AUT EVEN EVEN HOSPITA AUT H UT EVEN HOSPITAL KILKENNY KILKENNY KILKEN VEN HOSPITAL
KILKENNY
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AUT EVEN HOSPITAL KILKENNY
CONTENTS 03 CEO Welcome
22 Urology Team
04 Access & Admission
24 Urology Treatments
07 Quality and Patient Safety
25 Urodynamics Services
08 Lean Management
26 Ophthalmology
09 Insurance Cover & Self Payer Packages
29 Pain Medicine
10 Infection Prevention and Control 11 Theatre CSSD 12 Medical Services 14 Rheumatology 15 Endoscopy & DSU 16 Pre-Assessment 17 Orthopaedic Services 20 General Surgery 21 ENT Services & Paediatric Care
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30 Vascular Surgery 32 Gynaecology 34 Cardiology Services 36 Radiology 38 Dietetics 40 Respiratory Medicine 42 Plastic Surgery 45 Departments 46 Consultant Directory
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CEO INTERVIEW
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LEADING FROM THE FRONT Aut Even’s CEO, ANNETTE JOLLY, discusses the 100-year history of this unique hospital and her work to ensure it remains a leading healthcare facility.
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nnette Jolly oversees the activities of the entire Aut Even facility, ensuring that patient care is delivered and maintained to the highest standard. Her passion for the job is palpable, as is the responsibility she feels for each and every patient that enters Aut Even. Having built a successful career in healthcare, Annette was attracted to Aut Even by the strong ethos which the hospital has developed over the past century. “I’ve worked in a number of private hospital environments throughout my career and the one thing that sets Aut Even apart from any other hospital I’ve been a part of is the care and dedication of the staff. This is evidenced daily as I see staff from all levels going out of their way to be of assistance to our patients. At Aut Even you are treated as an individual instead of just part of a process.” Founded by a local benefactor in 1915, Aut Even shares the accolade of being the oldest private hospital in Ireland. It was purchased in 1933 by St John of Gods, a Catholic healthcare organisation, and run by nuns. Annette attributes the hospital’s strong caring philosophy to its shared history with these religious orders. “We have a set of values which are: Integrity, Competence through continuous improvement, Accountability, Respect and Empathy,” she asserts. In fact, these values make up the appropriate acronym of ICARE. “Our vision is – through our commitment to clinical excellence and patient care – to be the hospital of choice for patients, doctors and staff.”
STATE-OF-THE-ART ENVIRONMENT Despite its long history Aut Even has never failed to move with the times and has all of the modern amenities of any first-class hospital. “We are a 71-bed elective acute hospital,” she explains. “We have an 18-bed day surgery unit and six x-flow, ultra-clean laminar flow operating theatres and I’m confident we are the only private hospital in Ireland to have these in all of our operating theatres. We also have a twin suite endoscopy unit which is attached to the day care unit. We have a very broad range of surgical specialties. In terms of beds, we have 25 medical in-patient beds and 46 surgical inpatient beds, of which 80 per cent are private rooms. While Aut Even does possess all the mod-cons one would expect, Ms Jolly believes its stunning location, set in 25 acres of landscaped grounds among the outskirts of Kilkenny, makes it a unique facility. “When you drive in to the hospital you get an overwhelming sense of peace and calm, as you are greeted with a beautiful tree-lined avenue. It’s very different from going on to another hospital site because it’s not congested like most hospitals are. We have ample free parking, which is a big difference between the stressful situations you find yourself in larger urban hospitals. Coming to Aut Even is a relaxing experience, which we believe greatly aids the healing process.” A JOURNEY In 2008 Aut Even sought accreditation from the US-based
Joint Commission International (JCI). Hospitals worldwide can seek accreditation to demonstrate quality, and a JCI accreditation is considered one of the highest seals of approval for medical facilities that excel in providing safe and effective care of the best quality. Under Ms Jolly’s stewardship, Aut Even achieved its goal of receiving accreditation and it’s something the CEO cites as one of the highpoints of her time at the hospital. “It’s been a tremendous journey for the whole hospital. Unlike many other hospitals, we don’t have an accreditation manager as we believe it is part of everybody’s job to meet JCI standards. Managers are responsible for a particular part of accreditation because the JCI organise it into chapters, therefore we have chapter leads. For example, our theatre manager has responsibility for all standards relating to the operating theatres. She then works with her staff towards the policies that they are going to work to in order to meet JCI standards. This delegation means everybody feels a part of it. I’ve been invited to join the JCI standards subcommittee, which helps to lay out the standards. Every three years they change the standards and raise the bar that little bit higher.” With so much achieved in her relatively short reign, Annette Jolly remains committed to facing the challenges of leading Aut Even Hospital forward by raising the hospital’s own standards even higher and by continuing to provide the first-class care she has always demanded to each and every patient.
“Our vision is – through our commitment to clinical excellence and patient care – to be the hospital of choice for patients, doctors and staff.”
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ACCESS AND ADMISSION
Ease of Access at Aut Even As operational managers at Aut Even, DEIRDRE MOYLAN and AISLING MCEVOY ensure that the hospital runs as efficiently as possible while also providing ease of access to services for both patients and general practitioners.
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s Assistant Directors of Nursing at Aut Even, Aisling McEvoy and Deirdre Moylan are often the first point of contact for GPs when referring a patient for admission to the Kilkenny private hospital. With years of experience in the medical sector, their job revolves around ensuring the hospital runs as efficiently as possible for the patient while also making the task for the GP as efficient as possible. PUTTING PATIENTS AT EASE Maintaining a comfortable environment for incoming patients is a priority for the ADONs. Aut Even has developed a strong reputation for providing the best of available services to patients and a recent upgrade of patient accommodation has been a testament to the hospital’s continuing desire to provide the most comfortable and reassuring experience possible. All six of our operating theatres are Howorth’s Exflow ultra clean ventilation theatres, which have been proven to reduce the occurrence of micro-organisms
within the operating theatre and more specifically at the wound site, minimising the risk of infection. KEY SERVICE FEATURES The direct line to the bed manager, (056) 777 5269 is available from 8.30am to 5pm Monday to Friday and bed management are on call on (056) 777 5275 for out of hours queries. There are minimal waiting times for bed availability and in most cases we can admit the patient on the same day. Our house doctors provide 24-hour cover to our patients and we also offer access to highly specialised multidisciplinary teams as follows: v Highly skilled nursing team v Senior cardiac technician v Senior occupational therapist v Senior physiotherapists v Senior pulmonary lab technician v Senior dietician v Infection control clinical nurse specialist v Haemovigilance clinical nurse specialist v Diabetes clinical nurse specialist
“There are minimal waiting times for bed availability and in most cases can admit the patient on the same day.”
With an ever increasing number of patient referrals being experienced in Aut Even, the need to continually ensure an efficient and quality service to patient and GPs is clear. ADMISSION PROTOCOL FOR GENERAL PRACTITIONERS 1 Enquire if patient has adequate insurance cover for Aut Even Hospital 2 Contact the bed manager on (056) 777 5269 with the following information: Name, DOB, insurance cover 3 Presenting complaint (acute or chronic) 4 Preferable consultant if relevant 5 Routine or urgent admission 6 Fax/post a detailed letter of referral with a list of patient’s current medications attached, to the relevant consultant’s secretary or hospital admissions on (056) 776 2149. 7 Inform the patient of their admission time and date to Aut Even Hospital. SHAPING THE NEEDS OF GENERAL PRACTITIONERS The GP liaison managers strengthen the communications between the hospital with the GPs. They provide a point of contact for GPs to voice concerns, issues or enquire regarding services available within the hospital. This feedback facilitates Aut Even to continually improve our services for the general practitioners and their patients, promoting a positive patient experience and helping us to shape our services.
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PATIENT SAFETY
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Putting Quality and Patient Safety first
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he hospital has a long tradition of care, having been founded by a local benefactor and run by the sisters of the John of Gods for over 70 years. Today the hospital takes pride in continuing this tradition of care within a framework of quality and patient safety. OUR QUALITY AND PATIENT SAFETY FRAMEWORK At Aut Even Hospital we strive to place the patient at the centre of everything we do. Our definition of quality is that our patients and customers receive: v The right service v From the right staff v In the right place v At the right time v In the right way. Quality management is a core element of the management system at Aut Even. The quality management system encompasses the structures and processes for: v Setting clinical and managerial standards v Monitoring risks; clinical, environmental and business v Monitoring operational performance in relation to the set standards v Putting any necessary corrective and preventive actions in place v Continually improving standards and mitigating risks.
The quality system is implemented so that these matters are managed at the highest level in the organisation. In taking a structured approach to managing quality, safety and risk, Aut Even is seeking to continuously improve the quality of care and service through ongoing refinements in response to continuous feedback. Through a structured approach to managing quality, safety and risk Aut Even aim to: v Reduce errors, complaints, lost customers, absence/turnover, waste and ultimately costs. v Increase/improve clinical outcome and customer satisfaction, performance, productivity, involvement, motivation, market share and ultimately profit. CULTURE OF SAFETY Aut Even Hospital promotes a safe culture. The hospital recognises that the culture of safety is the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the organisational and individual commitment to the delivery of quality services that are safe. The hospital has defined the principles of our safe culture as: v A safe culture is built on the cornerstones of openness and fairness, characteristics required by staff and management at all levels.
v It reflects a culture which supports staff v It sees errors as learning opportunities v It motivates staff to communicate with each other and to share their experiences v A safe culture creates opportunities to ensure that problems identified are responded to v A safe culture does not unfairly penalise those who have made errors. It supports those who have made errors and ensures one code of behaviour for all v Within the safe culture there is an incident and near miss reporting system implemented to support staff to report errors as well as other opportunities for improvement. v A safe culture promotes trust and respect amongst staff at all levels. v A safe culture promotes accountability for safer practices. The hospital uses the Agency of Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Culture to assess the culture of safety and to identify opportunities for improvement. The hospital has run and will continue to run the survey on a triennial basis, commencing 2010.
PATIENT SATISFACTION SURVEY RESULTS SURVEY QUESTION
OVERALL RESULT 2013
OVERALL RESULT 2012
SURVEY QUESTION
OVERALL RESULT 2013
OVERALL RESULT 2012
How would you rate the information you received prior to admission?
91%
88.5%
Rate privacy & confidentiality
94%
96%
Rate pain assessment & management
95%
95.5%
Reception staff were courteous and helpful (rate)
96%
95%
Cleanliness
95%
96%
Rate your admission experience
95%
96%
Comfort
94.5%
95%
Rate communication & education provided by the nurse
97%
97%
Amenities
92%
94.9%
Quality of food
90%
93%
Rate communication & education provided by the doctor
96%
97%
Choice of food
88%
90%
Rate communication & education provided by allied health staff
95%
96%
Specific diet requirements (eg diabetic)
92%
93%
Rate care received from nurses
97%
98%
Portering services
93%
-
Rate care received from doctors
97%
98%
Involvement in plan for discharge
91%
93%
Rate care received from allied health staff
96%
97%
Prepared and educated for discharge
92%
93%
96%
94%
OVERALL RATING
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LEAN MANAGEMENT
Lean Transformation – Making the difference Lean methodologies have been deployed at Aut Even to aid in quality achievement and putting patients at the forefront of what the hospital does.
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ounded a century ago, Aut Even has enjoyed a reputation for quality and excellence. In 2006, management at the hospital decided to bring a fresh perspective to the way in which the hospital was run in order to build on their excellent level of patient services. “We decided to deploy lean transformation methodologies to help us achieve exemplary quality throughout our processes and systems, and to put patients and customers at the absolute forefront of what we do,” says AnnMarie Garbutt, Director of Nursing. Developed more than 40 years ago at Toyota, during the 1990s it was taken up and conceptualised by Massachusetts Institute of Technology (MIT) under the name of Lean. The methodology is beginning to appear more and more in the service industries, and has also begun to take root in hospitals. On this basis, lean results in innovation through better working practices becoming the norm, and the perpetuation of these practices to guarantee sustainability. LEAN METHODOLOGY “Primarily, lean methodology is about involving our staff and harnessing their expertise to lead change,” Ann-Marie explains. “Not only are they encouraged to look at ways to improve the processes and systems that affect them directly, but also hospital-wide. They are the ones who are leading the improvements at Aut Even.”
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Ann-Marie has previously worked in the NHS in England, where such methodologies have already been implemented with real success, while in Ireland Aut Even is one of the first hospitals in the country to adopt this methodology. Staff at the hospital are given the chance to visit other institutions which have employed lean methodologies to great effect, including the Royal Bolton Hospital in England which had been on the cusp of closure before the introduction of lean tools which turned its fortunes around. The applications in healthcare are very real and include reducing turnaround times and errors in laboratories, reducing changeover times in operating rooms, more time for patient care with fewer falls and infections, reductions in patient delays, increased capacity, and the reduction of diversions and improvement of the flow in emergency departments. Aut Even has also changed the way in which patients are admitted, as part of improving the experience of GPs who refer their patients to the hospital. Where once there were three or four steps involved there is now only one; consisting of a single phone call to successfully refer a patient. The feedback from the network of GPs regarding such improvements has been phenomenally positive. “We are very focused on access and customer satisfaction,” AnnMarie says. “We want to ensure
“We decided to deploy lean methodologies to help us achieve exemplary quality throughout our processes and systems, and to put patients and customers at the absolute forefront of what we do.”
that all of our processes and systems are free of waste and are defect-free. It’s a big ask, but that’s our vision and that’s where we’re heading.” AN INNOVATIVE APPROACH Aut Even is four years into our journey to implement this innovative approach to management, but though the hospital is still in its infancy with regard to lean continuous improvement, the results are already beginning to shine through. “We still see ourselves as being at the start of our journey,” says AnnMarie. “We have increased overall productivity and, within some specialities, we actually operate on more patients using the same number of staff and in the same timeframes. It has allowed us to reduce stock levels across our theatre environment. “It’s not only about money,” she continues, “It has allowed us to better utilise space and better organise our patient areas. Most importantly, lean supports a culture of continuous improvement which assures a service that is evidencebased, standardised and safe – where improvements are sustained because everyone is involved.” Ann-Marie is confident in the lean transformation agenda at Aut Even, and remains convinced that its introduction will not only meet the operational challenges faced by the hospital but will ensure its continued competitiveness in the Irish health market.
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PAYMENT OPTIONS
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Insurance Cover and Self-Payer Packages following information and will be given a procedure cost estimate in advance of treatment: v Confirm the procedure name and code with consultant’s secretary v Contact our patient accounts department on (056) 777 5194 PATIENT INFORMATION PRIOR TO ADMISSION We would ask that patients take note of the following:
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t Aut Even Hospital we are happy to help patients understand what, if any, cost, they may incur for any procedure. To do this there a few simple steps: v Check the name/type of your plan v Check your policy number v Confirm the procedure name and code with consultant’s secretary v Contact your insurance provider to ensure there are no exclusions under the terms and conditions of your policy. v Call us on (056) 777 5194 with the above details It is the patient’s responsibility to understand their level of insurance cover particularly as there are many variations of plans, many of which
have an excess included by the insurer. All hospital accounts must be settled on admission. OPTION FOR PATIENTS WITHOUT PRIVATE HEALTH INSURANCE/ SELF-PAYERS Aut Even has recently introduced our all-inclusive self-payer package prices for procedures, in order to provide more treatment options to patients without private health insurance. Our self-payer packages include the following: v H ospital fee v A naesthetic fee v Consultant fee F or quotations on procedures patients can contact our patient accounts department with the
“Aut Even has introduced our allinclusive self-payer package prices, in order to provide more treatment options to patients without private health insurance.”
v If you are taking anti-coagulant therapy such as warfarin, aspirin, diabetic medications or the oral contraceptive pill, please contact your consultant prior to your admission as you may need to discontinue this medication before your procedure. v Bring a list of your current medication; this may be obtained from your GP or from your pharmacy. v We advise that you organise transport to and from the hospital if you are having sedation or will be under a general anaesthetic during your procedure. v We recommend that you leave all valuables at home. v Smoking is prohibited in Aut Even Hospital. v Please bring dressing gown, slippers and towel with you on admission. v Bring with you any relevant scans/X-rays to this admission. v It is important that you follow your fasting guidelines (strictly no food or fluids).
Please refer to our website www.autevenhospital.ie or call 1890 493493 for further information in relation to your stay in Aut Even Hospital.
WE RECOGNISE THE FOLLOWING HEALTH INSURANCE PROVIDERS
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INFECTION CONTROL
Education and protection With some of the most advanced screening equipment available, Aut Even has a proven track record in hygiene and patient screening.
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he old saying ‘prevention is better than cure’, could not be more apt for the infection prevention and control programme of Aut Even Hospital. All patients entering the hospital are riskassessed and should an infection of any kind be found, the staff will put in extra precautionary measures to prevent it spreading to elsewhere in the hospital. Infection Control Nurse Dorothy Kealy-O’Brien explains. “Surveillance is a key priority for us. We actively collect data for MRSA, blood-stream infections, antibiotic prophylaxis, surgical site infections and needle-stick injuries. One of our latest focuses has been on preventing the spread of ESBL, which is a new type of multi-drug resistant organism. She adds: “Our surveillance expands every year to deal with new and emerging infections. We also annually review and develop new policies here at Aut Even. At the moment, we have about 40 infection prevention and control policies. We do a standing audit every year and a hand hygiene audit, sharps audit and a MRSA audit.”
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The education of staff from all disciplines including the management is also important when it comes to maintaining a high standard of infection control. Kealy-O’Brien says: “The infection control team hold regular training sessions, produce reminder posters and host awareness days for everyone in the hospital to ensure staff are kept abreast of any changes or developments.” Similarly, since 2010 the hospital has hosted a hand hygiene awareness day every May where the infection control team run promotional events and educational sessions for all staff members and the public.” SCREENING PROCESS On admission, patients who meet the MRSA screening protocol are screened for MRSA and isolated pending results. “We put a lot of importance on the education of staff regarding infection control. However, education alone is not enough,” says Kealy-O’Brien. “There is also the need for reminders, such as screening, swab flowcharts and visual reminders.” Luckily for Kealy-O’Brien,
“Surveillance is a key priority for us. We actively collect data for MRSA, blood-stream infections, antibiotic prophylaxis, surgical site infections and needle-stick injuries.”
the team at Aut Even are more than willing to learn and participate in the development. “Professional development is very important to us here at Aut Even, particularly when it comes to reaching the highest standard of patient care and safety. “ FACILITIES In terms of technology used to stop the spread of infection, Aut Even possesses the latest in a line of equipment that has a proven track record in stopping the infection at its source. The recent purchase of fogging machines, which pump a fine anti-bacterial fog into a room and that neutralises any organism present, has been one of the latest additions to complement the current infection prevention and control measures in the hospital. This also cuts down on the amount of time needed to disinfect a room by the housekeeping staff. For patients suffering from respiratory infections like tuberculosis, dedicated rooms include a HEPA filter which extracts the air, cleans it and releases it again; this is one of the best available on the market today.
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CENTRAL STERILE SUPPLIES DEPARTMENT (CSSD)
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Decontamination and Sterilisation The CSSD department at Aut Even Hospital has a dedicated frontline team who, through completion of a complex system of checks and balances, ensure that all operating instrumentation is sterile and fit for purpose.
WHAT HAPPENS IN THE UNIT? “Decontamination facilities are designed, constructed, maintained and controlled to provide effective segregation of clean and dirty activities and to provide an environment that minimises adventitious contamination of clean and disinfected reusable invasive medical devices (RIMD) including flexible scopes.” -HSE Code of Practice, v 2. (2010). The sterilisation process at Aut Even is a three stage process which takes place in the purpose-built three-roomed unit on site. CSSD manager Ashlene Ayres oversees the department to ensure that every precaution is taken when reprocessing instruments. “Instruments are cleaned, disinfected and then sterilised in the unit. Our purposebuilt department has a positive and
negative airflow system to ensure prevention of airborne contaminates,” she says. The decontamination room contains two state of the art Miele machines which wash and disinfect the equipment. These are computer controlled, lessening the risk of human contamination. Each machine is serviced and validated four times a year to ensure that they are performing to the highest standards at all times. Once the equipment has been through the sterilisation process, it is delivered to the appropriate speciality theatre for use. TRAINING AND TECHNOLOGY As this is an area which is constantly evolving and improving, it is important that Aut Even keep up to date with all developments. To this end the staff are regularly updating their training onsite, together with attendance at
“The room contains two stateof-the-art Miele machines which wash and disinfect the equipment.”
the National Irish Decontamination Institute (IDI) Conference. Ms Ayres together with her team are on hand to ensure that the hospital is at the forefront of modern technology and is constantly improving and modernising as appropriate. The CSSD is also responsible for ensuring that all instruments used for surgical procedures are functioning and fit for purpose. This requires the staff to have an excellent knowledge of each instrument and its purpose. This is no easy task considering the complexity of the instrumentation sets, some of which consist of 100 items or more. Much time is spent ensuring and validating the CSSD’s processes are correct and scientifically proven to provide the highest levels of decontamination and sterilisation for safe and effective delivery of highquality care.
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MEDICAL SERVICES
Medical Services Aut Even’s highly skilled medical team give us an insight into their particular areas of expertise, the facilities available to them at the hospital and their hopes for the future of their sectors.
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t Aut Even hospital, the facilities are of the highest standards. The third floor medical ward has 11 semi-private beds and 14 private beds with their own en-suite bathroom which has its own toilet and shower facilities – and patients are always commenting on the high standard of food in the hospital.” BUSY DAYS The average day at Aut Even is a busy one, with constant referrals from our medical consultants, or patients admitted by GP referral. A particularly strong emphasis is placed on diagnostics, including X-ray, MRI, CAT scan, ultrasound, dexascan and barium studies. Other more invasive diagnostic procedures available include direct access endoscopy and exploratory laparoscopic procedures.” Aut Even also offers cardiology testing, and should the patient require further attention, they are transferred to those other specialty hospitals, with direct access between these hospitals and Aut Even. MULTI-DISCIPLINARY TEAMWORK A multi-disciplinary team is in place, consisting of physicians, surgeons, non-consultant doctors, anesthetists, physiotherapists, occupational therapists, dieticians, pharmacists, respiratory therapists and the nurses and care attendants, all dedicated to providing a patient-centered service. Our feedback from these patients is overwhelmingly positive. EXPANDING ROLE OF THE NURSE The outlook for the nursing profession is positive for the next few years, with a focus on professional developments, which are updating all the time. One of the more positive changes has been that nursing has become more autonomous, enabling the nurse to make effective clinical decisions in co-operation with the medical staff. Now advanced nurse practitioners are coming to the fore. One of our nurses is initiating the nurse
2014
Dr Dilip Johndale
prescribing initiative in Aut Even. This will enable the prescription of medication under the jurisdiction of the physicians. DR MUHAMMAD AKRAM Dr Muhammad Akram, Medical Physician, maintains a private practice at Aut Even. The future for his specialist area, nephrology, has a similarly positive outlook, particularly in the area of early diagnosis and prevention. “I definitely see improvements in the future,” he says; if we treat disease at an earlier stage it can be prevented; early diagnoses can prevent patients from suffering major complications. TREATMENTS Dr Akram came to Ireland in 1995 and received membership with the Royal College of Physicians of Ireland in 2000, and completed a specialist registrar scheme in general medicine and nephrology in 2001. On completion of his training, he worked as a consultant nephrologist,
Dr Mohammed Akram
“Our team of consultants, nurses, allied health professionals and care attendants provide a patientcentered service.”
travelling between Waterford Regional and St Luke’s hospitals. Influenced by the presence of his family in the country, he joined the private practice in Aut Even in 2007. “I look after patients in the general nephrology area, people who can’t be looked after outside the hospital. The bulk of my practice is in general medicine. I usually treat chest infections, chest pains, minor strokes, and clots in the leg, etc.” One of the groups which Dr Akram treats most are those people coming with chronic kidney disease, hypertension, urinary tract infections, kidney stones and other conditions like electrolyte abnormalities. TOP FACILITIES Dr Akram is full of praise for the hospital’s facilities in helping him to provide the best service possible for the patients he sees. “From the general medicine point of view we have diagnostic cardiology services as well as allied health professionals to include senior dietician, senior pulmonary technician, senior physiotherapists and occupational therapist. Aut
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MEDICAL SERVICES
Even has access to a range of specialist consultants in neurology, hematology, rheumatology and pain medicine.” We have developed strong relationships with v Dr Crowley v Dr Hennessy v Dr Cotter v Dr McGovern, who are involved in care of the elderly and see patients on a referral basis or as required. RHEUMATOLOGY SERVICES Dr Fahim Kahn runs early arthritis clinics and screenings for patients with rheumatoid inflammatory arthritis, attempting to see patients in a timeframe of less than a week, through referrals from GPs. “We get patients through the GPs,” he explains. “When they come in they are asked for their medical history, then a clinical examination to detect any type of arthritis which takes 30 minutes to an hour. Once that is completed, a blood test will need to be done and possibly X-rays when combined take up to two weeks. “Rheumatologists would be treating arthritis with medication, tablet form and injection treatments, although we now have more up to date therapies with infections known as biologics. There are different types of arthritis. One type is known as ‘wear and tear’ arthritis (osteoarthritis). These are most common in elderly patients.
The other type is inflammatory or rheumatoid which is the most common. These patients are put on medication and are monitored every three to six months to see how it is affecting them. Injections are for a particularly diseased joint such as a knee joint affected by rheumatoid or osteoporosis. The rheumatologist would clean the joint with antiseptic and the injection could be steroid or synovial fluid injection. Then through an ultrasound we can locate where the injection is necessary and clearly visualise it.” A WINDOW PERIOD Dr Kahn graduated from the medical college in Khyber, Pakistan before travelling to the UK to undertake training. He then joined the senior house officer’s scheme in Ireland where he trained in rheumatology in Dublin, Cork and Leitrim before becoming a registrar. When you become a senior registrar, you can apply to become a consultant, and so Dr Kahn travelled to the US where he spent three years in a fellowship in Indianapolis before returning to the Irish private sector in 2000/2001. “We are providing the same treatment as anyone in the US, particularly the treatment protocols. I have my own ultrasound scan as well as MSK ultrasounds, which are not common in Ireland. There’s a window period where we can diagnose rheumatism before it can strike and
“Aut Even has access to a range of specialist consultants in neurology, hematology, rheumatology, care of the elderly and pain medicine.”
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thankfully GPs are well educated and bring patients to us showing the signs. We provide academic activities including GP sessions, study days etc. Aut Even is no different from the top clinics in the world.” A PAIN-FREE FUTURE The future for arthritis suffers is looking bright, Dr Kahn maintains, especially in regard to providing pain-free treatment for patients, and he is currently working with pain management clinics which have only just been established. “We offer Calmare therapy,” he says, “along with the Beacon in Dublin we are the only places in Ireland that offer such treatment. It is FD approved and uses electrodes attached to different parts of the body that would have only been treated with spinal injections in the past. “Without the use of medicine or injections, the patient can be relatively pain free. That’s an real breakthrough in pain management, and in fact Ireland and Italy are the only two countries which use it. We have treated eight patients with it so far and they have had excellent results. When they presented to their GPs they said they were on a 10/10 scale of pain. After the treatment, their pain was completely gone after 10 days of sessions. Even the top hospitals in Dublin don’t have these facilities.”
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RHEUMATOLOGY
Tackling Arthritis and Gout Experienced rheumatologist Dr Susan Sant is looking forward to working at Aut Even Hospital, where she will treat diseases of the bones and joints.
Dr Susan Sant
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ne of Aut Even Hospital’s newest arrivals is Dr Susan Sant, an expert in the field of rheumatology – primarily dealing with disorders and diseases of the bones and joints. “That encompasses diseases such as rheumatoid arthritis, osteo-arthritis, osteoporosis, connective tissue diseases, psoriatic arthritis, ankylosing spondylitis and gout,” she explains. “Then there are many soft tissue conditions that also come through to rheumatology, such as neck pain, back pain, shoulder pain, repetitive strain injury, carpal tunnel syndrome, etc”: a rheumatologist looks after a variety of cases. Dr Sant responds with a wide array of treatments such as medication therapy, physiotherapy and injection therapy. Some patients require disease-modifying therapy, particularly used to treat rheumatoid arthritis or psoriatic arthritis. Other patients need treatment by infusion. Injection therapy is another option: injections that patients self-administer on a weekly, twiceweekly or monthly basis. “It depends on the diagnosis,” says Dr Sant. “We see a lot of rheumatoids and patients with osteo-arthritis these days,” she says. “We see many, many people with back pain, neck pain, post-accident pain – a fall at work, a road traffic accident. We see a lot of gout. That’s the spectrum we have. “I think one of the good trends I’ve noticed is that GPs have become much more aware of rheumatalogical conditions, and
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they are much better at referring their patients on for early diagnosis and treatment. For conditions like rheumatoid, which is a very good example, the quicker you get diagnosed and the quicker you get on your substantive treatment, the better will be your prognosis. That’s a good thing.” Dr Sant grew up in Trinidad. Moving to Dublin, she did her undergraduate training and graduated in medicine from Trinity College Dublin. She then went to Manchester to work in a research institute. A stint in the United States followed, where she did a fellowship in rheumatology at the University of Michigan, Ann Arbor. Returning to Dublin once again, she started up her own practice in 1999. EXCITING DEVELOPMENT Dr Sant is hugely excited at the prospect of offering her services at Aut Even Hospital, beginning in autumn 2014. “I was looking to do some more work, they were
“One of the good trends I’ve noticed is that GPs have become much more aware of rheumatalogical conditions, and they are much better at referring their patients on for early diagnosis and treatment.”
looking for someone to come and that’s how it went. “I’m very much looking forward to it, because I’ve never in my life worked outside of Dublin. I love Kilkenny as a city. I had a very good impression of the hospital when I visited. I had a very good impression of all the people I met – everyone was excellent. People speak very highly of the facilities, and that’s very much my impression too. I’ve a good feeling about it!” Dr Sant’s secretary is based in Dublin because her main practice is there, but for the moment Dr Sant’s referrals will be handled directly through Aut Even because of the hospital’s familiarity with local GPs – though anyone is free to call her secretary with a query. For many people suffering from conditions such as arthritis and gout in the Kilkenny catchment area, the arrival of Dr Susan Sant to Aut Even’s already-strong rheumatology services is a welcome development.
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ENDOSCOPY AND DSU
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Dedicated Diagnostic Day Surgery Unit The opening of the Day Service Unit (DSU) was a positive step forward in offering more efficient and cost effective procedures, ensuring patients can be admitted and discharged in the same day.
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ut Even provides consultantled diagnostic and surgical day care services to patients referred by both consultants and general practitioners. The DSU is a selfcontained dedicated unit, facilitating an efficient and stress-free transfer of patients to and from the theatres. The unit and theatres are managed by the clinical nurse managers who lead their team of highly skilled nursing staff in providing a positive patient experience, while ensuring internationally recognised standards of care. A WELCOME ADDITION The aim of the day surgery team is to provide a patient-centered approach to care in an efficient manner to meet the needs of all who use the service. Our DSU provides a wide range of surgical procedures in our fully equipped ultra clean ventilation theatres. The DSU also has its own purpose-built washroom, which is attached to the endoscopy suite. It contains all of the state-of-the-art equipment required for cleaning, washing, processing, water validation and traceability documentation. The diagnostic procedures available in the DSU include: v Gastroscopy v Colonoscopy v Broncoscopy v Cystoscopy v Hysteroscopy v Laparoscopy v Dental procedures. DIRECT ACCESS ENDOSCOPY SERVICE KEY SERVICE FEATURES v Referrals: Triaged by GP’s preferred consultant and suitable patients booked into next available slot. v Routine appointments: Scheduled within two working weeks. v Urgent referrals: By direct contact with consultant. v Reports: Sent to referring doctor within 24 hours; urgent results given verbally.
v Results/management plan: Verbal and written discussed with patient. v Insurance cover: Available to patients with/without private health insurance. v Radiology: Onsite consultant radiologist. v Follow-on treatment: Access to follow on treatment if required. INSURANCE TERMS AND CONDITIONS The clinical indications for which insurance providers pay for surveillance/screening colonoscopy: Individuals who have the following: 1 Two first-degree relatives diagnosed with colorectal cancer. 2 A family history of polyposis coli. 3 A family history of hereditary nonpolyposis coli. 4 A first-degree relative who developed colorectal cancer before the age of 60 years will be entitled to benefit for colonoscopy every five years, beginning at age 40
“The aim of the day surgery team is to provide a patient centered approach to care in an efficient manner to meet the needs of all who use the service.”
or 10 years before the age of the youngest affected relative, whichever is the first. INSURANCE COVER AT AUT EVEN HOSPITAL For the majority of patients endoscopy procedures are carried out as a day-case procedure. At Aut Even Hospital we are happy to help patients understand what, if any cost, they may incur for any procedure. To do this there a few simple steps 1C heck the name/type of their plan 2C heck policy number 3C onfirm the procedure name and code 194 or 455 with consultant’s secretary 4C ontact the insurance provider to ensure there are no exclusions under the terms and conditions of their policy. 5C all our patient accounts department on (056) 777 5194 with the above details.
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PRE-ASSESSMENT
Assessing the situation Pre-operative assessment is essentially a clinical risk assessment whereby the health of a patient is appraised to ascertain that the person is fit to undergo the anaesthetic for a planned operation.
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or any vocation, preparation and having all the necessary information beforehand are vital before making any major decision; and undergoing surgery is no different. Consultants refer patients to the pre-assessment clinic once a surgery date has been decided between patient and consultant. THE PRINCIPLES OF PREOPERATIVE ASSESSMENT ARE: v To identify a patient’s medical, physical, psychological and spiritual needs before surgery v To liaise, where appropriate, with external agencies to implement discharge planning v To ensure a more effective use of hospital resources such as theatre time and bed occupancy by: - reducing the number of DNAs - reducing the number of cancelled operations - reducing the length of stay v To provide highly effective and efficient services characterised by clear,good practice guidelines aimed at meeting the needs of patients and the organisation v To provide continuous care, Mary Lavin, Pre-Assessment Nurse
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establish more person-centred nursing, and inform and support the patient during the surgical procedure v To identify patient suitability and/or fitness for surgery/ anaesthesia v To provide information for informed choices and consent v To reduce fears and anxieties v To assist better use of theatre and ward resources v To improve the surgical patient’s hospital experience THE PROCESS The first step of pre-assessment requires the Pre-Assessment Nurse Mary Lavin to contact the patient and organise a time and a date for pre-assessment. The first call is usually the most important in establishing a friendly link between the hospital and the patient until their assessment date arrives. When the patient comes into the hospital for their pre-assessment they will be asked routine questions about their past medical and surgical history as well as any regular medication they are taking. Routine investigations including blood tests, blood pressure reading and an ECG (tracing of the heart) are undertaken to determine whether the patient
“It is important to identify a patient’s medical, physical, psychological and spiritual needs before surgery.”
is a viable candidate for surgery. An echocardiogram is also performed to evaluate the condition of the patient’s heart depending on their medical history. In the case of any abnormalities arising from these tests, the preassessment nurse will liaise with the consultant anaesthetist and consultant surgeon, while the patient will be referred on for further investigations and other consultants if necessary. This may result in surgery being temporarily postponed until such time as the patient is fit for anaesthetic and surgery. The pre-assessment team will also liaise with GPs to monitor a patient’s abnormal results. THE PERSONAL TOUCH More often than not, a patient coming in for their pre-assessment may be nervous about their impending surgery and unsure of what to expect. That is why the pre-assessment nurse’s relationship with his or her patient is an important first step towards a successful operation. Pre-Assessment Nurse Mary Lavin explains the importance of easing patients’ fears: “The first phone call I make to the patient is important to identify a patient’s medical, physical, psychological and spiritual needs before surgery. During the call, I will talk the patient through the process of pre-assessment and what will happen before surgery, on arrival into the hospital, during their stay and on discharge home. I sometimes ask if they would like to bring a family member in with them if they find themselves particularly nervous.” With a continuing reputation as one of the best providers of healthcare in Ireland, Aut Even has seen its patient numbers rise over the last number of years. Currently, figures put the number of patients being seen at the pre-assessment clinic at 30 patients a week. Similarly, last year patients at Aut Even were asked to fill out a satisfaction survey detailing what how they found their time spent in the pre-assessment clinic. Unsurprisingly, a huge majority of in-patients were quick to compliment the friendly and helpful staff.
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ORTHOPAEDIC DEPARTMENT
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ORTHOPAEDIC TEAM EXPANDS The Orthopaedic Department at Aut Even is at the forefront of modern orthopaedic care.
Aut Even Hospital offers a full range of orthopaedic services to its patients. Orthopaedic surgery is constantly evolving; there are always innovative procedures being pioneered and we at Aut Even are no exception, offering treatments for: v Sports injury v Hip and knee v Foot and ankle v Hand v Shoulder balloon implants MR BREANDAIN LONG Mr Breandain Long, Consultant Orthopaedic Surgeon performs the full range of sport injury surgery including: v Tendinopathies v Meniscal repairs v ACL reconstruction v Rotator cuff repairs v Shoulder balloon implants He has also pioneered the use of anatomical double bundle anterior ligament reconstruction in Ireland.
This technique is gradually gaining acceptance as the best solution to the problems relating to the longterm outcome of ACL stability and joint degeneration. Breandain Long is the principal and consultant orthopaedic surgeon based at the Sports Injury Clinic. He graduated in medicine from University College Galway and did his orthopaedic training in Dublin and an arthroscopy fellowship in Birmingham, UK. He is a fellow of the Royal College of Surgeons in Ireland and a Fellow of the Faculty of Sports and Exercise Medicine. Mr Long also deals with shoulder pathology such as degenerative disease of the rotator cuff and the acromio-clavicular joint, issues with which increase with age. For patients who do not respond to the usual methods of treatment of injections and physiotherapy, subacromial decompression, AC joint resections and rotator cuff repairs are performed.
“My goal is the delivery of modern techniques in hip and knee replacement surgery, using modern bearing ceramic/ ceramic surfaces.”
MR STUART EDWARDS Mr Stuart Edwards explains: “my own sub-speciality includes primary and revision hip and knee surgery, both cemented and uncemented, minimal access surgery and resurfacing procedures. “My goal is the delivery of modern techniques in hip and knee replacement surgery, using modern bearing ceramic/ceramic surfaces.” SERVICE FEATURES v Rapid recovery programme 4-5 days. v Specialist pain management techniques. v Oral anti-coagulant therapy (Xeralto) post-operatively. v Pre-assessment service with in-house consultant cardiologist, senior OT and senior physiotherapist. v Full-time 24-hour house doctor v HDU initial 24-hour post-operative period. Mr Edwards did a fellowship in
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ORTHOPAEDIC DEPARTMENT
improved specialist techniques. He performs the following procedures: v Hip replacement surgery v Knee replacement surgery v Knee arthroscopic surgery v Basic hand and foot surgery v Dupuytren’s contracture – contractions in the hand v Carpal tunnel decompressions THE PROCESS “When a patient is referred to me for a hip or knee replacement the first thing we must address is whether or not the pain is coming from the joint in question,” Mr Edwards explains. “To determine this and to achieve a correct diagnosis the patient is sent to our Radiology Department for an X-ray. Once diagnosis has been confirmed we can discuss all options with the patient and their GP. If replacement surgery is the best option then the patient will be sent to our pre-assessment clinic where their heart, lungs and general health will be checked to establish that they are fit to undergo the operation. “They will then be seen by both our physiotherapist and occupational therapist, where the procedure along with the recovery and rehabilitation process is fully explained. Once they have completed pre-assessment, the patient will be admitted to hospital on the day of the surgery. The procedure takes 45 minutes to an hour to complete. During this time the defective bone or cartilage is taken away and a hemispherical cup is placed into the socket.
MR ALAN LAING Mr Alan Laing has been part of the orthopaedic team in Aut Even Hospital since 2009. Mr Laing has a sub specialist interest in surgery of the foot and ankle. He has completed Fellowships at the Hansen Foot and Ankle Institute, Harborview, Seattle and at the Clinique St Antoine de Padoue, Bordeaux. He is a member of the American Orthopaedic Foot and Ankle Society. His practice will offer a comprehensive orthopaedic service encompassing the management of acute foot and ankle fractures, sports and dance injuries. He has a particular interest in plantar fasciitis and Achilles tendon pathologies, deformity correction (flat foot and high arch pathologies), ankle arthritis (total ankle replacement) bunion and hammertoe deformities, rheumatological and diabetic foot conditions. AREAS OF INTEREST: v Arthroscopy v Pantelar fusion (ankle) v Cheilectomy (foot) v Cheveronosteotomy and hammer toe correction v Clavicular fracture repair v Hardware removal (pins/plates/ screws) v Hip replacement v Injection under sedation
“When a patient is referred to me for a hip or knee replacement the first thing we must address is whether or not the pain is coming from the joint in question.”
v MTP fusions/hallux valgus v Removal of ganglion from foot/hand v Total ankle replacement v Wiles/scarf osteotomy MR TURLOUGH O’DONNELL Mr Turlough O’Donnell graduated from UCD in 1994, completing his training in orthopaedic and trauma surgery in 2008. Following further fellowship training in Melbourne and Sydney, he returned to Ireland in 2009. Mr O’Donnell’s specialty interests include surgery of the knee, hip (total hip replacement) and upper limb. He has a particular interest in the field of preservation of the arthritic knee, and has an international reputation as one of the foremost experts in Europe on focal resurfacing and partial replacement of the knee. He performs approximately 220 partial knee replacements per year, and is a surgeon trainer for both Stryker Inc and Arthrosurface Inc. He lectures both nationally and internationally on the topic, and has published several key papers in the field. Mr O’Donnell also performs a large volume of total and revision total knee replacement. Mr O’Donnell performs approximately 400 arthroscopies of the knee per year. In addition, he performs arthroscopic reconstruction of the anterior cruciate ligament, as
POST-OPERATIVE CARE “We have a rapid recovery programme here at Aut Even. The patient is up and walking the day after the surgery as the sooner the patient is mobile the lesser the risk of infection or blood clots forming. Most patients are in hospital for four or five days after the operation and work with the physiotherapist twice daily during their stay. Once they are independently mobile and can navigate the stairs with crutches they are discharged. “We use specialist techniques to reduce post-op pain. We inject around the hip or knee, which reduces pain levels, which in turn increases the patients’ chance of gaining quick mobility.”
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well as the collateral ligaments. He also has wide experience in patellar realignment procedures. In addition, he performs a high volume of shoulder surgery. He has pioneered the use of platelet rich plasma (PRP) in Ireland, especially for injuries to the rotator cuff, and his clinical research into its use was awarded first prize in the upper limb category for clinical research at the 2013 American Academy of Orthopaedic Surgery (AAOS) meeting. He is the only Irish surgeon to have been awarded a prize of this nature in the long history of the AAOS. His research was selected from an entry of over 10,000 papers. Mr O’Donnell also performs a large volume of rotator cuff surgery, shoulder replacement surgery, arthroscopic surgery of the wrist, partial elbow
replacement, and has a particular interest in trauma of the upper limb. MR MAURICE NELIGAN Mr Maurice Neligan has been granted privileges at Aut Even Hospital and commenced clinics in October 2014. He was appointed to Tallaght Hospital as an orthopaedic consultant in February 2005 and worked there until 2012. He was then appointed to chief of orthopaedics in the Beacon Hospital. After leaving Blackrock College, he did his undergraduate degree in medicine in the RCSI in Dublin. He entered the Irish specialist training programme in orthopaedic surgery after obtaining his FRCSI. He completed this programme in 2005 and was awarded his CCST and the FRCSI (Tr & Orth).
“Orthopaedic surgery is constantly evolving; there are always innovative procedures being pioneered and we at Aut Even are no exception.”
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Following this he undertook a specialist fellowship in the Fowler Kennedy Sports Medicine Clinic, based in the University of Western Ontario, under the mentorship of Dr Peter Fowler. Mr Neligan’s interests are in: v Sports surgery of the knee and shoulder v Arthroscopic surgery v Knee preservation surgery v Hip and knee arthroplasty v Trauma surgery in the areas of hip, knee, and shoulder. His memberships include the Irish Institute of Orthopaedic Surgery, the Irish Orthopaedic Association, the American Academy of Orthopaedic Surgery, and the American Orthopaedic Society for Sports Medicine.
Mr Maurice Neligan joins the Orthopaedic Team that in the future this will include expertise in spinal conditions, to complement the existing services. The sense of pride and professionalism in the hospital from the top down is something rarely seen in other institutions, and has been an overriding impression on my visits. I look forward to practising in Kilkenny and hopefully meeting many of our referrers in the future.
Mr Maurice Neligan
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t is a privilege to soon commence practice in Aut Even Hospital. It is an exciting time for my family and I. My wife’s family live in Thomastown and we are frequent visitors. I also spent two years of my higher training programme in orthopaedic based at the local regional centre in Waterford Regional Hospital, and am familiar with the area in general. I am looking forward to joining my established colleagues in Aut Even to provide a comprehensive musculo-skeletal service. It is hoped
AREAS OF INTEREST My areas of interest are in sports medicine and adult reconstruction. I trained specifically in these areas on fellowship at the Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario in Canada. I also attend many international meetings to keep abreast of current techniques. I perform many arthroscopic knee and shoulder surgeries and the pace of development in this area is exponential. It is exciting to join Brendan Long, who is well established in this practice area. I have a particular interest in the young arthritic knee using a combination of chondral regeneration techniques and
“The sense of pride and professionalism in the hospital from the top down is something rarely seen in other institutions.”
offloading osteotomies about the knee. These techniques can also be used in complex knee instability problems. I was the first surgeon to use MACI in Ireland, an autologous chondral replacement system. In collaboration with my colleague Turlough O’Donnell, who has an interest in focal prosthetic resurfacing techniques, I believe we have a unique range of treatments in this challenging area. I am also interested in arthroscopic surgery about the shoulder, especially in the area of rotator cuff assessment and repair. This field is rapidly expanding and has the possibility of offering shorter rehabilitation times to selected patients. I also undertake primary and revision hip and knee replacement, and I look forward to joining Stuart Edwards and Turlough in this area. Again, this is a sub-speciality that is undergoing rapid change in terms of surgical techniques and in the materials used. I look forward to meeting the surrounding GPs in the near future, and I am always available to discuss any interesting cases you may have.
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GENERAL SURGERY
In safe hands Aut Even’s general surgery offering is one of the most comprehensive in the country. Consultant Surgeon MR IAN WILSON gives us an insight into the services available.
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eneral surgery at Aut Even represents one of the most important aspects of the hospital’s remit. Currently there are four highly skilled general surgeons operating in the newly refurbished UltraCleanAir theatres offering a wide range of surgical interventions and procedures. KNOWLEDGE AND EXPERIENCE A qualified surgeon for 24 years, Mr Ian Wilson is one of the most senior members of the surgical team at Aut Even. “We have a purpose-built day unit here at Aut Even where we do the bulk of the general medical procedures,” he says. “The facilities here mean that we can really maximise the efficiency of dealing with patients, which is key.” For Mr Wilson, the general surgery facilities offered at Aut Even surpass any of its nearest rivals both in terms of
scope and experience. “The facilities are excellent – for instance, if a patient requires more than one day of recovery time (from a medical procedure) in the hospital we know we have the beds and facilities to deal with that,” says Mr Wilson. The unit has a total of four surgeons: Mr Wilson, Mr Michael Hurley, Mr Paul O’Byrne and Mr Terry Christle, all of whom are consultant surgeons with vast experience. Before the centre expanded, there were just three surgeons – Mr Wilson, Mr O’Byrne and Mr Hurley – working in the unit. However, due to patient demand over the years the unit was able to expand both in terms of personnel and the number and scope of procedures on offer. PROCEDURES Mr Wilson says: “We do all of the typical abdominal procedures, which includes things like hernias, gallbladders and bowel surgery,
“The positive feedback is helped greatly by the highly skilled team of nurses and support staff available... The staff here are excellent.”
many of which are direct referrals from GPs in the area, so we often deal with things like endoscopy and laparoscopy.” Always changing, the field of general surgery has certainly seen many advances during Mr Wilson’s career, many of which have been successfully adopted at Aut Even. “Aut Even has definitely kept pace with the general curve, particularly with regard to technology in areas like laparoscopic surgery, which has seen the greatest change during my career.” The services on offer are certainly technologically advanced for the region, as Aut Even is the only hospital in the Kilkenny area with an MRI scanner, which is a vitally important diagnostic tool. Mr Wilson adds: “The next nearest hospitals offering MRI are in Waterford or Dublin, which can be quite a journey for patients.” PATIENT NUMBERS The variety of procedures in the field of general surgery at Aut Even has certainly gained some favorable traction from attending patients. Mr Wilson says: “Patients have commented very favorably about their stay at Aut Even, both in terms of the efficiency of the hospital and the technology available and the courteous way in which we treat our patients.” To date, patient numbers are holding steady and the satisfaction rate with general surgery continues to grow. The positive feedback is helped greatly by the highly skilled team of nurses and support staff available. “The staff here are excellent. They are extremely flexible and provide above and beyond the call of duty,” says Wilson remarking on his colleagues. No doubt, the positive patient feedback and innovative approach to new surgical technologies will continue to fuel Aut Even’s appetite and expansion long into the future.
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ENT
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ENT at Aut Even Offering extensive ENT services to patients in the Kilkenny area and beyond, Aut Even’s highly skilled team of ENT surgeons are putting the hospital on the map for ENT services in the east of the country.
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skilled team of two ENT surgeons at Aut Even provide comprehensive evaluation and medical/surgical treatment of both adult and paediatric patients with all ear, nose and throat (ENT) conditions. The full gamut of ENT procedures is catered for at Aut Even, including tonsillectomy, laryngoscopy, endoscopic sinus surgery, adenoidectomy, nasal polyps, grommets in ears, repair of ear drum perforations, repair of nasal deformity and some ENT cosmetic surgery.
Mr Neil Riley WHY AUT EVEN? ENT Consultant at Aut Even Mr Neil Riley, who has based his private practice at the hospital for a number of years and is highly complimentary of the facilities available, says: “The services here are excellent. The hospital offers highly skilled anaesthetists, well equipped theatres and excellent post-op care to all patients.” Mr Riley adds that the hospital’s flexibility in terms of adult
and paediatric procedures was what originally drew him to base his private practice there. “One of the major advantages and differences to other private clinics is that here at Aut Even I can perform minor procedures such as insertion of grommets on children from the age of two. That kind of flexibility in terms of paediatric ENT isn’t as common elsewhere.” One of the services we offer is hearing tests and we are fortunate to have a Senior Audiologist, Sinead Ryan, to perform hearing tests for children of any age in terms of acoustic emission and a tympanogram.” According to Mr Riley, “in the last two years the patient numbers have increased. It’s probably related to the reduction in patient numbers to the public sector who have left in response to the long waiting times,” he says. There has been a significant rise in patient numbers, with up to 40 or 50 patients treated every week – a rise attributed to the hospital’s good relationship with referring GPs in the locality.
“One of the major advantages and differences to other private clinics is that here at Aut Even I can operate on children from the age of two. That kind of flexibility in terms of paediatric ENT isn’t as common elsewhere.”
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UROLOGY
A Sensitive Subject Urological conditions, always a sensitive issue for patients, are handled by Aut Even’s expert team of MS HELEN HEGARTY, MR PAUL HEGARTY and MR BARRY
© thinkstockphotos.com
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rology, the study of the urinary tract and male reproductive system, is a complicated field, and one of vital importance to patients’ quality of life. It has the potential to cause severe physical and emotional discomfort, a fact compounded by the traditional reluctance of patients who are often too embarrassed to approach their doctor or otherwise seek help. Aut Even has assembled an expert team comprised of Consultant Urologists Mr Barry Jones, Ms Helen Hegarty and Mr Paul Hegarty. The latter two urologists began their clinics at Aut Even in January 2014, and have an impressive track record in delivering services at some of the most respected healthcare facilities at home and abroad.
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“I usually see mostly female patients with incontinence, infections or other bladder problems,” explains Ms Helen Hegarty. “I do see quite a lot of general urology as well, including stones, scrotal problems and male voiding problems.” She deals with female and male urinary incontinence, bladder dysfunction/problems of all types (including frequent, urgent need to void and problems emptying the bladder), recurrent problematic urinary tract infections, pelvic pain syndrome/interstitial cystitis, gynaecological fistulas, the management of urethral lesions/ diverticulae, urological cancers including prostate and bladder, reconstruction of the urinary tract (excluding the urethra) and neuro-
“Aut Even is a lovely hospital and very pleasant to work in. It is wellplaced geographically and has a pleasant working atmosphere.”
urology. She does not perform prolapse repairs such as bladder, vault or rectocoeles. “I trained in science, then medicine in Australia, where I grew up,” she explains. “I then trained in surgery and urology in the UK, working at the Royal Marsden, St George’s Hospital, Stanmore Spinal Injuires Unit and the University College London Hospitals. I completed a two year fellowship at the MD Anderson Cancer Centre in Houston, Texas in reconstruction, neuro-urlogy and bladder and incontinence problems. I then worked as a consultant urologist at the Southend University Hospital in the UK until 2013. I moved to Ireland in 2013 working in the above specialties. “Aut Even is a lovely hospital and
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© thinkstockphotos.com
“Men in particular are often too embarrassed or ashamed to seek help, making a bad situation far worse.”
very pleasant to work in. It is wellplaced geographically and has a pleasant working atmosphere.” MALE UROLOGY Meanwhile, male urology services are provided by Mr Paul Hegarty. “My two areas of interest are urologic oncology and andrological reconstruction – the reconstruction of male sexual dysfunction. We also offer general urology, which is well served in Aut Even,” he says. Urologic oncology invloves cancer of the kidney, bladder, prostate, urethra, penis or testicle. Hegarty has a particular interest in penile cancer, which is a rare cancer occurring in one in 100,000 people – 25 or 30 people in Ireland per annum. Men in particular are often too
embarrassed or ashamed to seek help, making a bad situation far worse: they are often reluctant to acknowledge there’s a problem, let alone act upon it by seeing their doctor. “By the time they come to me they’ve usually had the condition for some time and are quite frustrated,” Hegarty says. “It’s better if their partners are involved and can keep patients motivated to get help. There’s a high relationship attrition rate with a lot of these conditions: for men with erectile dysfunction, up to 90 per cent will have had the loss of a relationship due to erectile dysfunction. It has a large knock-on effect for individuals and society. Most things can be treated very successfully.” Hegarty comes to Aut Even from
having worked in the US and UK, and finds that Irish people are a little bit more private and more uncomfortable about talking about their sex life. “But then compared to when I left Ireland 10 years ago, I’ve noticed that they’ve moved on quite considerably: there’s been a major shift. It has improved, but there’s generally some reluctance.” Hegarty speaks highly of his experience in Aut Even thus far. “There’s a very good atmosphere in Aut Even. Morale is high. People have an attitude of ‘let’s do these things, let’s help patients, let’s work in a happy environment’. They achieve a lot for the patient. In all areas – theatres, wards – there’s a positive work environment. That’s good for everybody, and patients appreciate that too. I was very pleased to be asked to join.” Like Ms Helen Hegarty, he has an impressive track record working in a variety of hospitals at home and abroad, including University College Hospital and Great Ormond Street Children’s Hospital in London and the MD Anderson Cancer Centre in Houston, Texas. Of his two-year fellowship stint in Texas, he says it was intense and hard work – but very rewarding and great experience. Returning to London for four years, he set up the andrology service in Guy’s Hospital, using exciting and innovative new technology with a large team, an experience from which he learned a great deal. Back in Ireland, Hegarty is happy to run teaching and information sessions for fellow doctors, and says he always enjoys interacting with primary care as he ends up learning about patients and how services are accessed and operate. “It’s nice that they can put a face to the name when they refer patients,” he says.
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UROLOGY
Leading the field Aut Even has one of the leading urology units in the country, with expert care, the latest technology and ease of referral making it a trusted choice for patients and their GPs in Kilkenny and far beyond.
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he urology unit at Aut Even Hospital is one of the leading units of its kind in the country, paving the way for other hospitals by delivering some of the most advanced urology treatment technology available today. Mr Barry Jones, Mr Ahmad, Mr Paul Hegarty and Ms Helen Hegarty are the consultant urologists working in the unit and have years of experience treating urological disorders in both Ireland and abroad. Mr Jones was one of the leading pioneers in the treatment of sling surgery, now the mainstay of incontinence treatment – previously this would have been a long and complicated operation. The unit also undertakes scrotal procedures ranging from hydrocele, varicocele, epididymal cystic incisions, circumcision and vasectomy. Many patients come to Aut Even for removal of bladder stones and uroteric stones. Renal stones are treated with extracorporeal shockwave lithotripsy (ESL), which is a non-invasive procedure that breaks up the stones in the body using sonic waves. Andrology is also a major component of the work done at the urology unit, treating people with erectile difficulties and Peyronie’s disease, all on an out-patient basis. Neuro-urology, uro-oncology and the treatment of prostate cancer are all key interests of Aut Even’s urologists. UTILISING LATEST TECHNOLOGY By far the most common urological complaint is regarding the prostate. Mr Jones has put great emphasis on utilising the latest urological technology, all of which is available at Aut Even. “One of the latest developments of technology has been laser treatment of prostate enlargement,” he explains. “This is great news for patients who have had heart conditions and might be on blood thinning medications as they can now have laser surgery where normal surgery would not be possible.” It also means a much shorter stay in
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the hospital for the patient: it is now usually just an overnight stay, whereas a standard operation could require a three or four-night stay. “I also treat a benign prostate using this method, and also use it on patients who may have had radiation damage to their bladder; it has shown good results. It’s great to be able to treat people locally as opposed to sending them off to Galway for treatment.” Aut Even is one of only four hospitals in Ireland to offer such a service. Surgical options available include prostatectomies or trans-urethral injections into the prostate. GREENLIGHT LASER THERAPY GreenLight is an alternative therapy to a TURP, to treat patients with benign prostatic hyperplasia (BPH). The laser transmits laser energy to the tissue. The laser is absorbed in the oxyhaemoglobin or red cells in the prostate tissue; the laser energy is thermal and obliterates the prostate tissue. The main post-operative benefit is less risk of bleeding; conventional TURP carries a high risk of postoperative bleeding. There is no risk of TURP syndrome, as normal saline instead of glycine is used as the irrigation solution. TURP syndrome is a side effect of using glycine, as it is the medium solution used in a TURP procedure. Patients who are on coagulative medications such as plavix and warfarin can be treated. These patients are very often considered to be high risk for a TURP procedure due to the bleeding risk, as it may not be advisable for these group of patients to come off their medication for any period of time, due to their co morbidities. The GreenLight patients’ bleeding risk is lower than that associated with TURP. Therefore, shorter hospitalisation and quicker recovery time can be expected. The MoXy fibers allow for more effective coagulation as it works with the TRu Coag feature on the laser machine, therefore
“One of the latest developments of technology has been laser treatment of prostate enlargement.”
providing enhanced and improved responsiveness to bleeders during the procedure.The MoXy fiber is also water-cooled and so has longer life expectancy per case, up to 650, 000 joules’ capacity.The MoXy fiber, used in combination with increased power facility of the Greenlight XPS laser (up to 180 watts), allows larger glands to be treated effectively in a shorter period of time. EASY ACCESS FOR PATIENTS AND GPS Strong lines of communication between the hospital, patients and their GPs are important to Aut Even Hospital. The key to running a successful urology unit is to communicate with patients as much as possible and to leave open access for them to ask questions about urological problems which can often be quite painful. “The reaction from patients has been very good. At the end of the day, they want availability, quick appointment and quick treatment. After that they expect a regular follow-up and easy-to-deal-with administration. I have had no problems with patients because usually my appointments would be within two weeks.
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URODYNAMIC SERVICE
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Urodynamic Service at Aut Even Hospital Aut Even provides an outpatient urodynamics service that involves the investigation of functional disorders of the lower urinary tract, i.e. the bladder and the urethra. Our nurse-led service provides fast access for patients under the care of our specialist consultants and skilled nursing team.
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ur outpatient service is run on a monthly basis or as activity dictates by Staff Nurse Rita Rainey and Staff Nurse Niamh McGoff from the theatre department. When the service was initially set up here at Aut Even, there were limited options for patients living in the catchment area of the hospital to attend for urodynamic testing. Before this unit was established, any patients looking to avail of the test were required to go to Dublin or Cork. URODYNAMIC SERVICE The aim of clinical urodynamics is to reproduce symptoms while making precise measurements in order to identify the underlying causes for the symptoms and to quantify the related pathophysiological processes. By doing so it should be possible to establish objectively the presence of a dysfunction and understand its clinical implications. Therefore, we may either confirm a diagnosis or give a new specifically urodynamic diagnosis. ACCESSING THE SERVICE Referrals are made to the service
through the consultant specialists working at Aut Even who will receive a copy of the test results which will be reported on and feedback given to the referring GP. REFERRING CONSULTANTS v Mr Barry Jones, Consultant Urologist v Mr Imitaz Ahmed, Consultant Urologist v Ms Helen Hegarty, Consultant Urologist v Mr Paul Hegarty, Consultant Urologist v Mr Trevor Hayes, Consultant Gynaecologist v Mr Ray O Sullivan, Consultant Gynaecologist v Dr David McMurray, Consultant Gynaecologist. TESTS COMPLETED:UROFLOW This study measures your urinary flow rate. PRESSURE FLOW STUDY This study measures how well the bladder muscles, the sphincter and the urethra work together. The computer will measure the strength
“Before this unit was established, any patients looking to avail of the test were required to go to Dublin or Cork.�
of your bladder muscles and sphincter, as well as the urinary flow rate and voided volume. PREPARING THE PATIENT FOR URODYNAMICS v Complete a bladder diary or questionnaire. Please bring this with you to the appointment. v Patients should take normally scheduled medications and may eat and drink prior to the study. v The series of tests typically takes less than two hours. Patients will be able to resume all previous activities, including driving, upon completion of the urodynamics studies. v Please arrive for the study with a comfortably full bladder. We have received a lot of positive feedback from the patients using the service. Before the patient comes for their appointment, they will be sent information from the Consultant secretary about what the test involves which prepares them for it and dispels any fears they may have prior to their appointment. The outpatient test is a relatively lengthy procedure, taking approximately two hours.
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OPHTALMOLOGY
Leading the way in ophthalmology Ophthalmology has entered a new phase in its development. New treatments and technologies have brought the once-niche service into the future. Consultant Ophthalmic Surgeons at Aut Even give us an overview of the ophthalmology services available at the hospital.
EYE CARE AT AUT EVEN “Ophthalmology as a whole has become very technologically driven. Things have changed enormously in the last 10 years, and very much to the advantage of patients,” says Mr Tom Stumpf, Consultant Ophthalmic Surgeon at Aut Even. “The services offered are highly advanced and lasers have become frequently used tools in the treatment of many eye diseases, which is something we have embraced at Aut Even. We now offer diode laser treatment of retinal diseases and YAG laser treatment of capsule opacification/ fibrosis following cataract surgery. In addition, a laser scanner (OCT) is used to diagnose and monitor patients with glaucoma and many retinal diseases,” he says. While Mr Stumpf ’s main focus is on cataract and glaucoma surgery, he also treats patients suffering from a wide range of other ophthalmic conditions. Mr Stumpf ’s colleague at Aut Even, Mr Gareth Higgins, also a consultant ophthalmic surgeon, believes that the service provided by Aut Even is second to none,
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ut Even Hospital provides the facilities for one of the most comprehensive ophthalmology services in the country, with treatments for external eye disease, cornea, cataract and refractive surgery, glaucoma and a number of retinal conditions including macular degeneration, diabetic eye disease, retinal vascular diseases and uveitis (intraocular inflammatory diseases). Aut Even’s state-of-the-art custom-designed UltraCleanAir theatres, coupled with the latest technological instrumentation for the performance of intraocular surgery including small incision cataract surgery, allows patients to receive the very best of care at the facility.
particularly in the Kilkenny region. “All of my patients have been very happy with their treatment at Aut Even. So far, all of the procedures I have performed here have been day cases, so the patient can come in, have their procedure and go home again on the same day.” Mr Higgins’ area of focus concerns general ophthalmology as well as a number of other procedures including eyelid surgery, pre-ocular tumours and blepharoplasty. SPECIALTY SERVICES In terms of the procedures offered, Aut Even’s five fellowship trained consultant ophthalmic surgeons (Ms Cleary, Mr Higgins, Mr Kent, Mr O’Reilly and Mr Stumpf) certainly lead the way. Mr Stumpf, like his colleagues, performs all of his cataract surgeries using a technique called phacoemulsification. Describing the method, he says: “Phacoemulsification involves using ultrasound to break up the cataract inside the eye. It is effectively keyhole surgery in the eye and sucks out the fragments of the cataract leaving behind a capsule which is essential to hold the replacement lens in the eye. The replacement intraocular lenses used in Aut Even are at the cutting edge of technology and provide excellent visual results, which we have shown in our audit.” Similarly, Mr Higgins’ special area of interest is in periocular tumours and reconstruction following tumour removal. He says: “Certain tumours can be tricky to remove, as often it can be difficult to
“The services offered are highly advanced and lasers have become frequently used tools in the treatment of many eye diseases, which is something we have embraced at Aut Even.”
identify the margins of the tumour. Often I will work in conjunction with a specialist Mohs surgeon, usually a dermatologist, who will examine slices of the tumour and will be able to tell if the entire tumour has been removed successfully. Then the Mohs surgeon and I will liaise during the re-construction phase. This method can be used in about 10 per cent of cases. Obviously, this can save a lot of time and repeat surgeries if you can determine that the tumour has been completely removed. Similarly, in a third of patients it means you can remove less tissue than you might have done otherwise, which is also of benefit.” The range of services offered in Aut Even by the innovative team of consultants allow for the provision of a comprehensive ophthalmic service for its patients.
Mr David Kent
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PAIN CLINIC
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Interventional Pain Therapy There us a new chronic pain service for patients in the Aut Even Hospital, as DR TADHG LYNCH explains. Chronic pain affects many patients on a daily basis: the predominant symptom is chronic low back and neck pain but major joints, limbs, abdominal and pelvic pain, facial pain and headache are all important pain sources. Many patients seek treatment for daily severe pain. For the first time in Aut Even, a specialist pain clinic is available to provide patients with appropriate investigation, diagnosis and interventional treatment. DR TADHG LYNCH Dr Lynch is a graduate of NUI Galway, and a consultant anaesthetist and pain medicine specialist with training and expertise in minimally invasive interventional pain treatments. He is extensively trained, having completed specialist training in anaesthesia, intensive care and pain medicine. He is a member of the Royal College of Physicians of Ireland and a Fellow of the College of Anaesthetists he also is a diplomate of the European Society of Regional Anaesthesia and holds a Diploma in Pain Medicine from the College of Anaesthetists. Each patient with chronic pain has a unique set of symptoms. A variety of techniques are available to reduce the chronic pain that each individual patient is suffering from and treatment is offered to target each patient’s pain diagnosis. Pain injection interventions can be both diagnostic and therapeutic, helping to locate the precise area of pain generation and reduce inflammation and nerve sensitisation, which are features of chronic pain syndromes. After patient consultation and investigation, a range of interventions may be suitable and are tailored to suit each patient, including: v Epidural injections v Selective nerve root blocks v Facet joint blocks v Individual nerve blocks v Sympathetic nerve ganglia blocks
v Lignocaine/Ketamine infusions. When chronic pain is reduced, patients can start returning to normal function, often with the help of appropriate multidisciplinary advice including physiotherapy. Sometimes patients’ patterns of thought and fear of movement can be improved with cognitive behavioural therapy. DR KATHIR TAMILMANI Dr Tamilmani specialises in interventional techniques for treating chronic pain and has commenced full-time private practice in Aut Even Hospital. On graduation from medicine he undertook surgical training and obtained a Fellowship of the Royal College of Surgeons, Dublin. He then underwent specialist training in anaesthesia, intensive care and pain medicine and was awarded a fellowship and specialist certification by the College of Anaesthetists of Ireland. He went on to undertake advanced training in pain medicine in Ireland and Australia and was awarded the fellowship of the Faculty of Pain Medicine. He completed advanced training in interventional techniques, neuromodulation and multidisciplinary pain management from the Royal Brisbane and Women’s Hospital, Brisbane and the Peter MacCallum Cancer Centre, Melbourne.
“Chronic pain affects many patients on a daily basis. The predominant symptom is chronic low back and neck pain but major joints, limb, abdominal and pelvic pain, facial pain and headache are all important pain sources.”
Dr Tadhg Lynch
Dr Kathir Tamilmani
THE FUTURE Our scientific understanding of the complex neuro-biological basis of chronic pain is constantly evolving. Medications to treat chronic pain have improved and can provide benefit. Interventional therapies to restore normal nerve function can be most effective for patients suffering with chronic pain. Neuromodulation (changing nerve function) through minimally invasive and radiofrequency procedures is an effective strategy for the management of chronic pain.
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VASCULAR SURGERY
Vascular Surgery at Aut Even Hospital With a team of highly experienced surgeons, Aut Even offers the best in vascular surgery for its patients. Mr Paul O’Byrne
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ur team of vascular surgeons, Mr Paul O’Byrne and Mr Michael Murphy, provide a range of treatment options to patients in the following areas: v Vascular v Endovascular v Endovenous v Chronic venous disease v Venous ulceration. MR MICHAEL MURPHY Venous and arterial conditions such as varicose veins are treated using the latest techniques and technology at Aut Even Hospital as Mr Michael Murphy, Vascular Surgeon, explains. “On the venous side, the commonest condition is varicose veins, and complications of varicose veins – venous ulcers, venous eczema,” he explains. “My methods of treatment are for the main part minimally invasive; they’re endovascular treatments. For veins, when treating venous reflux and varicose veins and the complications of venous reflux, I use endovenous thermal ablation techniques. We use a laser here to heat up veins from the inside; treatment is delivered through needles rather than making surgical cuts. That’s replaced the traditional open surgery for varicose veins and venous conditions. “For arterial work, again I use mainly endovascular techniques: angioplasties and treatments that are delivered through small needles and catheters rather than making big cuts to expose it and stitch it.” Murphy also uses traditional methods such as taking a history and performing an examination, but ultrasound is another important
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high-tech tool. “That allows me to look under the skin, look at the blood vessels and look at the flows in the blood vessels, in the outpatient department, and plan treatments.” It usually means that he can get treatments planned and organised much more quickly than traditionally, where several consultations and steps were required before a treatment plan emerged. “We try as much as possible to provide a one-stop shop,” he says, and to offer a service that fits in with people’s busy lives. Varicose veins seem to be becoming more common, Murphy reports. “Maybe it’s that people are more aware of them and are more aware of the treatments, and know that they can be treated much more easily nowadays, with minimally invasive day case procedures that only take a couple of hours with no downtime. Also, in the past people have associated varicose vein treatments with having to wear stockings for weeks on end and to go on long walks. None of that is applicable today.” There is some evidence that modern lifestyles are leading to more varicose veins: more sitting at work, particularly at the computer, or in jobs where one stands for long periods of time may be the cause. SUPERB FACILITIES These world-class treatments take place in a hospital where the best of facilities and an inspirational environment are combined. “I find Aut Even to be a lovely place to work,” says Mr Murphy. “It’s in a beautiful location: that’s what it means, ‘Aut Even’ is from the Irish
“Laser treatment of varicose veins shows clear patient benefits over surgery and other alternative treatments.”
Mr Michael Murphy
for ‘beautiful place’. It has lovely surroundings. It’s a very friendly hospital: the staff I work with down here are very friendly; there’s always a nice atmosphere down here and it’s a pleasant place to work. I think patients like it as well, particularly local people: it very much feels like part of the community. “The facilities here are excellent: we have the latest ultrasound technology and the latest laser technology. These are the top brands and the top types of equipment: they’re the same as you’d find in the latest state-of-theart facilities in Los Angeles.” Murphy did his medical degree in UCD, qualifying in 1993, and went into medicine having always wanted to be a surgeon. “I was interested in cardiac and vascular surgery from early on, as well as plastic surgery. Eventually I streamlined into vascular. I was particularly interested in vascular because at the time I was training, more modern endovascular techniques were being developed and they were very exciting – they’re the techniques I use mainly today,” he says. Training in hospitals across Ireland, an academic job at Oxford University saw him researching venous diseases, and he learned the most state-of-the-art techniques during an endovascular fellowship in Australia, which he describes as a “great experience”. Mr Murphy’s referrals at the hospital are handled by Edel Brennan, and Murphy himself is happy for a GP to contact him directly: at Aut Even, world-class vascular surgery is accessible to patients in Kilkenny and its catchment area.
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VASCULAR SURGERY
ENDOVENOUS LASER THERAPY Endovenous laser treatment for the elimination of varicose veins is quickly becoming the gold standard in the treatment of varicose veins. The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day. Laser treatment of varicose veins with the VenaCure EVLT procedure shows clear patient benefits over surgery and other alternative treatments, including a success rate of up to 98 percent with minimal-to-no scarring or hospitalisation, a lower risk of complications and a quick recovery with strong patient satisfaction. First pioneered in 1999 by Dr Robert Min and Dr Luis Navarro in conjunction with AngioDynamics, the VenaCure EVLT procedure continues to undergo refinements and enhancements reflecting the company’s ongoing commitment to the science and practice of vein management. The VenaCure EVLT system currently utilises an FDA-approved catheter with a gold-tip “jacket” to disperse energy from the diode laser in a manner to reduce pain and discomfort after the procedure. This easy-to-perform procedure has patients back on their feet in approximately 45 minutes. Laser treatment of varicose veins shows clear patient benefits over surgery and other alternative treatments.
REMARKABLE RESULTS AND ADVANTAGES IN VEIN CARE The VenaCure EVLT system is the number one physician’s choice in laser vein treatment, and brings remarkable results and significant advantages to remedying superficial vein reflux. The VenaCure EVLT procedure is a minimally invasive, clinically proven alternative to surgical vein stripping that effectively and safely treats varicose veins using a diode laser fiber to occlude the vein. To treat chronic venous insufficiency, it is important to fully understand the venous anatomy, learn how to properly diagnose the affected veins based on how the patient is presenting, and ensure proper steps are taken in the treatment process to ensure reimbursement.
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“These are the top brands and the top types of equipment: they’re the same as you’d find in the latest state-of-theart facilities in Los Angeles.”
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GYNAECOLOGY
An Innovative Approach to Gynaecology Aut Even offers one of the largest private gynaecology facilities in the country, with a large team of consultants offering their expertise to patients at the hospital. MR RAY O’SULLIVAN, Consultant Gynaecologist and DR DAVID MCMURRAY, Consultant Obstetrician and Gynaecologist offer an overview of the services on offer. Mr Ray O’Sullivan
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highly skilled team at Aut Even provide one of the most comprehensive gynaecology services in the country. Gynaecology at Aut Even covers a large range of conditions including fertility problems, vaginal prolapse, endometriosis, fibroids, polycystic ovarian syndrome and treatment for ovarian cysts. Other unique surgical procedures include hysterectomy, colposcopy, tubal ligation and pelvic floor repair. GYNAECOLOGY AT AUT EVEN “We are offering some of the most advanced gynecologically advanced surgery in the country,” says Mr Ray O’Sullivan, Consultant Gynaecologist. For Mr O’Sullivan, the decision to base his private practice at Aut Even was an easy one: “The facilities here are fantastic. It’s a modern private hospital and when you compare it to the facilities available elsewhere, Aut Even is right up there on a par with any private clinic in the country.” In terms of the standard of patient care, Mr O’Sullivan is also highly complimentary. “Due to the hospital’s JCI accreditation, the standards here have to be extremely high. However, the management and staff go beyond that with the level of patient care and services. Any of my own patients who have been treated
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here always compliment the level of care,” Mr O’Sullivan says. SPECIALITY SERVICES In regards to the scope of procedures and surgical approaches offered by Aut Even, the hospital leads the way in terms of innovation. Mr O’Sullivan works with a team that is well prepared to undertake keyhole surgery, diagnostic investigations, hysterectomy and infertility and endometriosis treatments. He says: “We primarily focus on fertility investigations as well as the investigation of endometriosis, which is a common problem in Irish women. Women are coming from all over the country and even overseas for that kind of surgery,” says Mr O’Sullivan. Aut Even takes pride in offering a large array of services covering a broad field of gynecology. The state-of-the-art equipment available offers a medical service well equipped for the diagnosing of the full gamut of gynaecological problems. Mr O’Sullivan says: “The expertise we’ve developed here at Aut Even means that we can take on any challenges presented to us.” There’s new technology all the time but it’s more from a technique point of view that the technology comes along but the overall principle remains the same. We now use the merina coil but if that doesn’t work we use endometrial ablation and those technologies are really coming
“I’ve worked in much bigger hospitals, but this has a very homely and personal feel to it. Everyone is very much on a first-name term basis – that goes for staff and patients.”
Dr David McMurray
along. It’s a day case procedure to get rid of the heavy periods and patients back to normal the next day which is a godsend for women who suffer from heavy periods. DR DAVID MCMURRAY Dr David McMurray was recently appointed consultant obstetrician and gynaecologist at the hospital, returning from Scotland to take up the post. “I’m a general gynaecologist, serving most aspects of care for women with gynaecological problems,” he explains. “In particular, I focus on the diagnostic side of things. I employ ultrasound scanning, which is a routine part of the examination in consultation. I’ve 12 years of experience doing this: it’s a much more accurate way of assessing the pelvic organs than other examinations. It’s quite useful in helping women who have heavy periods or period problems, women who have pelvic pain, and women who have bleeding after the menopause.” On the treatment side of things, McMurray practises minimal access surgery: keyhole surgery. “This is an easier way of treating conditions and performing the likes of hysterectomies or removing ovarian cysts,” he says. “The main bulk of my workload comprises of seeing women who have menstrual upset: heavy or prolonged periods, and also women
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who have problems with prolapse, urination, urinary incontinence and infertility.” McMurray has been at Aut Even since December 2013. “I like working here – it’s a very friendly and personal place. I’ve worked in much bigger hospitals, but this has a very homely and personal feel to it. Everyone is very much on a firstname term basis – that goes for staff and patients.” EXCELLENT FACILITIES He highly praises the facilities as the main reason why he chose to move to Aut Even: 11 years ago he worked in Kilkenny, and the Aut Even facilities have come on in leaps and bounds since then. “I happened to be visiting a friend who is a consultant in Aut Even last summer and I couldn’t believe the transformation in the place: it’s become a modern hospital,” he says. “My perception was completely changed.” McMurray was born in Co Down and grew up in Belfast, training in Queen’s University. He then went to Glasgow for postgraduate training, before a stint researching
in Edinburgh and an appointment as a consultant for 11 years in the west of Scotland, just outside of Glasgow. All throughout, he built up experience in fields such as treating post-menopausal bleeding and in risk management. “The majority of my patients come from the Kilkenny/Carlow area, but people also come from Wexford, Offaly, Laois, Tipperary and Waterford,” he says. They choose Aut Even and Mr David McMurray because of the scanning expertise he offers, and because of the laparoscopic hysterectomies he performs – a service that is not commonplace in Ireland. Mr McMurray’s referrals are handled by his secretary, Clare Farrell on (056) 777 5254. “We offer a high-quality service with a personal touch. It’s very much a one-to one service,” he says. Accessible and personable, Aut Even’s gynaecology offering is an important service to women in the wider Kilkenny region. FUTURE INNOVATIONS Regarding the future of the service, Mr O’Sullivan is confident
“We’re implementing new technology and techniques here all the time. An example of this is our new procedures for the treatment of women with heavy periods.”
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the expertise already at hand will continue to develop. “We’re implementing new technology and techniques here all the time. An example of this is our new procedures for the treatment of women with heavy periods. We now use the mirena coil and endometrial ablation when required,” he says. “It’s a day case procedure and patients are back to normal just one day after the procedure, which is both time- and cost-effective for them.” According to Mr O’Sullivan the procedure is relatively unknown to many women who suffer needlessly from heavy periods and is now seen as an alternative to a hysterectomy. “It’s a relatively new procedure and Aut Even is one of the only clinics in the country to offer it, however, it’s a godsend to many patients who may be considering a hysterectomy. The results from both procedures are the same: the patient won’t have any more periods; however, with the mirena coil and endometrial ablation they will still have a womb and they won’t be subjected to major surgical investigations if they have the ablation.”
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CARDIOLOGY
Expanding Cardiology at Aut Even Hospital The Cardiology Department at Aut Even provides an excellent cardiac service for those living in the south east of the country. DR JOHN CLARKE, Consultant Cardiologist, discusses the importance of the cardiac service to this area.
Dr de Buitléir
Dr John Clarke
The Cardiology Department at Aut Even Hospital offers a range of noninterventional cardiac services. These include: v Outpatient consultations v Echocardiography v Stress testing v Arrhythmia monitoring v DSE.
the patient requires more invasive cardiac testing or indeed cardiac surgery, they will promptly be referred to Blackrock Hospital, with which Aut Even has a strong working relationship.
Patients generally present with a number of common problems such as chest pain, shortness of breath, heartburn, heart palpitations, dizziness or loss of consciousness. A patient may also be admitted for testing if the patient has a family history of heart disease or there are any other adverse risk factors such as a heart murmur, high cholesterol or long-term high blood pressure. If
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THE FACILITIES Aut Even Hospital provides an invaluable service to those living in the catchment area of Kilkenny, Waterford, Carlow and the hinterland as far as Thurles and Enniscorthy. Often rapid access to service is key when dealing with heart diseases. Ease of access for a patient is a very important factor. If a patient needs bypass surgery, they can be seen by Dr Clarke at Aut even and transferred to Blackrock for surgery the very next day.
Dr Heiko Kindler
“Cardiology is a dynamic game which is constantly evolving. This evolution of the service is particularly beneficial for our elderly patients.”
THE TEAM Dr John Clarke trained in UCD. He worked in the Mater Hospital, Dublin before moving to London where he completed his MD and PhD. He then went on to work in Stanford, California where he completed a post-doctorate fellowship before returning to Ireland and taking up employment in Aut Even Hospital, with which he has a long association. Dr Micheal de Buitléir has worked in Aut Even since 2000. Prior to his appointment he worked internationally in the UK and United States, where he was awarded fellowship of the prestigious American College of Cardiology.
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SUDDEN CARDIAC DEATH SYNDROME SCREENING The sudden death of a young athlete is a tragic event that has devastating effects on families and communities. These deaths are usually due to unsuspected heart disease. Unfortunately, many heart conditions are still not detected by routine screening measures. The goal of screening is to detect an abnormal medical cardiac condition that could harm or kill the athlete when they exert themselves. It is for this reason that Dr Clarke along with his clinical colleague Dr Kindler (a specialist in cardiology and cardiac MRI) and Dr Gerard King (specialist in cardiac echocardiography) have developed an accredited screening programme to help in the detection of sudden cardiac death in players for the GAA and also, through collaborative efforts with a group in Boston, to further our knowledge and understanding of the various contributors to sudden death in young people. This screening programme will be held on site and include a questionnaire, a resting electrocardiogram (ECG) and an echocardiogram. The fee will include the interpretation of all tests and a written report. The total cost of this will be €150.00 By carrying out these tests we hope to help in the detection of sudden cardiac death (SADS) in our athletes but also to further our research efforts with our colleagues in Boston to gain a further insight into the causes of these tragic events.
PROCESS INVOLVED: 1ST LINE SCREENING Karen Coen, Senior Cardiac Physiologist trained in the cardiology department of the Mater Misericordiae Hospital in Dublin. She gained paediatric experience while working in Crumlin Children’s Hospital. She is currently a BLS instructor for the Irish Heart Foundation and an associate member of the society for cardiology science and technology. Karen has been a valued part of the team in Aut Even Hospital since 2007. Dr Gerard King, Chief Cardiac Clinical Psysiologist, is regarded as a leader in the field of sudden cardiac death cyndrome internationally. He is a renowned specialist in cardiac echocardiography and has published extensively on the subject in peerreviewed medical journals. He was recently invited by a prestigious American cardiology journal to write the editorial in relation to the effects of exercise on the performance of the heart chambers. This was done together with his co-workers from Massachusetts General Hospital in Boston. Dr Heiko Kindler is a highly experienced consultant cardiologist. He undertook his undergraduate
training in Hanover, Germany. He completed his cardiology training in London at King’s, Hammersmith, St Thomas and the Brompton Hospitals. As well as being clinically trained, he has a major interest in advanced cardiac imaging, including CT angiography, cardiac MRI imaging and positron emission temography (PET scanning). The tests will be carried out by Dr Clarke’s highly experienced team. We recommend that individuals aged 14 years or older involved in high-intensity, highly competitive sports have a cardiac investigation. Treatment and prevention of complications is possible in most people once cardiovascular disease is identified.
HEALTH QUESTIONNAIRE/RESTING ECG/ECHO (IF ABNORMAL ECG OR ECHO PROCEED TO NEXT STEP)
2ND LINE SCREENING PHYSICAL PRESENTATION CONSULTATION WITH DR CLARKE
3RD LINE SCREENING EST/HOLTER MONITOR/ EVENT MONITOR AS INDICATED
FURTHER DIAGNOSIS THE FUTURE OF CARDIOLOGY IN AUT EVEN HOSPITAL Cardiology is a dynamic game which is constantly evolving. This evolution of the service is particularly beneficial for our elderly patients. Open-heart surgery is no longer the only treatment method; instead a catheter inserted through the groin can be equally effective. This is a great advancement for elderly patients who may not be strong enough to survive major surgery.
ELECTRICAL PRESENTATION EP STUDIES
MECHANICAL PRESENTATION CARDIAC MRI/ANGIOGRAM
TREATMENT ELECTRICAL PRESENTATION ICD/PACEMAKER
MECHANICAL PRESENTATION ICD/PACEMAKER/ SURGERY
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RADIOLOGY
Diagnostic Imaging Department The Radiology Department offers an excellent diagnostic imaging service to patients. MARY PRENDERGAST and MARY MURRAY explain.
THE FACILITIES The MRI Department at Aut Even Hospital operates as a stand-alone service. Patients come directly to the MRI reception, where once their details are taken they are brought straight in for their scan. All details are double checked by the radiographer on staff to ensure that it is safe for the scan to proceed. The MRI scanner on site is a state-of-the-art 1.5 Tesla Magnet Siemens Symphony which produces computerised sectional images of most parts of the body in highquality detail. The approach to scanning is extremely patientcentred and every attempt is made to ensure the patient is kept as comfortable as possible. The scanner is open both ends and the
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MRI suite has a large window with a view of the fields beyond the hospital, which goes a long way to alleviate anxieties and stressors relating to claustrophobia which can present difficulty for certain patients. Aut Even has a full range of services available including MRI, ultrasound, dexa scanning for bone mineral density/osteoporosis assessment, barium studies, IVP and general X-ray with a full time staff of five and three part time staff to run the department. THE SERVICE The MRI suite runs six days a week, 12 hours per day and sees approximately 25 patients daily. Most of our patients come directly
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from GP referrals but we also treat in-patients. We pride ourselves on making prompt appointments; once a referral letter arrives we make contact with the patient straight away to arrange their scan. We also contact the GPs immediately upon receipt of the scan results. All MRI referrals are reviewed by the radiographer on staff to assess their urgency. If urgent, the X-ray can be done that same day – however, for non-urgent cases the average turn around is five days. The average patient will be checked in and have undergone their scan within an hour of arrival. Each scan takes approximately 20 to 30 minutes and the report is done that night and posted out to the patient’s GP the next day. The GPs will have the report within five days of the scan. Each patient will also be given a CD copy of their scans upon leaving the hospital. If they are later referred to a specialist then they will be able to give them their scans directly. INSURANCE Upon arrival, patients can inform
reception of their private healthcare details and the hospital will arrange direct billing where appropriate, or provide a quote for the procedure. The hospital will liaise directly with their insurance provider if applicable. Aut Even Hospital deals directly with the following insurers: v VHI v Laya Healthcare v Aviva v ESB Medical Provident Fund v St Paul’s Garda Medical Aid v GLO Health. PATIENT-CENTRED CARE The Radiology Department has a great relationship with referring GPs, who are in regular contact to discuss patients and get results. We take a very hands-on approach and believe that maintaining a good working relationship with our patients’ GPs is of the utmost importance. Good communication between GPs and hospitals ensures that the best care is provided to the patients. Our onsite radiologist Dr Murray is at hand to determine whether a patient needs urgent attention. Dr Murray has been here for a number of years.
“The average patient will be checked in and have undergone their scan within an hour of arrival. Each scan takes approximately 20-30 minutes.“
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Patients know him and find it easy to approach and talk to him. He is also very quick to reply to patients. If something is very urgent, we can have a report sent within an hour of the scan. This rapid access to the service is greatly beneficial to patients living in the south east of the country.
Dr Tom Murray
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DIETETICS
You Are What You Eat RACHEL O’REILLY, BSc., M.I.N.D.I graduated from University of Ulster, Coleraine in 1999 with a degree in human nutrition and dietetics. She has worked in hospitals in Ireland and the UK. She has been the dietitian in Aut Even Hospital in Kilkenny for the last five years.
H
ere in Aut Even private hospital we aim to educate people regarding diet and nutrition. Each person is given nutritional advice that is specific to the individual and their medical condition. We provide an inpatient and outpatient service covering all medical diets for women’s and men’s health. Rachel has a wide ranging interest in how nutrition affects health and specialises in the following: vB owel disorders, especially irritable bowel syndrome v Coeliac disease v Diabetes v Weight and cholesterol management. The first consultation may take up to 50 minutes. The follow-up review appointment usually takes about 20 minutes. Most people will need at least one review, and depending on the patient’s condition several reviews may be required. ACCESS TO THE SERVICE A referral letter from GP/consultant is not required to access this service but is advisable for the purpose of the patient’s background history. Any recent bloods or copy of tests pertaining to the patient’s medical condition may be helpful in assessment. Rachel is a member of the Irish Nutrition and Dietetic Institute and as such is recognised by private health
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insurers as being qualified to give advice on nutrition. All patients will be entitled to claim partial costs from their private health insurer. They will be advised to contact their health insurer for more information in relation to claiming expenses. OUTPATIENT FEES v Initial consultation: €85.00 v Follow-up: €40.00 THE FUTURE OF DIETETICS IN AUT EVEN Rachel has recently undertaken a skills training course on the application of the low FODMAPs diet for those with functional gastrointestinal disorders. HEALTHY EATING AWARD Aut Even Hospital has been recertified the Happy Heart at Work Eating Award for the fifth year; the initial audit was in 2008 by the Irish Heart Foundation. This award recognises the commitment and hard work of Aut Even Hospital to ensure that the food and menus in the staff restaurant still meet the healthy eating guidelines as set out by the Irish Heart Foundation and Department of Health and Children. 63 companies have been certified and recertified with the Healthy Eating Award in 2012, which equates to almost 40,000 employees nationwide. Over 300 companies of all types have achieved the award over the years. The objective of the catering audit is to assist a staff restaurant to adopt healthier cooking practices and
“We provide an inpatient and outpatient service covering all medical diets for women’s and men’s health.”
provide healthier food choices for staff, visitors and patients without incurring substantial cost. Recommendations given to the catering manager would meet the Irish Heart Foundation and the Department of Health’s ‘Healthy Eating’ Guidelines. The Healthy Catering Guidelines are based on the key goals of the Happy Heart at Work Healthy Eating Programme, which aims to: v Reduce saturated fat and total fat v Increase fruit and vegetable consumption v Increase fibre v Reduce salt and sugar. The catering audit was carried out by a consultant dietitian from the Irish Heart Foundation in conjunction with the catering manager Lillian Connolly and in liasion with Senior Dietitian Rachel O’Reilly. This audit is an independent assessment identifying Aut Even Hospital’s individual needs and includes an assessment of: v Overall food choice v Food counter layout v Food preparation practices v Menu recommendations to reduce fat, sugar and salt and to increase fruit, vegetables and fibre v Employee feedback. When the assessment has been carried out, the catering staff then implement the recommendations. A follow up monitoring visit by the dietitian to check and assist in the implementation of recommendations will take place eight to 10 weeks after the audit. Further Information: Aut Even Hospital, Freshford Road, Kilkenny. Hospital Number: 056 7775187 Fax: 056 7775292 Mobile: 087 9536547 Email: roreilly@mcm.ie or racheloreilly1@gmail.com (out patients)
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RESPIRATORY AND SLEEP SERVICES
A Breath of Fresh Air The Respiratory Function Laboratory and Sleep Medicine Clinic at Aut Even is one of the most advanced facilities in Ireland. As a nation seeing a dramatic rise in respiratory diseases, the need for the best available services is paramount.
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espiratory diseases are on the increase in Ireland, with latest figures showing us ranked second worst in Europe in lung health. That is why it is vital for a person suffering from a respiratory condition to avail of the latest diagnostic technology to ensure a condition is diagnosed and treated appropriately. Aut Even is a leading centre in respiratory diagnosis with state-ofthe-art diagnostic equipment. When a patient is referred to the Pulmonary Department, they can expect to avail of a range of diagnostic studies including spirometry (to measure airway obstruction), DLCO (to measure oxygen absorbing capacity) and measurement of lung size and responses to inhaled therapies (bronchodilator response testing). These provide reliable information on lung capacity and may indicate the presence of lung disease. This equipment is also ideal for measuring the effectiveness of treatment for diseases such as chronic obstructive pulmonary disease (COPD), sarcoidosis, asthma, emphysema and lung fibrosis. TREATING ALLERGIES One of the most common conditions seen at the Pulmonary Laboratory in
Aut Even is allergic asthma. Asthma is becoming more common in Ireland, where it now affects about 490,000 people; one of the highest rates in Europe. Often ignored or undertreated, asthma should be diagnosed and characterised with spirometry and allergy testing, both of which are available at Aut Even. Skin prick allergy testing is also available and can be used to determine the presence of an allergy to certain dusts like pollen or cat dander. Other examples of allergic disorders include eczema, hayfever and nasal allergies (allergic rhinitis). In the respiratory laboratory, specific respiratory-related allergens are used to discover the precise source of an allergic disorder. One of the team working in the Pulmonary and Sleep Diagnostics Laboratory, Aisling McDonald, describes how they perform and measure respiratory allergies: “Where a patient has a history of asthma, it is likely there is an allergic element to their condition. That is why a skin prick test provides valuable information on identifying these triggers and lets the patient become aware of potential environmental triggers which may subsequently have a direct effect on their health.”
“Aut Even is a leading centre in respiratory diagnosis with stateof-the-art diagnostic equipment.”
DIFFICULTIES SLEEPING Another problem that is rising in incidence and severity (affecting about 100,000 people in Ireland) are sleep disorders due to snoring and/or sleep apnoea syndrome. Obstructive sleep apnoea syndrome is a breathing disorder that occurs during sleep, whereby a person pauses or stops breathing. In some cases it appears that the muscles of the airways collapse during sleep and cause nocturnal choking, which in turn causes interruptions in sleep. Patients suffer the consequences of poor sleep quality: excessive sleepiness throughout the day. Often it is difficult for the sufferer to understand the condition, because it occurs during sleep. Some patients complain of morning headache, daytime fatigue, snoring, or sleepiness. That is why a sleep diagnostic service is available in Aut Even to diagnose and treat sleep disorders. Sleep studies are vital for the correct diagnosis and management of sleep and circadian disorders including periodic limb movement disorder, narcolepsy, and sleep apnoea syndrome. The ideal way to fully understand a patient’s sleep disorder is through a formal sleep Dr John Faul
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Aisling McDonald, Senior Sleep Scientist
study known as polysomnography (PSG). PSG provides eight hours (about 1,000 pages of tracings) of simultaneous measures of rapid eye movements, EEG, oxygen saturation, EMG, ECG, periodic limb movement, microphone, respiratory movements and heart rate. The study provides the data on which the interpretation of the sleep test relies: quality of sleep, snoring, periodic leg movement and the presence and extent of any respiratory-related sleep disorders. Following a diagnosis of sleep apnoea, a patient is treated for their condition by using a continuous positive airway pressure machine (CPAP), which acts like an air splint. It consists of a mask which the patient wears during the night and connected to the machine via a tube supplying air into the airways under a specific pressure. This keeps the airways open throughout the night, thus preventing airway collapse and apnoea. Patients who have been diagnosed with sleep apnoea are also assessed within Aut Even to measure the effectiveness of CPAP. All of these services are provided by the physicians, scientists, and nursing
staff at Aut Even Hospital who have been trained to treat patients with sleep disorders. Dr John Faul is one of the respiratory consultants at Aut Even and he has an interest in sleep medicine. As a fellow of the American Board of Sleep Medicine, he is optimistic about the new therapies which patients can obtain at the Sleep Medicine Clinic: “Some patients meet the criteria for an overnight sleep study. This can be a strange night’s experience and all patients are expected to sleep less than they would at home. This way we can compare how patients sleep compared to all our other patients.” According to Dr Faul, Many patients who attend the sleep studies are simply not getting to bed in time. A hectic and disorganised schedule can lead to reduced sleep time because it disturbs a person’s normal sleep schedule. Before any sleep study, patients need to improve their sleep habits and timetables and need to understand the benefits and risks of the procedure. An initial consultation, which attempts to improve a patient’s respiratory status
“We receive a large number of in-patient referrals for pulmonary function tests and skin-prick allergy testing, and we have excellent diagnostic facilities at Aut Even when investigating respiratory conditions.”
while awake, can vary between 20 minutes and an hour. An overnight study requires hospital admission during the afternoon to become accustomed to the recording equipment. Most patients rise at 7am and have a shower and breakfast before going home or straight off to work. The results of the sleep study usually take about two weeks to process, analyse, and quantify the 1,000 pages of data. PATIENT FEEDBACK Feedback from the patients attending the Pulmonary Laboratory and Sleep Studies Clinic has been very favourable; particularly in relation to the quality of care and facilities available: “We’re kept very busy with patients coming in for sleep diagnostics,” says Aisling McDonald. “We receive a large number of in-patient referrals for pulmonary function tests and skin-prick allergy testing, and we have excellent diagnostic facilities at Aut Even when investigating respiratory conditions, so it’s a good starting point for anyone suffering from a breathingrelated illness.”
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PLASTIC SURGERY
Plastic surgery: ‘see-and-treat’ Plastic and reconstructive surgeon MR PETER MEAGHER offers a wide range of services at Aut Even – and his speed and accessibility put patients and GPs at ease.
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r Peter Meagher is one of the country’s leading plastic and reconstructive surgeons – and while some of that is familiar territory, the sheer scope of the cases that a plastic surgeon undertakes can be surprising. “As a plastic surgeon it’s more of a skillset than a specialty,” Meagher explains. “Within plastic reconstructive surgery there are the full range of obvious aesthetic surgical procedures such as breast augmentation, liposuction and abdominoplasty. There are non-surgical interventions such as botox and fillers; the recognised gamut that any properly trained plastic and reconstructive surgeon would do.” When plastic surgeons finish their training they also specialise. After the four years of general surgery training and standard six years of plastic surgery training, Meagher went to Australia for three years to specialise in breast reconstruction, before working in the UK for eight years. He has been a consultant in Dublin since 2007. “In addition to breast reconstruction after cancer surgery, I provide a full range of hand services at Aut Even, for conditions such as carpal tunnel syndrome, tendon transfers, hand tumours – any pathology that involves the hand. That comes as a surprise to a lot of people who wouldn’t see a plastic surgeon as responsible for fixing a hand. But that’s just the way the training in hand surgery has evolved in Europe over the last 25 years: the lion’s share of hand surgery in Dublin and around the country is done by plastic surgeons.” TREATING CANCER The third element of his work is in skin cancer – ever on the increase, unfortunately. To date, Meagher has treated hundreds of patients in Aut Even with various different types
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of skin cancer, the most common and high-profile being malignant melanoma. But there are other non-melanoma cancers that are particularly prevalent in rural Ireland – such as head and neck skin cancers that affect people who spend a lot of their working lives out of doors. “Whatever hole their treatment makes, we can reconstruct using various techniques,” he says. “After that, there’s a ‘mixed bag’ of services, as I call it, that a plastic surgeon can provide, ranging from the management of pressure sores to leg ulcers, skin ulcers, trauma – although there’s no A&E in Aut Even, that doesn’t stop us from seeing acute emergencies with lacerations.” One of the skillsets that plastic surgeons develop is nerve repair, a very important concept. If a patient cuts their finger the skin can be stitched together, but if they damage the nerve they need someone with microsurgical skills such as a plastic surgeon. Meagher also removes facial lesions, port wine stains, blemishes on faces, unusual birthmarks. Some of this work is for children who are being bullied or whose appearance makes them unhappy. “We intervene earlier rather than later and treat them as necessary,” says Meagher. “Typically, if people are stuck and don’t know what to do they’ll call a plastic surgeon and that’s a culture I want to try and develop within Aut Even. I think we are doing that: GPs are ringing and saying that they’ve heard one of my talks and want me to see a patient.” GREAT FACILITIES, EXCELLENT STAFF Meagher is enthusiastic about his experience at the hospital. “Aut Even is fabulous. Over the last 25 years I’ve worked in the UK for 10 years and worked in six or seven hospitals, and I’m up in the big hospitals in
“There are top-class facilities: good equipment and well-trained nurses who know what they’re doing and there’s no hanging around.”
Dublin too, but I’m delighted to work at Aut Even. There’s a combination of a really good work ethic and the kind of empathy that is almost lost to private healthcare. Perhaps because it’s a bit more rural, everybody knows everybody and they can have a bit of a chat. That puts patients at ease. “One of the big fears for a patient is the great unknown. If a patient comes in worrying about a skin cancer and knows one of the nurses, it immediately puts them at ease. On Fridays I run a clinic in the morning and operate in the afternoon, and I’ve never before come across a place where if you ask for something there’s absolutely no problem. It’s a warm environment and patients love it. “There are top-class facilities: good equipment and well-trained nurses who know what they’re doing and there’s no hanging around. The theatres are beautiful, as good as any hospital as I’ve worked in.” SEE-AND-TREAT The rest of the time, Meagher’s practice is based in Dublin and he
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has a private secretary, Mary Rice, who is approachable and looks after GPs who are busy and want to talk to somebody directly. “If GPs want something done it’s done straight away,” he says. “I also give an undertaking to all GPs that if they have an urgent referral to see me, that patient will be seen within seven working days, and if necessary have surgery within seven working days. That’s unparalleled: there’s nowhere else in Ireland where a GP with a concern for a patient can have a consultant see them within a week. “We call it a ‘see-and-treat’ service. That’s very appealing for GPs: if they have a patient sitting in their practice with a mole and they’re worried it could be cancer, they can say “I’m going to get you to see a consultant on Friday and he’s going to take it off on Friday afternoon.” It helps the flow to the GP’s practice, helps the patient and puts them at ease. GPs then get an emailed or faxed letter from my practice within 24 hours. It’s very easy to access me.” At the forefront of such an
important and diverse discipline, Meagher’s services at Aut Even are invaluable to the many patients who depend upon him to treat their cancer, or restore their quality of life in such a wide variety of different ways.
Ms Elizabeth Purcell MS ELIZABETH PURCELL Ms Purcell graduated from TCD in 1996 and pursued plastic, reconstructive, aesthetic and hand surgery specialty training in Ireland, completing studies in 2009. During that period she also taught
“One of the big fears for a patient is the great unknown. If a patient comes in worrying about a skin cancer and knows one of the nurses, it immediately puts them at ease.”
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anatomy at TCD and obtained a postgraduate medical science degree in the subjects of anatomy and anthropology from UCD. She completed a laboratory-based research fellowship at Brigham and Women’s Hospital and Harvard Medical School in Boston, USA. In addition to her FRCSI(Plast) qualification, she holds a European (FESSH) diploma in hand surgery and is European board certified in plastic surgery (EBOPRAS). She completed training with a clinical fellowship in breast and microsurgery at Addenbrooke’s Hospital, Cambridge, UK. Since returning to Ireland, she has worked as a locum consultant at St James’s Hospital, Dublin and at Clane General Hospital as well as at her office based in Naas, Co. Kildare. She is specialist registered with the Medical Council and is a member of the Irish Association of Plastic Surgeons (IAPS). Ms Purcell welcomes all referrals for skin lesions, breast surgery, hand surgery (including trauma) and for aesthetic issues both surgical and non-surgical.
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INTERNAL TELEPHONE DIRECTORY
45
RECEPTION/GENERAL ENQUIRIES
CARDIAC TECHNICIAN
PULMONARY FUNCTION LAB
1890 493493
(056) 777 5125
(056) 777 5279
ACCOUNTS (056) 777 5194
DAY SURGERY UNIT
RADIOLOGY X-RAY/MRI APPOINTMENTS
AUDIOLOGY
(056) 777 5191 (056) 777 5253
(056) 777 5250
Sinead Ryan (056) 777 5172 086 6097762
GP LIAISON MANAGER
BED MANAGEMENT
(056) 777 5121 086 025 0049
(056) 777 5269
BONE DENSITY APPOINTMENTS (056) 777 5250
BOOKINGS OFFICE/ ADMISSIONS (056) 777 5268
CARDIOLOGY Dr John Clarke (056) 777 5133 Dr Micheal De Buitleir (056) 776 2754 (056) 7775175
NUTRITION AND DIETETICS
RADIOLOGY REPORTS (056) 777 5128
WARDS 1st Floor (056) 777 5130
Rachel O’Reilly (056) 777 5187
2nd Floor
PATHOLOGY
3rd Floor
(056) 777 5185
(056) 777 5158
(056) 777 5140
PHYSIOTHERAPY (056) 777 5173 (056) 777 5223
PRE ASSESSMENT CLINIC (056) 777 5155
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CONSULTANT DIRECTORY
ANAESTHETIST
CARDIOLOGY
Dr E Barnor
Dr M Conway T: 056 778 5769 St. Lukes Clinic Days: Mon
ANAESTHETIST
CARDIOLOGY
Dr G Browne
Dr H Kindler T: (056) 777 5133 F: (056) 777 5136 E: heiko.kindler@ eaglelodge.ie
ANAESTHETIST
DERMATOLOGY
Dr J Cudmore
Dr G Morrow T: (01) 497 0392 F: (01) 497 4119 E: Dermatology.secretary @gmail.com Clinic Days: Fri/Sat monthly
ANAESTHETIST Dr S Prasad
DENTAL Dr M McAuliffe T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
ANAESTHETIST Dr T White drtwhite@indigo.ie
ANAESTHETIST Dr Rao Vinjamuri somsasi@gmail.com
CARDIOLOGY Dr J Clarke T: (056) 777 5133 F: (056) 777 5136 E: info@eaglelodge.ie Clinic Days: Wed
CARDIOLOGY Dr M de Buitléir T: (056) 7762754 F: (056) 7762754 Clinic Days: Mon-Fri
ENDOCRINOLOGY Dr M Ryan T: (061) 490516 F: (061) 312939 E: mary.ryan@BHL.ie Clinic Days: Tue, Wed. twice monthly
ENT SURGERY Mr N Riley T: (056) 777 5258 F: (056) 777 5178 E: nrileykk21@gmail.com Clinic Days: Thursday, every third Friday
Dr M Akram T: ( 056) 772 2078/ 087 9895440 F: (056) 772 2109 Clinic Days: Mon alternate Tuesday clinics
GENERAL SURGERY Mr T Christle T: (056) 775 0070 F: (056) 775 0071 E: freshfordclinic@eircom.net Clinic Days: Monday mornings
GENERAL SURGERY Mr P O’Byrne T: (056) 883 2022 F: (056) 883 2024 pamfreshford@eircom.net Clinic Days: Monday afternoon
GENERAL SURGERY Mr M Hurley F: (056) 776 2222 F: (056) 776 4344 surgeonhurley@hotmail.com Clinic Days: Monday afternoon
GENERAL SURGERY Mr I Wilson T: (056) 777 5142/ (056) 777 1468 F: (056) 777 5285 E: wilsonkk@eircom.net Clinic Days: Wednesday
GYNAECOLOGY Mr R O’Sullivan T: (056) 779 5302 F: (056) 779 5303 Clinic Days: Mon-Fri
GASTRO ENTEROLOGY
GYNAECOLOGY
Dr Aftab T: ( 056) 777 5149/ (056) 772 2078 F: (056) 772 2109 Clinic Days: Direct access
Mr T Hayes T: (056) 779 5302 F: (056) 779 5303 E: jeandonegan@gmail.com Clinic Days: Mon-Fri
GASTRO ENTEROLOGY
GYNAECOLOGY
Dr S Nugent T: (051) 359909 F: (051) 359911 E: suite3@whitfield.ie
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GENERAL MEDICINE / NEPHROLOGY
Mr D McMurray T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
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NEUROLOGY
ORAL SURGERY
Dr P Crowley T: 087 242 0773 F: (056) 770 3452 Clinic Days: Thur
Mr J O’Connor T: (051) 561170 F: (051) 561170
OPHTHALMOLOGY
ORTHOPAEDIC
Mr Paddy Condon, T: 051-844982 E: pcond@eircom.net
Mr S Edwards T: (056) 777 5126 F: (056) 777 5276 E: orthojoint-kilkenny@ mcm.ie Clinic Days: Wed, Thur
PLASTIC SURGEON
ORTHOPAEDIC
PLASTIC SURGEON
Mr B Long T: (056) 772 3252 F: (056) 772 3253 E: cootesinjury@eircom.net Clinic Days: Thur, every third Tue
Dr L Purcell T: 0 87 2774884/0872323876 F: (045) 898427 E: lizpurcell@gmail.com
OPHTHALMOLOGY Mr G Higgins T: 087 1530727 F: 058 75797 E: garethhigginsophth@ gmail.com Clinic Days: Alt Wed
OPHTHALMOLOGY Mr J O’Reilly T: (056) 778 6070 F: (056) 770 2616 theeyesurgery@eircom.net Clinic Days: Tue, Alt Fri
OPHTHALMOLOGY Ms C Cleary T: 061 482378 F: 061 482529
OPHTHALMOLOGY Mr T Stumpf T: (056) 778 6070 F: (056) 770 2616 E: stumpf.tom@gmail.com Clinic Days: Mon, Wed, Thurs
OPHTHALMOLOGY Mr D Kent T: (056) 772 2021 F: (056) 777 0776 E: david.kent@thevisionclinic.ie Clinic Days: Wed
ORAL SURGERY Mr S Nayyar T: (057) 866 2111 F: (01) 7719101 E: sharifnayyar@gmail.com
DIABETES SPECIALIST/ GENERAL PHYSICIAN Dr Dilip Jondhale Marie: (056) 772 2078 E: drdilipjondhale@eircom.net
Mr P Meagher T: 1890 493493 F: (056) 7775145 E: Suite5beacon@ireland.com Clinic Days: Twice monthly
PSYCHIATRIST
ORTHOPAEDIC
Dr N Carrigan (051) 359242 (051) 378831
Mr A Laing T: (056) 777 5156 F: (056) 776 2149 E: deirdrefarrell@mcm.ie Clinic Days: Tue, Fri
RADIOLOGIST
ORTHOPAEDIC Mr Turlough O’Donnell T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
Dr T Murray T: (056) 7775251/(056) 777 5225 F: (056) 777 1359 E: radiology-kilkenny@mcm.ie Clinic Days: Mon-Fri
ORTHOPAEDIC
RESPIRATORY
Mr Maurice Neligan T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
Dr J Faul T: 056 7775280 F: 056 7775285 Clinic Days: Mon, third Fri
PAIN SPECIALIST
RADIATION ONCOLOGY
Dr T Lynch T: (056) 777 5281 F: (056) 777 5285
PAIN SPECIALIST Dr Kathir Tamilmani T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
Dr D Hacking T: (051) 319857 F: (051) 337445 E: hackingdj@upmc.edu Clinic Days: Thur, every third Tue
RHEUMATOLOGY Dr F Khan T: 0 56 7721726 / 056 7775146 F: 056 7789846 E: drfahimknan@gmail.com Clinic Days: Thur, every third Tue
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CONSULTANT DIRECTORY
RHEUMATOLOGY
UROLOGY
Dr S Sant T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
Mr I Ahmad T: 056 7775280 F: 056 7756864 Clinic Days: Every Second Tue
UROLOGY Mr B Jones T: 0 56 7752442 / 086 819 0322 F: 056 7752442 E: barryjones@eircom.net Clinic Days: Thur, Every third Tue
UROLOGY Ms H Hegarty T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
VASCULAR SURGERY Mr P O’Byrne T: 0 56 8832022 F: 0 56 8832024 E: pamfreshford@eircom.net Clinic Days: Monday Afternoon
VASCULAR SURGERY Mr M Murphy T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
UROLOGY Mr P Hegarty T: 1890 493493 F: (056) 7775145 E: info@auteven.ie
2014
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Helplink S o u th
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For the past 50 years the Whelehan Group has been a leader in the sales, marketing and distribution of pharmaceutical, medical products. The Whelehan Surgical division’s focus is on the hospital supply area with particular emphasis on key areas of surgery, including cardiac, ENT, orthopaedic, ophthalmic, general and minimally invasive surgery. In addition, Whelehan Surgical division also supplies general medical and surgical consumables to other areas of the hospital such as accident and emergency departments. Each sector of the business is promoted by highly skilled specialist representatives, all with expert knowledge in their chosen sphere of activity.
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a unique approach to marketing, sales and distribution
Contact Us T:
01 806 8600
F:
01 836 2271
E:
surgical@tpwhelehan.ie
W: www.whelehansurgical.ie Bunkilla Plaza, Bracetown, Clonee, Co. Meath
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