superannuation In-Patient Income
H
NET
INCOME
EXPENDITURE
FOR
THE
YEAR
-106-
"
1
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY In 1983, a total of 2,422 women were delivered at all stages of gestation to whom 2,138 babies were born at or after the 26th week of pregnancy. This represents a fall of 7% compared with 1982 which broadly reflects the national decline in the birth rate experienced throughout the country. There was no maternal death, but the reproductive wastage continues to be high. Thirty perinatal deaths were recorded in 2,138 babies born after the 28th week which represents a rate of exactly 14 per 1,000. Two conditions - lethal fetal anomaly in 6 and placental abruption in a further 6 women were responsible for 40% of the deaths. Five babies died in association with intra uterine anoxia caused by herion addiction in one, postmaturity in one, gestational diabetes in one and cord complications in a further two. Regrettably, three babies died due to accidents of labour - two breech deliveries, one of whom was delivered at home before arrival in hospital and the second due to prolapse cord at 30 weeks, the thirl death in labour was associated with prolonged second stage. Two twins died, one from twin transfusion syndrome and the other from intraventricular haemorrage. Three further deaths were due to severe preeclampsia in one, necrotising enterocolitis in one and placental insufficiency in a baby of 800 grms at 29 weeks gestation in the third. Despite a necropsy rate of 93%, no cause could be found in the remaining five deaths. One hundred and thirty-six babies born weighed 2500 gms or less - 6.4% of total deliveries either because of the pre-term birth or due to retarded intrauterine growth. Fifteen of the perinatal deaths took place in these small babies which represents a perinatal mortality rate of 110/1000 for this group as against a rate of 7.4/1000 for the 2002 babies born weighing more than 2500 gm.
-2-
The yardstick by which results are traditionally measured in obstetric departments is that of true perinatal mortality defined as the sum of stillbirths and first week neonatal deaths of babies born at or after the 28th week of gestation, That this is a poor indicator of reproductive wastage is well exemplified if account is taken of the death of a baby at an earlier stage of pregnancy or the demise of a baby after the seventh day of life, circumstances that can be just as distressing for parents as the occurence of a true perinatal death. Sixteen women were delivered between 20 and 28 weeks, the babies weighing between 500 and 1,000 gms. Six of these babies were born alive and a further four weighing less than 500gms showed signs of life, but none of these 10 survived birth more than a few hours. Multiple pregnancy was the most important factor responsible for the onset of a pre-term labour. The other 6 born between 20 and 28 weeks were stillborn, 4 weighed between 500 and 1,000 gms and 2 less than 500 gms. Placental seperation was the major cause responsible in these. Five late infant deaths were reported, three from sudden infant death at 5 weeks, 6 weeks and 20 weeks respectively, one from congenital heart disease at 16 days and one from septic menengitis at 28 days. Two hundred and fifty-four patients were treated for abortions, 7 patients had laparotomy for ectopic pregnancy and the unusually high number of 7 were found to have hydatidiform mole, all confirmed histologically. A conservative approach to intervention is indicated by a low rate of operative deliveries - forceps in 130, Ventouse in 10 - a combined rate of 6.6%. Caesarean section was carried out 120 times - a rate of 5.7% and induction of labour in 217 by either prostaglandin or artificial rupture of membranes - a rate of 10.2%.
.
•
-3TRAINING 1983 saw the introduction of the two year course for student midwives in accordance with E.E.C. Directive. There is general consensus that this course is unnecessarily long. In consequence of this change, no candidates presented for the State Examinations for Midwives. Seventeen undergraduates from the University of Dublin undertook their obstetrical and gynaecological clerkships in St. James's. All were successful in the final professional examination in the discipline. Six non-consultant hospital doctors presented for the Diploma in Obstetrics of the Royal College of Physicians in Ireland. All were successful. The Department was inspected by a delegation from the Royal College of Obstetricians and Gynaecologists and recognition of the resident posts for the Membership and Diploma of that college continued as heretofore.
