Bon Secours 2015

HOSPITAL, Glasnevin, Dublin 9.

Advanced Medical Exceptional Care

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CONTENTS

Contents 1 Contents 3 Welcome 5 Standards, Quality and Accreditation 8 Infection Control 11 Information Technology 12 Rapid Access Service 15 Cardiology 19 Dermatology 22 Diagnostic Imaging 25 Endocrinology 29 Dietetics 31 ENT Surgery 32 Gynaecology 35 Gastroenterology 39 Endoscopy 41 Laboratory 43 Medical Assessment Unit Editor: Mary Connaughton Editorial Manager: Mary Connaughton Creative Director: Jane Matthews Layout: Antoinette Sinclair Advert Design: Jennifer Reid Production: Nicole Ennis Managing Director: Diarmaid Lennon Published by: Ashville Media Group, Old Stone Building, Blackhall Green, Dublin 7.

Tel: +353 1 432 2200 Fax: +353 1 676 7100 Email: info@ashville.com Web: www.ashville.com All articles Š 2015. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without written permission from the publisher. Opinion and comments expressed herein are not necessarily those of Ashville Media Group.

46 Oncology 49 Ophthalmology 51 Orthopaedic Surgery 54 Podiatry 57 Plastic Surgery 58 Respiratory and Sleep Medicine & Sleep Apnoea 62 Rheumatology 63 Surgery 64 Urology 65 Health Insurance and Self-Payer Packages 66 Consultant Directory 71 Patient Information

BON SECOURS HOSPITAL

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WELCOME

Advanced Medicine and Exceptional Care

B

on Secours Hospital located in Glasnevin, Dublin 9 was officially opened on 27 February 1951. This landmark Dublin development emphatically re-enforced the presence of the Bon Secours congregation in Ireland and greatly enhanced the long-established contribution of the Bon Secours Sisters to healthcare delivery on a local, national and international scale. Importantly, the hospital then and now provides practical evidence of the Bon Secours Mission which was first declared in Paris in 1824: ‘Good Help to Those in Need’ The Bon Secours Hospital Dublin is part of the largest independent hospital group in Ireland with over 2,000 staff and 350 leading consultants. The Group treats more than 200,000 patients annually in its four technologically advanced hospitals located in Cork, Dublin, Galway and Tralee together with a Consultation Centre in Limerick and a Care Village in Cork.

The 'Bons', as it is affectionately known to generations of Northsiders and the wider Irish population, has always commanded a well-earned and enviable reputation for the highest standards in patient care, delivered with the utmost compassion. This proud legacy remains vibrant today at Glasnevin.

Bon Secours, Dublin was the first Irish hospital to gain accreditation by Joint

Commission International (JCI) in 2002 and is currently accredited to 2017. The laboratory is also fully INAB accredited.

The hospital is a recognised teaching facility for the Royal College of Surgeons in Ireland and also accommodates student nurse placements from Dublin City University. Academic links are also established in other areas such as radiographer training in magnetic resonance imaging. The hospital has seen ongoing investment since its inception with major development activity in recent years. A comprehensive range of modern diagnostic, therapeutic and support services underpinned by the latest technology is delivered by a highly skilled and motivated multi-disciplinary team. In excess of 50,000 patients avail of our services annually. Over six hundred staff are employed and there are currently one hundred plus consultants practicing at Bon Secours, encompassing a comprehensive range of clinical specialties and diversity of sub-specialty interests.

Bon Secours continues to attract new, talented consultants. The people who work at Bon Secours are our strength.

Quite a number of leading medical staff have endorsed their belief in the hospital’s reputation and capability by

contributing to this publication. General practitioners from near and afar clearly remain central to the hospital’s success.

Their loyalty over many years and over a wide catchment area provides Bon Secours with the confidence and commitment to continually meet patients’ needs and to seek to exceed all stakeholder’s expectations. In the last year there have been a number of key initiatives and developments including; • Cardiology - Cath lab / eletrophysiology • Direct Access Endoscopy • E-referrals from GPs via Zeus platform • Vascular and Vein Surgery • Continuing Professional Education for GPs • Public Information Seminars This publication is designed to offer you an overview of the services which are currently available at the “Bons”. If you have any suggestions for new services or enhancement of existing provision please do not hesitate to get in touch. Professional visits to the hospital are always welcome.

Please contact our Medical Liaison Co-ordinator on 087 1444204.

Finally, thank you for your support of Bon Secours. It is greatly appreciated.

Gareth Jones Hospital Manager

"The 'Bons'... has always commanded a well-earned and enviable reputation for the highest standards in patient care delivered with the utmost compassion."

BON SECOURS HOSPITAL

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MPS PAPER URGES GOVERNMENT TO CONSIDER PROCEDURAL AND TORT REFORM

BY EMMA HALLINAN Director of Claims and Litigation at Medical Protection Society (MPS)

The claims environment in Ireland has deteriorated for a number of years, and significantly so in some areas of practice. When considering the claims environment for private hospital consultants in early 2014, the actuarial estimates of the cost of indemnity for claims per member had increased by over 90% over two years. This is predominately a result of large increases in both the rate at which private hospital consultants are being sued and the average size of those claims. We believe that there are a number of reasons for this, and the picture is complex.

Importantly, we do not believe this reflects a deterioration of professional standards. Rather, the factors contributing to this deterioration include an increase in patient expectations, the economic downturn, high plaintiff costs and the lack of an efficient and predictable legal process for handling clinical negligence claims.

Delay is endemic in the legal process. This has far reaching consequences: both patients and doctors have to endure a great deal more stress while they wait for a resolution, and the final cost of settling the claim becomes much more expensive. Legal bills continue to mount, and compensation awards often increase in size. The cost of settling a claim that should have been resolved in 2011, for example, can be significantly greater to settle in 2015.

Last November, we launched a policy paper at a meeting at the Royal College of Surgeons in Dublin that contains some bold but achievable recommendations to begin to tackle some of the underlying causes behind this deterioration. The meeting was attended by officials from the Department of Health and representatives from professional organisations and industry bodies.

In the paper, we recommend that government should consider introducing a package of measures including a Bill which provides a definition of the tort of clinical negligence, a limit on general damages, a cap on lawyers’ fees in smaller value cases, full implementation of the 2011 Law Reform Commission’s review of the Limitation of Actions and introduce a Certificate of Merit. We recognise that the recommendations put forward in the paper are not exhaustive; our aim is to stimulate this important debate.

As a consequence of the deteriorating claims environment, MPS had to increase its subscription rates in 2014, and for some specialties, this rise was significant. MPS is a not for profit organisation; these increases reflect the need to cover the rising cost of clinical negligence.

We are acutely aware of how detrimental this increase is for members and the potential impact on society. We have concerns that the claims experience (and therefore the cost of protection) for some specialities risks threatening the sustainability of private practice, negatively impacting on both the profession and patient care. Because of this, we are not satisfied with only raising concerns; we want to help find solutions.

We also recognise the important role that MPS must play. We have committed to trialling a pre-action protocol to help make the legal system more efficient. But more importantly, we will continue to encourage and support our members to embrace open disclosure. This will ensure that patients and their families are provided with the answers they need when a consultant’s care is questioned and in our experience, can assist in avoiding unnecessary escalation.

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STANDARDS, QUALITY AND ACCREDITATION

Standards, Quality and Accreditation Best Practice Facilitator, Sheila O’Leary explains how Bon Secours Hospital Dublin leads the way in quality improvement and patient safety.

W

e took our first formal step in December 2000 into the, new to us, world of Quality Accreditation. Looking back we now appreciate how far we have come.

Bon Secours Hospital Dublin was the first hospital in Ireland to achieve international healthcare accreditation.

Best Practice Facilitator, Sheila O’Leary explains how they are the leaders in quality improvement.

CLINICAL GOVERNANCE Clinical governance defines the culture, the values, the processes and the procedures that must be put in place in

As part of Bon Secours Health System, Clinical Governance starts at the top of the organisation with the Board. Structures and processes are in place that permeate throughout the organisation to ensure excellent patient care.

order to achieve sustained quality of care in healthcare organizations. Clinical governance involves moving towards a culture where safe, high quality patientcentered care is ensured by all those involved in the patient journey.

- Report of the Commission on Patient Safety and Quality Assurance 2008.

As part of Bon Secours Health System, Clinical Governance starts at the top of the organisation with the Board. Structures and processes are in place that permeate throughout the organisation to ensure excellent patient care. This is validated through Hospital Accreditation by Joint Commission International (JCI).

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STANDARDS, QUALITY AND ACCREDITATION

WHY JCI Joint Commission International (JCI) is a highly respected international accreditation body. Founded in 1994, it works with healthcare organizations in over 90 countries. JCI has developed a set of international standards to evaluate hospitals and provide an objective review of the quality of patient services.

JCI AND THE BON SECOURS In 2002, Bon Secours Hospital Dublin was proud to become the first internationally accredited hospital in Ireland. The hospital is re-surveyed every three years against a revised set of standards. The standards are revised by JCI to ‘raise the bar’ and keep pace with evidencebased practice. We are proud to have maintained our accreditation through each of these tri-annual surveys, most recently in 2014. JCI provides the hospital Governance with an independent, objective, external review of the systems and processes in place to assure safe, quality patient care.

On a daily basis, the hospital seeks to maximise the quality of care that is provided to patients whilst reducing the risk. We see quality improvement and risk management as two sides of the one coin. This is a continuous journey, where we learn from and share best practices with other healthcare organisations. We are fortunate to be part of the largest independent healthcare group in Ireland,

Our 2014 customer satisfaction survey shows that 97% would be happy to return to the hospital with 98% happy to recommend the hospital to friends or family.

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which enables us to benchmark internally. We also participate in, the National Infection Control Projects and also benchmark with other independent hospitals in Ireland.

In addition to JCI accreditation, Bon Secours Pathology Department is ISO15189 accredited and certified

by INAB. Our catering department has received the Happy Heart Eating Award and we have recently won a NISO award for Health & Safety.

We are currently on the journey to accreditation for the Endoscopy Department.

WHAT DOES THIS MEAN TO THE CUSTOMER? The voice of the customer is important to us and we use customer feedback to improve our services. Our 2014 customer satisfaction survey shows that 97% would be happy to return to the hospital with 98% happy to recommend the hospital to friends or family.

As one participant commented: ‘You can be trusted to produce good health outcomes appropriate to any case and with a positive experience that is life giving in itself.’

BON SECOURS HOSPITAL

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INFECTION CONTROL

Hand Hygiene Education and Protection At Bon Secours a dedicated Infection Prevention and Control Team focus on identifying and reducing the risk of infection transmission among patients, staff and visitiors to the hospital.

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he aim of the dedicated Infection Prevention and Control Team (IPCT) at The Bon Secours Hospital Dublin is to identify and reduce the risks of acquiring and transmitting infection among patients, staff and visitors within the hospital. Their focus is on continually improving standards to ensure the delivery of high quality, safe patient care.

The team is led by a consultant microbiologist and includes two fulltime IPC clinical nurse specialists with

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dedicated administrative support. Advice on infection control is available on a 24 hour basis. The IPC committee is multidisciplinary and is chaired by the consultant microbiologist.

INTRODUCTION OF THE SUREWASH SYSTEM In Autumn 2014, the hospital introduced the SureWash system as part of their infection prevention and control programme. Cleaning hands properly whether with soap or alcohol rub, is the

single most important action to prevent infections in a hospital. According to the WHO (2009), in Europe Health Care Associated Infections (HACI’s) are acquired annually by 5 million patients resulting in 50,000 deaths each year and 25 million extra bed days costing 13 – 24 billion annually. Hand Hygiene (HH) is the single most important procedure in preventing HCAI. Their consequences can be reduced by up to one third if HH is performed correctly. SureWash uses gaming technology to train and assess

BON SECOURS HOSPITAL

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INFECTION CONTROL

LEVELS OF HAND HYGIENE Social Hand Hygiene - using 3 - 5mls of soap and water for 40 - 60 seconds after most daily tasks. This removes transient micro-organisms, preventing cross infection.

ASEPTIC HAND HYGIENE using 3 - 5mls of an antiseptic such as Chlorhexidine Gluconate 4% for 40 - 60 seconds. This is particularly important prior to conducting aseptic procedures and contact with immunosuppressed patients. Alcohol hand gel may be used for social and aseptic hand hygiene for 30 seconds once hands are visibly clean. Please note alcohol hand gel is not sporicidal therefore hand washing with soap and water is recommended in cases where C difficile infection is suspected.

WHO Guidelines on Hand Hygiene

the hand hygiene technique of healthcare workers, patients and visitors. Developed in Trinity College Dublin and used in 20% of Irish hospitals, SureWash is a mobile unit that can be moved to train staff on the ward and is available 24/7.

Using the World Health Organization recommended hand hygiene technique, SureWash allows a person to practice their technique in the same order each time enhancing muscle memory so it becomes an unconscious competency – like tying your shoelaces!

SureWash is used in hospitals across the United Kingdom, Europe, the Middle East and the United States and medical schools are now incorporating it as part of their curricula for training medical staff.

BON SECOURS AND NATIONAL HYGIENE COMPLIANCE AUDITS The Bon Secours Hospital Dublin has been participating in the National Hand Hygiene Compliance Audits since 2010.

The Average compliance rate over the period from Nov 2013 – Nov 2014 is 93%.

This figure far exceeded the HSE national target rate of greater than 90%.

HOSPITAL VISITORS AND HAND HYGIENE In October 2014, a survey was carried out by the Bon Secours Health System to promote good hand hygiene and to get a better understanding of hand hygiene amongst the general public and in particular amongst visitors to hospitals.

The national survey revealed interesting facts about general hand hygiene and despite 94% of those surveyed rating washing their hands when visiting a hospital as being ‘extremely important’ or ‘very important’ the research revealed that 36% do not always wash their hands when visiting a hospital.

Bon Secours is committed to the very highest hygiene levels; we continually remind staff, patients and visitors of the importance of washing their hands and strive to make it as easy as possible for them to access anti-bacterial gel dispensers. The Sure Wash system is

SURGICAL HAND HYGIENE using an antiseptic for 2 - 5 mins prior to surgical procedures. This removes resident skin flora and prevents surgical site infection.

regularly available in the main reception area in the hospital allowing patients and visitors to practice their hand washing techniques.

The Bon Secours Hospital Dublin has been participating in the National Hand Hygiene Compliance Audits since 2010. The Average compliance rate over the period from Nov 2013 – Nov 2014 is 93%. This figure far exceeded the HSE national target rate of greater than 90%.

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The unique formulation of Oxivir Plus contains patented Accelerated Hydrogen Peroxide (AHP) and is fully compliant with the European Biocidal Product Directive. It has passed numerous standard microbiological tests including EN14476, EN1276, EN13697 and EN13727 with five minutes contact time or less.

It also passes EN1650, EN13624 and EN14348. AHP kills viruses including Norovirus in two minutes.

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INFORMATION TECHNOLOGY DEPARTMENT

Information Technology at Bon Secours Cliona Byrne, IT Manager talks about some of the more recent IT updates at the Bon Secours Hospital.

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he IT journey at Bon Secours Dublin is ongoing, with every opportunity taken to avail of process and quality improvements. IT plays a key role in ensuring that the patient's pathway through the hospital runs as smoothly and as easily as possible. We also ensure that we support GPs as much as possible in the care of their patients in their practices.

E-REFERRALS From early 2015, GPs using the Socrates patient management software system have been able to refer patients to our Consultant team and Outpatient department through an e-referral platform called Zeus. Zeus is Ireland’s first private e-Referrals and communications platform and the Bon Secours Hospital and our consultant team are the first hospital in Ireland to be in a position to receive and manage referrals this way. Zeus allows GP’s, Consultants and Hospitals to seamlessly refer and discharge patients in a fully safe, secure and traceable environment. Referrals are received securely within seconds and the processing and appointment confirmation times are greatly reduced to the benefit of the patient and all concerned. The follow-on report and / or consultant letters can be sent directly back to the GP through Zeus and is stored directly into the patient file. In the autumn, Zeus will also be available not only to Socrates Practices but also to Helix Health Practices who collectively provide patient management software systems to 95% of the GP practice throughout Ireland.

CONNECTING TO HEALTHLINK Since the introduction of Healthlink in 2014, GPs have been able to access their pathology results as soon as they are available though Healthlink. This has significantly benefited the patients ensuring their GP has far quicker access

to their results and can download the available results directly into their Patient Management System. The introduction of Healthlink has also increased the number of referrals to our INAB accredited laboratory. Plans are underway to introduce Healthlink for other services including Diagnostic Imaging within the hospital.

PATIENT ADMINISTRATION SYSTEM The backbone of the hospital’s IT infrastructure is our Patient Administration System. This allows the Hospital to manage the patient’s journey electronically. It also provides information to other connecting systems ensuring there is continuity in patient identification and clinical information across all diagnostic and treatment areas.

One such connection is the Radiology Information System (RIS) and Picture Archiving and Communications System (PACS). This technology allows radiologists to view scanned images as soon as the scan is complete.

They can then report on these images dynamically using voice recognition technology enabling the hospital to deliver highly efficient turnaround times for the final report to be provided to the attending or referring clinicians.

These reports are available at the point of care in the hospital or via remote access for authorised users. RIS/PACS also allows for images acquired to be viewed at any screen throughout the facility by the care team.

ENDOSCOPY INFORMATION SYSTEM Another key important development and step towards moving the hospital to full system integration has been through the introduction of the EndoRAAD system. EndoRAAD has helped to improve the patient journey through the Endoscopy Unit to the extent that reports once signed off by the

consultant are now reaching the recovery area even before the patient. Existing patient reports can be quickly recalled and displayed during a patients visit to compare previous and current conditions.

With the introduction of EndoRAAD, the hospital is the first and only private hospital in Ireland to fully engage with the National Quality Improvment Programme in GI Endoscopy. Quality data is uploaded quarterly to the National Quality Assurance Intelligence System (NQIS) based in the Royal College of Physicians. The NQIS system develops quality assurance reports based on National Quality Indicators providing opportunities for the department to benchmark its performance and to continuously review processes to ensure patient care is optimised whilst also providing patients and their consultants with increased confidence in diagnosis.

IT SUPPORT, TRAINING AND DEVELOPMENT There are also other IT systems within the hospital which do not having a direct role in patient care but do ultimately support service delivery. For example, staff utilise hand held devices to support the delivery of services such as stock requisitioning, infection control audits and endoscope validation.

On-going training and development is important to Bon Secours, Dublin.

IT training is provided in-house for administration staff, nursing and other care disciplines who participate in an IT certification programme specifically designed for healthcare workers. The hospital is a recognised centre for the Health Informatics Training System (HITS). The HITS programme was developed by the Irish Computer Society and has been designed to provide a basic understanding of the use of IT in healthcare, for those who work in the sector, at any level. To date Bon Secours has over 100 employees have achieved certification.

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RAPID ACCESS SERVICE

Straight to the Point The Rapid Access Service provides a 24-hour medical care service, in a welcoming environment with compassion and courtesy in keeping with the values of the Bon Secours Hospital.

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ince the Rapid Access Service started in the Bon Secours Hospital in 2009, it has grown rapidly and is a source of great pride to the hospital. The idea for the service stemmed from an increasing demand from local GPs and a recognition that particular patients needed access to immediate treatment or investigation without having to attend the local emergency department. The service now receives referrals from the thirty-two counties. The north is an unexpected referral source, however the hospital's location adjacent to the M1 and M50, coupled with its reputation and proven expertise in the compassionate and efficient care of patients has made it an attractive option for northern patients and those from adjacent counties.

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RAPID ACCESS UNIT TEAM • Dr Colette Barry • Prof Richard Costello • Dr Ross Morgan • Prof Chris Thompson

"This is a streamlined system for GPs to refer suitable patients who require hospitalisation for investigation or treatment and who want avoid the emergency department and its attendant delays."

The Rapid Access Service is led by a team of four consultants, Prof Richard Costello, Dr Ross Morgan, Prof Chris Thompson and Dr Colette Barry with the support of a medical registrar and three dedicated clinical nurse managers David Keogh, Collette Nolan and Suzanne Donlon. Its initial focus was to provide a service for patients with respiratory problems such as ineffective exacerbation of COPD, pneumonia or those with persistent chest infection. It has since evolved to include patients with other medical difficulties such as suspected pulmonary embolism, cellulitis, UTI, suspected DVT, endocrine and gastric issues. Additional specialities will be added to the service in the next 12 months potentially including Urology and Surgical patients.

The Rapid Access Service only accepts

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RAPID ACCESS SERVICE

GP referred patients and not walk-in patients. As with all patients in the hospital, the focus is on ensuring that the patient receives the best possible care available in the most appropriate setting.

As such, all referrals are triagged over the phone prior to admission to ensure the appropriateness of the referral. As Dr Morgan explains: “This is a streamlined system for GPs to refer suitable patients who require hospitalisation for investigation or treatment and who want to avoid the emergency department and its attendant delays. However it is not suitable for non-ambulatory patients or those who may require resuscitation – these patients are best seen in an emergency department.”

ACCESS TO SERVICE At present the Rapid Access Service operates between 7.30am and 6pm Monday to Friday. All patients are referred directly by their GP who will have identified a need for hospital treatment from their consultation with the patient.

Most medical insurance plans that include in-patient and out-patient treatment will cover referral to the Rapid Access Service at the Bon Secours Hospital. Full details of the insurance

THE RAPID ACCESS SERVICE at the Bon Secours Hospital is suitable for patients with general medical issues such as the following who have been assessed by their GP prior to referral: • Obstructive airway disease (Asthma, COPD) • Recurrent cough or respiratory tract infections • Pulmonary embolus • Urinary tract infections • Low haemoglobin • Gastrointestinal complaints • Jaundice • Possible DVT • Cellulitis • Endocrine disorders The emergency department of an acute hospital is more suitable for patients whose condition is unstable or those who require acute surgical intervention such as those presenting with: • Acute chest pain / MI • Collapse • Lacerations / burns • Stroke • Acute abdominal pain

Clinical Nurse Managers, David Keogh and Collette Nolan, co-ordinate the Rapid Access Service admissions process and explain what patients can expect when they are referred to Bon Secours, “First of all the patient will be contacted by a Rapid Access nurse co-ordinator to arrange admission at the most appropriate time to the patient. On arrival in the hospital, the patient is met by one of the Rapid Access Service team and once admitted, they are reviewed by a registrar and any tests or investigations such as scans, blood tests etc will be arranged and treatment will commence.

This all happens within approximately one hour. The patient care pathway is fully planned and any follow up is organised before the patient is discharged from the hospital. “Once the patient has been treated and discharged from the hospital, a full report will be sent to their GP within 24 hours. If ongoing treatment is required, appointments will be scheduled with either their GP or their consultant, depending on their condition,” say David and Collette.

companies benefits are listed on the hospital’s website – www.bonsecours.ie The benefit to patients is evident in that they can receive timely intervention and treatment for a broad spectrum of conditions.

GOING FORWARD With the success of the Rapid Access Service, there are plans to extend the service further in line with demand and the possibility of adding a surgical strand is currently being explored along with urology and ophthalmology services. The key criteria shaping any developments in this area is the Bon Secours commitment to delivering timely patient care in a safe environment where medical excellence is the standard.

CONTACT DETAILS Mon-Fri 7.30am - 6pm Rapid Access Co-ordinator Tel: 01 8065498 / 086 2098380 Fax: 01 8065405 Out of hours contact: 01 806 5331

RAPID ACCESS ADMISSIONS PROCESS

BON SECOURS HOSPITAL

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CARDIOLOGY DEPARTMENT

Cardiology Services New Technology and Developments Cardiology at Bon Secours has undergone monumental change over the last number of years and the department is now at the forefront of cardiology services in Ireland.

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ardiac arrhythmia affects greater than 10% of over 65’s with conditions such as Atrial Fibrillation showing increasing prevalence in older age groups.

Atrial fibrillation (AF) is a major risk factor for stroke and a patient with AF is at five times higher risk of having a stroke. In addition, 15% of all people who have strokes have AF too. With early diagnosis and treatment, patients with AF have already taken the first steps to preventing and reducing the possibility of them of suffering from AF – related stroke.

AF can also contribute to faints and falls

and can significantly reduce the quality of life for the patient through dizziness, shortness of breath and fatigue.

IDENTIFYING THE ISSUES The challenge for all medical personnel is to firstly identify which patients have cardiac issues; this is the screening element of the equation. Once these patients have been identified, the next stage is ensuring that they have access to appropriate level of care as quickly and seamlessly as possible.

Over the past twelve months, Bon Secours Hospital Dublin has made

significant changes to meet these twin challenges through the purchase of additional equipment, changes to referral programmes, ongoing training of staff and the recruitment of an additional cardiologist to our team.

EARLY INTERVENTION With cardiac disease the physicians goal is to treat the condition as early as possible in the disease development. To help in the early diagnosis of patients, the cardiology department at the Bon Secours Hospital has made significant changes to increase the numbers of

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patients screened and to make the path to screening as straightforward as possible.

The department recently doubled its ECG machine inventory and made the ECG results remotely accessible for consultant cardiologists. Changes to GP referral programmes have also made it easier to receive walk-in pre-assessment. Our other assessment methods such as Holter ECG monitors and ambulatory blood pressure monitors have also undergone significant expansion – all this with the goal of making it easier for patients to be tested early in the disease cycle.

The second element of the treatment of cardiac disease is the cardiac specialist who will help to stratify the disease state.

In this respect Bon Secours Dublin have leaders in their respective specialism’s within cardiology. With our full range of diagnostic services we have the leading specialist to manage the issue whether it be specialised structural cardiac issue requiring specific echocardiography studies under Dr Angie Brown, interventional procedures under Dr McAdam or cardiac rhythm management

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with Dr Gumbrielle and Dr Robert Kelly; the specialist within the Bon Secours work on a collaborative basis to ensure cardiac patients receive the best possible care across all cardiology specialities.

FACILITIES UPGRADE The Cath lab was upgraded to allow the effective treatment of arrhythmias via the discipline of Electrophysiology (EP). This significant investment in high technology systems for Electrophysiology allows us for the first time to map and treat cardiac electrical conduction issues.

These arrhythmia issues often present following syncope or falls and can be symptomatic via palpitations or chest discomfort. The necessary diagnostic measurement techniques are all in place in the hospital – whether it be Tilt Table

testing for differential diagnosis of syncope / fainting, extended Holter monitoring for quantification of arrhythmias or Cardiac MRI/Stress Echo for analysis of structural issues in the heart which lead to arrhythmias.

PROGRESSIVE PATIENT FOCUSED SERVICE The EP service is led by Dr Jonathan Lyne, for whom referrals can be made directly on 087 6221793. Dr Lyne is available for consultation in the hospitals consultants clinic and works closely with his cardiac specialist colleagues in offering a full cardiac treatment service.

Another area where the Bon Secours Hospital is making significant changes is in the application of the latest technology in communications to enhance the patient/

The specialist within the Bon Secours work on a collaborative basis to ensure cardiac patients receive the best possible care across all cardiology specialities.

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specialist service. Mark Roach, cardiac services manager, explains this further:“One of the major issues we face in arrhythmia analysis is 'catching' the arrhythmia. Traditional methods such as the 10-second 12 lead ECG and 24 Holter monitor have their place, but new measurement methods are being developed which will enhance our ability to record and analyse transient, but nonetheless significant and symptomatic arrhythmias. We believe these new systems will increase our window of opportunity to diagnose cardiac arrhythmias such as supra-ventricular tachycardia, and via web-based analysis and reporting dramatically reduce the window from first GP referral to final treatment.”

The final element in trying to treat arrhythmia populations is the issue of the cost of treatment. The department has made structural changes to make the diagnosis of cardiac issues more affordable. Unfortunately, many private medical insurance plans do not cover for outpatient testing such as ECG, pacemaker follow-ups or Holter monitoring. In response to this, we have developed competitively priced package deals which will minimise the cost of the out patient arrhythmia work-up phase.

Cardiac arrhythmia is a population-wide issue and our aim is to make rapid access to cardiac rhythm analysis available and as accessible as possible to the population.

CARDIOLOGIST TEAM • Dr Angie Brown • Dr Tom Gumbrielle • Dr Robert Kelly • Dr Jonathan Lyne • Dr Brendan McAdam • Dr Richard Sheahan CARDIOLOGY SERVICES MANAGER • Mr Raymond Conboy CONTACT DETAILS Cardiology dept: 01 8065368 Outpatient apt: 01 8082300

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DERMATOLOGY DEPARTMENT

Dermatology at Bon Secours The Dermatology Department at Bon Secours treats a myriad of different conditions writes Consultant Dermatologist, Dr Nicholas Walsh.

THE TEAM Presently, the dermatology department at Bon Secours Hospital consists of six dermatologists offering the very best in inpatient and outpatient care.

It specialises in providing both medical and surgical support for its patients, striving to deliver a swift diagnosis and implement a treatment plan which will alleviate the patient of their dermatological condition.

COMMON SKIN ABNORMALITIES While many patients present with suspected skin cancer, not all of our treatments are focused on cancer

patients. Common conditions we deal with on a regular basis include: • psoriasis • eczema • acne vulgaris • warts • acne rosacea All but the most severe of these are dealt with via medicinal treatment.

SKIN CANCER Skin cancer occurs in two forms; melanoma and non-melanoma. Melanoma occurs primarily in the melanocytes – the pigment cells present in the skin.

It is normally darkly pigmented, and can spread to other parts of the body if not treated in time. Consequently, early diagnosis is paramount. Patients themselves are often the first to become aware of potentially problematic issues as the disease visually manifests on the surface of the skin in the form of spots or moles. Fortunately, most spots or moles that appear are harmless; they are not cancerous and lack the capacity to become so.

However, if a suspicious looking mole does arise it is always better to exercise caution and have it checked by a doctor who can, if necessary, refer the patient to us for treatment. Typically, suspicious

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moles are larger than their more benign counterparts, have irregular shapes with uneven borders and are different in colour to other spots on the body. Although less frequent than non-melanoma, melanoma is a very aggressive strain of cancer, and therefore early recognition and intervention are vital for successful treatment.

DIAGNOSIS AND TREATMENT Dermatologists are the main point of referral for suspected skin cancer. Skin cancer diagnosis typically transpires via a skin biopsy, which is available as a day case in the hospital. A diagnostic biopsy is not always needed to determine if treatment is necessary. Often the necessary course of treatment will be immediately evident to the dermatologist.

If there is any uncertainty then a diagnostic biopsy will be performed.

Non-melanoma skin cancer is the more common of the two, increasing at a steady annual rate for much of the last two decades. It occurs in two distinct forms; basal-cell carcinoma and squamous-cell carcinoma. Basal-cell carcinoma (BCC) is the single most common fform of cancer occuring most frequently in people over the age of 40 and those with freckled

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skin being most at risk. BCC manifests in the epidermis of the skin, including the scalp and areas most regularly exposed to sunlight and other forms of UV radiation.

It is normally painless and less obvious than melanoma skin cancer, consisting of subtle bumps that may be pearly or waxy, ranging from flesh-coloured to brown in colour, and even pink or white. Squamouscell carcinoma also occurs in skin that is regularly exposed to sun rays and often developing in skin that has been injured or inflamed. Old age and exposure to sunlight put one at a greater risk from this cancer, and reveals itself in the form of scaly, crusted, reddish patches on the skin.

Once a biopsy has been performed, the results will determine the subsequent

DERMATOLOGY TEAM • Dr Callaghan Condon • Dr Tony Egan • Dr Fiona Keane • Dr Sandra Kirke • Dr Brigid O'Connell • Dr Nicholas Walsh CONTACT DETAILS Tel: 01-8082340

management of the condition. For instance, treatment of melanoma is contingent upon the depth of the tumour in the skin. After the biopsy results are available, a wider excision of the tumor may be carried out which may involve surgical removal and other post surgery treatments. Outpatient surgery of this kind is performed on a near daily basis in our minor operating theatre with only some instances being referred to classic surgeons.

EQUIPMENT We are well equipped here at Bon Secours with the latest in dermatological care. We use a number of specialised instruments, including an Intense Pulse Light (IPL) used in the treatment of vascular lesions (broken veins on the face), leg veins, liver spots and for hair removal and a YAG Laser for vascular abnormalities in the skin.

WORKING TOGETHER Although all six dermatologists working here at Bon Secours are adept in both surgical and medicinal care, we augment our surgical prowess with strong working relationships with plastic surgeons at the hospital that help us amend skin disfigurements.

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DIAGNOSTIC IMAGING DEPARTMENT

Diagnostic Imaging at Bon Secours Significant investment in Diagnostic Imaging services ensures fast and effective diagnosis for patients and clincians.

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urrently the Diagnostic Imaging Centre is collaboratively led by Ciara Sweeney and Professor Michael Lee. Professor Michael Lee directs eight dedicated, and experienced Consultant Radiologists, a Consultant Rheumatologist, and a Vascular Physician specialising in Non invasive Vascular Investigation using Duplex Ultrasound scanning.Their expertise incorporates a great expanse within Radiology including Vascular Imaging, Musculo-Skeletal Imaging, Neuro-Radiological Imaging, Gastro-Intestinal Imaging, GenitoUrinary Imaging, Cardiac Imaging, Breast MR Imaging, Bone Densitometry, and General Imaging. Our Consultant

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Radiologists have close linkage with Beaumont Hospital allowing for joint care of patients, were required, in a multidisciplinary setting.

This skilled Radiology team is supported by 14 enthusiastic, dynamic and experienced Radiographers and a compassionate administration team.

The department provides a complete range of state-of-the-art diagnostic equipment to support our many Diagnostic Specialties to include Magnetic Resonance Imaging (MRI), Multi-Slice Computed Tomography (CT), Ultrasound (including vascular studies), Fluoroscopy, Dual Energy X-Ray Absorptiometry (DEXA), Digital Radiography (DR) and Ankle Brachial Indices (ABI).

COMPUTED TOMOGRAPHY (CT) Computed Tomography (CT) provides an extensive service to the hospital, particularly to the endoscopy, cardiology and oncology units. The Siemens Definition 64 slice scanner provides dynamic image detail and resolution that allows for a more accurate diagnosis. The scanner also includes a dose management technology - Iterative Reconstruction (IR) with second generation SAFIRE. This SAFIRE shield ensures patients only receive the minimum clinically relevant dose of radiation.

The syngo.via application helps to improve productivity by giving radiologists the flexibility to analyse and report on CT scans at any suitable work

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station within the hospital, removing the dependency on single review points.

Specialised CT software and hardware enable dedicated sub-speciality CT services including: • Virtual CT Colonoscopy – an increasingly useful diagnostic tool that can in some cases replace colonoscopy.

If colonoscopy fails to get a clear image of the bowel then CT colonoscopy is used to produce a 3D image to visualise the bowel.

• Dedicated oncological imaging • Cardiac/coronary vessel imaging • Vascular imaging The department is actively involved in extensive post-graduate CT training and education, ensuring the highest standards of quality and care are consistently maintained.

MAGNETIC RESONANCE IMAGING (MRI) Magnetic Resonance Imaging (MRI) is one of the most important diagnostic tools at the department’s disposal and provides an invaluable service to the hospital.

The 1.5 Tesla Siemens Avanto MRI unit is a cutting edge scanner with a wide range of capabilities. The department performs cardiac, neurological, breast, musculoskeletal, whole body, vascular and gastro intestinal MRI. The images produced are of the highest resolution and contrast, enabling fast and accurate diagnosis.

The scanner facilitates feet first scanning, which greatly improves patient comfort alleviating anxieties and stressors relating to claustrophobia which can present difficulty for certain patients.

The department has hosted numerous MRI training courses and is an integral element of post-graduate MRI education and training in Ireland, affiliated to both Trinity College Dublin and University College Dublin.

takes less than 15 minutes to complete.

It is essential when assessing those at risk for osteoporosis. A consultant rheumatologist is at hand to report on the DEXA scans and offer lifestyle advice with regard to treatment.

ULTRASOUND Ultrasound is a non invasive modality used to investigate a wide variety of conditions including disease of the thyroid, kidneys, liver, gall bladder, pancreas and pelvis. Ultrasound is also used for musculoskeletal imaging and trans-rectal and trans-vaginal imaging of the prostate and the uterus. Biopsies are performed in the department.

There are regular doppler ultrasound clinics providing vascular services including duplex scanning and screening for suspected DVTs. ANKLE BRACHIAL INDEX (ABI) ABI is a non invasive test used to investigate a patients risk of peripheral artery disease. Blood pressures of the upper and lower limbs are measured in conjunction with a Doppler Ultrasound probe to measure the sound waves within the arteries. This is becoming an increasingly valuable test for vascular surgeons.

most of the major health insurers. This means that patients need only fill in their insurance information and we bill directly to their insurance company.

Such schemes are in situ with VHI (all MRI scanning), AVIVA (all MRI/CT scanning), ESB (all diagnostic imaging), GMA (all diagnostic imaging), GLO Health (all MRI/CT scanning).

WALK IN SERVICE The Radiology Department offers a walk-in service between 8am and 5pm Monday to Friday. Patients with a referral letter from their GP can come in without an appointment and will be seen straight away for all plain radiographic and ultrasound examinations which do not require specific patient preparation. This is an excellent facility which saves valuable time and expense for those who may be travelling to Bon Secours from outside the greater Dublin area.

CONTACT DETAILS General Enquiries : 01-8065406 Mon - Fri 9am - 5pm Appointments: 01-8082300 Mon - Fri 8am - 6pm

DIRECT PAYMENT SCHEMES Direct payment schemes are in place with

DEXA Bone densitometry is the assessment of the density of a person’s bones which is crucial in detecting the early stages of osteoporosis. The DEXA scanner quantifies bone mineral density by measuring the patients bone density and then comparing it to the mean bone density for their age and demographic.

The test is safe, accurate and painless and

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ENDOCRINOLOGY DEPARTMENT

Endocrinology at Bon Secours The Endocrinology Department is dedicated to the timely treatment of its patients.

Professor Chris Thompson, Consultant Endocrinologist discusses the role which this department plays in the day to day life of the hospital.

ENDOCRINOLOGY Endocrinology is the study of glands and the hormonal control of the body, the regulation of which can be upset by particular conditions including diabetes and pituary malfunction. It is one of the many disciplines pursued at Bon Secours Hospital by a dedicated team determined to deliver the highest quality of treatment to sufferers of endocrine disorders including hormonal imbalances.

Endocrinology at Bon Secours is divided into two tenets; diabetes and pituitary.

DIABETES Our diabetes related services have been facilitated by our dedicated diabetes nurse who has been on staff for a number of years now. She provides inpatient education for people who are admitted to the hospital for diabetes care, as well as newly-diagnosed patients who have become aware of their diabetes during their stay here at Bon Secours. This is a vital role as education is the first step needed when learning to live with diabetes.

According to the Diabetes Federation of Ireland, diabetes afflicts around one in every 20 people living here (including approximately one in every eight old people) and that figure is set to grow substantially over the coming years. By 2020, it is estimated that over 200,000 people in Ireland will suffer from the condition. This highlights the real need for access to top-quality treatment for sufferers. Awareness about the symptoms, implications and management of diabetes are also of critical importance, and

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pituitary tumours is a particular focus and area of interest for our endocrine team.

The hospital has a specialised ward geared towards the administration of pituitary function tests for patients with pituitary tumours.

Over the last number of years we have seen a great increase in the number of pituitary patients seeking to have their treatment at Bon Secours as opposed to through the more traditional means of public hospitals. This serves as a terrific testament to the quality of the treatment we offer our patients and we look forward to further expanding and improving this service over the years ahead.

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Bon Secours Hospital continues to work towards delivering this crucial service to inpatients and out patients.

3. Shared Care - The patients care plan is devised by the endocrinologist and the plan is delivered by the GP.

THE DIABETES CARE CENTRE The Diabetes Care Centre at the Bon Secours Hospital is a specialist coordinated care and education service for recently diagnosed patients who are experiencing current and / or ongoing problems managing their diabetes.

The centre focuses on patient empowerment through educational programmes delivered by a dynamic multidisciplinary team including a diabetes clinical nurse specialist, dieticians, endocrinologists, psychologists and podiatrist backed up by ophthalmologists, vascular surgeons, cardiologists and renal physicians as required.

The Bon Secours Diabetic Care Centre has developed three different care options to support GPs in the management of their diabetic patients.

1. GP Managed Care - The care is solely managed by the GP with referral into the centre for consults with one of the specialist team as required.

2. Diabetes Centre Managed Care - The patients ongoing diabetic care is managed by the Bon Secours Diabetic Care Team with regular updates provided to the referring GP.

BENEFITS TO THE PATIENT OF ATTENDING THE CENTRE • Immediate and timely appointments • Quick and early intervention reducing and / or preventing the risk of complications developing • Team based approach to care • Access to a range of specialists as required • Convenient same day scheduling of appointments with the care team and laboratory tests if required • 'One stop shop' - minimising the time off work and disruption to personal time PITUITARY - THE 'MASTER GLAND' Increasingly, we are seeing a growing number of patients suffering from issues with their pituitary gland. Situated at the base of the skull, the ‘master gland', as it is aptly named, is the dominant gland within the body – stimulating other glands to release hormones in accordance with the body’s requirements. It is responsible for regulating – among other things – hunger, growth and metabolic activity and as such, pituitary malfunction can be the cause of a catalogue of bodily difficulties which can seriously affect the health of a patient.

The management of patients with

DIAGNOSTICS Endocrinology as a discipline requires very little in the way of specialised equipment, but its practice does demand access to blood testing and the most upto-date MRI scanning, both of which are available at Bon Secours. MRI scanning is central to endocrinology as it is the only definitive way by which images of suspected abnormal pituitary glands can be acquired, enabling diagnosis.

Collaboration with our Diagnostic Imaging Department is fundamental to the delivery of appropriate treatment and ensuring the best possible outcome for our patients.

WHAT THE FUTURE HOLDS With continued advances in MRI technology there will be far greater accuracy when imaging tumours which will engender superior precision in the deliverance of surgery, radiotherapy, etc.

This being the case, technological change – particularly within the realm of radiology – will be crucial to ensure the continued and improved treatment of patients suffering from pituitary problems and Bon Secours fully intends to be at the forefront of this shifting paradigm to make sure our patients receive only the best care.

ENDOCRINOLOGY CONSULTANT TEAM • Dr Margaret Griffin • Dr Diarmuid Smith • Prof Chris Thompson DIABETES CARE CENTRE Tel: 01 806 5488 Fax: 01 808 2343

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DIETETICS DEPARTMENT

Dietetics at Bon Secours The Dietetics Department at Bon Secours provides a comprehensive service to its patients on the importance of nutrition for a healthy lifestyle.

well being, and our dietitians can offer support and advice for a wide range of conditions/diet plans to include; • Malnutrition, enteral and parental nutrition • Weight management/obesity including bariatric patients • Diabetes, IGT and reactive hypoglycaemia • PCOS (Polycystic Ovary Syndrome) • IBS as treated by the new FODMAP diet plan • Sports performance and enhancement • Cancer • Coeliac disease • Lactose Intolerance • Constipation and diverticulitis • IBD (Chron’s disease and colitis), • High cholesterol, triglycerides and blood pressure • Gout and gallstones • Nutritional deficiencies e.g. anaemia

WHAT IS A DIETITIAN? Dietitians are experts in food and nutrition and advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. They use their knowledge of food, nutrition and other related disciplines such as biochemistry, physiology and social science to promote health, and aid in the management of illness. The professional body for clinical nutritionists/dietitians in Ireland is the Irish Nutrition and Dietetic Institute (INDI).

DEPARTMENT INFORMATION The nutrition and dietetic service is available to all inpatients during their stay in Bon Secours hospital, and is also available to outpatients by appointment.

It is supported by a wide range of services and the multidisciplinary teams within the hospital to include; consultants, doctors, nurses, physiotherapists, diabetic nurse specialist, speech and language therapists, pharmacists, podiatrist, tissue viability nurse, and discharge planner.

The department's dedicated team of dietitians are trained to degree or masters level and are members of the INDI. SEEING A DIETITIAN Referrals are accepted from consultants as inpatients. Both self referrals, GP and consultant referrals are accepted to our outpatient department.

SPECIALIST AREAS Nutrition plays a vital role in health and

DIABETES CARE CENTRE The dietitian team is an integral part of the services delivered by the Diabetes Care Centre. Together with the diabetes nurse specialist, the team provides a two hour educational consultation session for newly diagnosed diabetes patients and existing diabetes patients who are experiencing current and/or ongoing problems managing their diabetes.

Patients can self refer but a GP referral is preferable to ensure continuity of care and the best possible outcome for the patient.

DIETETICS DEPARTMENT For appointments and additional information please call 01 8065488 DIABETES CARE CENTRE Tel: 01 806 5488 Fax: 01 808 2343

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ENT SURGERY DEPARTMENT

ENT at Bon Secours Mr Peter Walshe, Consultant Otolaryngologist discusses the range of ENT services at Bon Secours Hospital.

THE SERVICE Mr Walshe is one of a team of five consultant surgeons in this department, providing comprehensive evaluation and medical or surgical intervention to both adult and paediatric patients. “Along with my colleagues I operate on both paediatric and adult cases,” explains Mr Walshe. “I have particular sub-specialty interests in thyroids and salivary disease and fellowships in rhinology, head and neck cancer surgery and I practice in otology, in which I also hold a research fellowship.”

Mr Walshe’s colleagues, Mr Tadhg O’Dwyer, Mr Munish Shandilya, Prof Michael Walsh, Mr Rory McConnWalsh and Mr Kieran O'Driscoll have

complimentary interests in a wide range of subspecialty ENT areas.

ACCESSIBILITY Mr Walshe believes that one of the best things about Bon Secours is its accessibility and affordability to those with different levels of private health cover which is not the same in many other private hospitals.

“I would say that the overwhelming majority of patients at the hospital can be treated here without surcharges, significantly differentiating it from other private hospitals.

The hospitals location adjacent to the M50 and the M1 also means that we receive referrals from all around the country.”

TEAMWORK The otolaryngology team are enthused by the ethos and teamwork at Bon Secours.

“It’s a fantastic working environment,” adds Peter. “We have access to state-ofthe-art technology and the theatre staff at Bon Secours are superb. Staff at the hospital have a fantastic ‘can-do’ attitude.

If it needs to be facilitated and it can be facilitated, we will do it.

That ethos, working towards the solution instead of the problem is one of the biggest plus factors of working at Bon Secours.”

Patients reap the benefits of this ethos with excellent quality care and medical and surgical support, providing a much more positive hospital experience.

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GYNAECOLOGY DEPARTMENT

Gynaecology at Bon Secours The Gynaecology Department at Bon Secours offers a full range of gynaecological services to its patients. Dr Paul Byrne, Consultant Gynaecologist explains.

A

t the forefront of modern gynaecological treatment, Bon Secours Hospital offers the best of gynaecological care to its patients. There are five consultant gynaecologists in attendance with an excellent support staff in place, ensuring that the very highest standards of patient care are maintained at all times. Each consultant gynaecologist has their own sub-specialty, including special interests in infertility and urinary incontinence.

LAPAROSCOPY Laparoscopy is one of the more common

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procedures used in gynaecology. Its onset has transformed the field allowing surgeons to access the abdomen and pelvis through a key hole incision. This minimally invasive procedure has greatly reduced post-operative pain, hospital stay duration and post-operative recovery time. It can be used to treat a number of gynaecological complaints including endometriosis which is commonly associated with infertility.

ENDOMETRIOSIS Endometriosis occurs when there is an abnormal growth of endometrial cells

outside of the uterus. Endometrial cells are cells shed each month during menstruation. Endometriosis is when these cells attach themselves to tissue outside the uterus forming endometriosis implants – commonly formed on the ovaries, fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity.

Pelvic pain and infertility are common symptoms of endometriosis, however many women present with non-symptomatic endometriosis.

Laparoscopy is a great diagnostic tool for patients presenting with a suspected

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GYNAECOLOGY DEPARTMENT

diagnosis of endometriosis. A laparoscope will be inserted to examine the abdomen and pelvis for endometriotic implants.

Biopsies may also be taken during this procedure. It is performed as an inpatient procedure and is usually carried out under general anaesthesia.

to go home within a few days of having the surgery. The surgery involves the placement of a prolene or nylon mesh into the vagina to support the bladder. The operation is called a Trans-Obturator Tape (TOT) procedure. Bon Secours is one of the busiest hospitals in this field.

OVARIAN CYSTS The team here at the "Bons" also diagnose and remove ovarian cysts which are one of the more common gynaecological problems amongst women. Ovarian cysts are fluidfilled sacs that form on the ovaries. Most are benign, but some can cause rupture or pain. Laparoscopy is used to remove smaller non-malignant cysts. If there is a risk that the cyst is malignant then a more invasive procedure called a laparotomy may be necessary.

COLPOSCOPY I run the colposcopy clinic in the "Bons."

Colposcopy examinations are carried out when a Pap smear test is abnormal. It enables the gynaecologist to take a closer look at the cervix and examine the reasons for such results. The procedure is a short, simple one, lasting around 5 minutes. If an abnormality is seen, a biopsy is taken for a more detailed analysis. If abnormal (pre-cancerous) cells are found, a LLETZ procedure is done. This involves removing a small part of the cervix containing the abnormal cells. This is done in the colposcopy clinic under local anaesthesia and takes no more than 10 minutes.

PROLAPSE A complication sometimes arising after childbirth is a prolapsed uterus. Various muscles, tissue and ligaments ordinarily hold the uterus in place within the pelvis. However, the weakening of these muscles during the stages of childbirth or the decrease of oestrogen with the aging process can cause the uterus to prolapse into the vaginal canal. Surgery for prolapse is usually done through the vagina. The prolapse of the bladder and rectum is repaired. If the uterus is also prolapsing, a vaginal hysterectomy will be done as part of the procedure.

URINARY INCONTINENCE Urinary incontinence or leakage is likely to be suffered by women due to the effects of childbirth, pregnancy, and menopause.

This can lead to involuntary leakage when laughing, sneezing, coughing or performing strenuous activities. We have a fully integrated urodynamic service at Bon Secours Hospital. This allows us to investigate the cause of urinary incontinence before deciding on the best form of treatment.

My own special interest is surgery for stress incontinence. There have been significant developments in this type of surgery over the last 15 years. Until recently, surgery for stress incontinence required major abdominal surgery with a hospital stay of 7 to 10 days. Using modern techniques, the surgery is done through the vagina and requires very small incisions. Women are usually fit

NEW AWARE AND PREPARE CLINIC A recently launched service at the Bon Secours Hospital is for patients where previous fertility altering conditions or interventions have occurred or who are concerned that previous or family history might affect their future fertility. The types of patients who may benefit from attending the clinic are ones who may previously have had chemotherapy or radiotherapy, genital surgery (testicular, ovarian, tubal, uterine), previous PID (Pelvic Inflammatory Disease) or previous diagnosis of severe endometriosis, testicular trauma, ovarian cysts, large

fibroids, family history of premature menopause. The service is provided by Dr Edgar Mocanu and consultations are by referral from a GP preferably or by self referral.

As a doctor, Bon Secours Hospital is a wonderful place to work. There is a great team spirit here. This is seen at every level in the hospital – medical, nursing, paramedical, laboratory, household, administration and clerical. Based on feedback from my own patients, there is an extremely high satisfaction rate.

I am delighted to be associated with this hospital.

GYNAECOLOGY DEPARTMENT • Dr Paul Byrne • Dr Barry Gaughan • Dr Yahya Kamal • Dr Nikki Kroon • Dr Edgar Mocanu

BON SECOURS HOSPITAL

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GASTROENTEROLOGY DEPARTMENT

Gastroenterology at Bon Secours The Gastroenterology Department at Bon Secours offers a full range of endoscopy procedures and is fully equipped to diagnose and treat all disorders affecting the gastrointestinal tract.

THE TEAM Gastroenterology is the branch of medicine which focuses on the digestive system and its disorders. These are diseases affecting the gastrointestinal tract which includes the organs from mouth to anus along the alimentary canal. Endoscopy is a minimally invasive diagnostic medical procedure used to assess the interior surfaces of an organ by inserting a tube into the body. This is done using a rigid or flexible tube which has a built in fibre optic camera which will provide an image

for visual inspection and photography.

Endoscopy is also capable of taking biopsies and retrieving foreign objects.

At Bon Secours we have twelve consultants specialising in this area.

The consultant team provide a direct access service whereby their GP will refer directly in for the procedure. They also provide a consultant-led service whereby the consultant will meet with and evaluate the patient prior to the procedure being carried out to assess whether the test is required and in the best interest of the

patient.

The team provides both inpatient and outpatient care. The majority of procedures are carried out on outpatients.

The service is quick and easy; patients who arrive in the morning are seen to immediately and then ready to leave by the afternoon.

CLINICAL GOVERNANCE The Gastroenterology service is governed by the GI Endoscopy User group who have responsibility to oversee and manage all

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GASTROENTEROLOGY DEPARTMENT

for biopsy or removal of suspected lesions.

Virtual colonoscopy which uses 2D and 3D imagery reconstructed from computed tomography (CT) scans or nuclear magnetic resonance (MRI) scans, is also possible, as a totally non invasive medical test.

However, virtual colonoscopy does not allow for therapeutic manoeuvres such as polyp/ tumour removal or biopsy, nor visualisation of lesions smaller than five millimetres. If a growth or a polyp is detected using a CT colonography, a standard colonoscopy would still need to be performed. Colonoscopy can remove polyps smaller than one millimetre.

components of the service provision and clinical governance to include the best quality service for patients through the use of: • Operational Planning, Service Planning and Development • Clinical Audit • Clinical Efficiency • Clinical Risk Management • Patient Feedback The user group is chaired by Prof Stephen Patchett, clinical lead for the GI Endoscopy Service and who is also Chair of the National Quality Improvement Programme in GI Endoscopy.

scope is guided through the stomach and passed through the pylorus to examine the first and second parts of the duodenum.

Photographs are taken of the pathway during the procedure for examination.

Biopsy can also be performed during a gastroscopy, this is done using a biopsy forceps which is passed through the scope and allows sampling of one to three millimetres of tissue which can then be examined by a pathologist to render an opinion as to whether there are abnormalities in the cells.

COLONOSCOPY There has been an increasing demand for colonoscopies in recent years. This

GASTROSCOPY Gastroscopy is the most commonly performed type of endoscopy. Gastroscopy is a diagnostic endoscopic procedure used to visualise the upper part of the gastrointestinal tract up to the duodenum.

It is a minimally invasive procedure that takes only four to five minutes and does not require any significant recovery time. This procedure is carried out on patients who have stomach ulcers, acid reflux disease or cancer of the stomach or oesophagus.

The patient must fast for 4 hours prior to the procedure taking place. Most patients undergo the procedure with no more than a topical anaesthesia which numbs the throat. However some patients opt for sedation if they are particularly anxious or nervous. The patient is asked to lie on their side resting their head on a pillow. The endoscope is then placed over the tongue and into the oropharynx, it is then guided into the oesophagus. A camera attached to the scope allows for examination of the oesophagus as the

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is due, in part, to the proposed National Colon Cancer Screening Programme.

Once polyps are removed, they can be studied to determine whether they are precancerous.

Larger polyps which cannot be removed during a colonoscopy can be surgically removed. In most cases a partial colectomy is performed. This is when the cancerous tissue is removed along with a small amount of the surrounding normal tissue. If the cancer has not spread, the colectomy will usually provide a complete cure.

SIGMOIDOSCOPY Sigmoidoscopy is similar but not the same as colonoscopy. The difference being the parts of the colon each can examine. Sigmoidoscopy allows doctors to view only the final two feet of the colon, while colonoscopy allows an examination of the entire colon, which measures four to five feet in length. Often a sigmoidoscopy is used as a screening procedure for a full colonoscopy.

This screening programme is in response to the growing numbers of people being affected by colon cancer, which is now one of the leading forms of cancer in Ireland.

This government initiative is increasing awareness amongst the public and GPs, prompting more and more people to get screened. This is a welcome development as early detection is key to tackling and curing this form of cancer. Colon cancer begins as small polyps in the bowel, which are small benign growths which form on the lining of the bowel. If undetected they will increase in size and can become cancerous.

Colonoscopy is a minimally invasive

GASTROENTEROLOGY DEPARTMENT • Dr Richard Farrell • Prof Fergus Gleeson • Dr Gavin Harewood • Dr Jack Hollingsworth • Dr Padraic MacMathuna • Prof Frank Murray • Dr Conor O’Brien • Dr Cathal O’Keefe • Prof Colm O'Morain • Dr Barbara Ryan • Dr Shiobhan Weston

endoscopic procedure which is used to screen for colon cancer. It lasts 20 to 30 minutes and the patient is usually

CLINICAL LEAD • Prof Stephen Patchett

sedated. It is an examination of the large colon using a fibre optic camera on a flexible tube which is passed through the anus. It may provide a visual diagnosis

RAPID ACCESS SERVICE Tel: 01-8065491 Fax: 01-8065490

of these polyps granting the opportunity

BON SECOURS HOSPITAL

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Endoscope storage cabinets The Importance of Routine Microbiological testing of Storage Cabinets for Heat-labile Endoscopes (SCHEs) Endoscope storage cabinets are designed to maintain microbiological levels in reprocessed endoscopes within acceptable limits that will not pose a risk to patients.

It is therefore necessary to control the performance of the SCHE through routine testing that will allow the identification and solving of performance issues that may lead to potential use of contaminated endoscopes in patients.

Certain cabinets, depending on manufacturer’s claims, may or may not include an endoscope drying stage.

Due to the absence of approved Irish guidance for the routine testing of SCHEs, the procedures and test methodology currently performed are based on NF S 98-030 (French Standard) or alternative

documents or drafts such as BS EN 16442.

As a general principle, a solid routine testing programme should be monitoring 3 important aspects of the performance of the storage cabinet: 1. Maintenance of the microbiological quality of the endoscopes These tests are designed to check that the SCHE, once installed (performance qualification) or tested at regular intervals (routine testing), is capable of maintaining the microbiological quality of endoscopes.

2. Contamination of inside surfaces of the SCHE Collection of samples is performed using TSA and SDA contact plates

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3. Air quality Collection of samples is performed using sedimentation onto TSA and SDA settle plates (90mm).The air circulating within the SCHE enclosure must have acceptable limits of viable bacteria and it should be free of filamentous fungi.

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ENDOSCOPY DEPARTMENT

Endoscopy at Bon Secours The current aim of the Endoscopy Department is to achieve an A grade in the JAG accreditation process.

ABOUT The Endoscopy Department in the Bon Secours Hospital is the second busiest Endoscopy Unit and second only to St James's Hospital in terms of the number of procedures that are carried out annually.

The Unit operates Monday to Friday and occasional Saturdays to meet the growing demand. A total of 25 endoscopists work within the unit in the area of Gastroenterology, Respiratory, Urology and also General Surgery.

GASTROENTEROLOGY Dr Richard Farrell Prof Fergus Gleeson Dr Gavin Harewood Dr Jack Hollingsworth Prof Padraic Mac Mathuna Prof Frank Murray Dr Conor O’Brien Dr Cathal O’Keefe Prof Colm O'Morain Prof Steve Patchett Dr Barbara Ryan Dr Shiobhan Weston RESPIRATORY Prof Conor Burke Prof Richard Costello Dr Ross Morgan SURGERY Mr Paddy Broe Mr Joe Deasy Mr Parnell Keeling Ms Deborah Mc Namara Mr Eadbhard Mulligan Mr Colm Power Prof Tom Walsh

The Unit's focus is ensuring that patient care and best practice is at the centre of everything that we do in the unit.

This drives us to continually review our systems and look for ways to develop and improve the work we do.

The following projects have been rolled out to ensure that we are at the forefront of endoscopy care in Ireland.

UROLOGY Mr Tom Creagh Mr Hubert Gallagher Mr Denis O'Sullivan Mr Richard Power

DECONTAMINATION UNIT AND BUILDING DEVELOPMENTS The completion of the new decontamination unit within the Endoscopy Unit has significantly changed

and improved the workflow and practices within the department. The state of the art unit was completed in Summer 2014 and brings the unit one step closer towards achieving JAG accreditation of the unit which is considered the gold standard in excellence in endoscopy units. The unit is on track to be the first private hospital to achieve this accreditation standard.

The next stage in the development plan will be the reconfiguration and expansion of the unit to further enhance the patient experience and flow in the unit. This exciting development is expected to be completed later this year and will be final

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ENDOSCOPY DEPARTMENT

piece in the jigsaw towards achieving accreditation.

ELECTRONIC REPORTING SYSTEM (ERS) During 2013 the unit installed a new electronic reporting system, which allows the endoscopist to electronically record the results from each procedure. The recording of information in this way allows for previous reports to be quickly and easily retrieved electronically for comparison purposes. Some consultants have also started to send the report generated through the system directly to referring practitioners which has significantly reduced the report turnaround times. The system also allows for the electronic storage of images and videos captured during each procedure and the high quality imagery is extremely useful when formulating management plans for patients.

The use of this system also enables the endoscopy unit to participate in the National Quality Improvment Programme for Endoscopy and it is planned that the unit will be the first private facility to fully engage with the programme. Engagement in this programme is a vital part of our steps toward achieving the area specific accreditation.

TRAINING At the forefront of care in the unit is the dedicated nursing and allied health

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professional team whose focus is on delivering the best possible care for patients. Support and development of the nursing team within the unit and throughout the hospital is ongoing through education and training programmes. The Endoscopy Unit hosts an annual training courses for endoscopy Nurses which is only course of its kind on the island of Ireland. The Endoscopy Training course has become feature and necessity on all Endoscopy Nurses training calendar nationwide. The course is organised and developed by Sheila King, Clinical Nurse Manager and also the Unit Manager.

THE FUTURE - ACCREDITATION The endoscopy team in Bon Secours Dublin is working towards achieving JAG accreditation and to being the first private hospital to achieve it in Ireland. The Unit regularly uploads data to the Global Rating Scale web site which is one of the requirements to achieve full accreditation.

PATIENT CARE The department is focused on patient care and has a very effective strategy in place to ensure that the patients needs are always prioritised. Keeping waiting times down and ensuring the patient is kept informed at all times is central to this.

The department's aim is to minimise the waiting time in the unit, to improve the overall patient experience and minimise

any potential anxieties that the patient may experience.

THE FUTURE Endoscopy is very much an evolving sector with amazing technology being consistently pioneered. Ireland has an ageing population and in future years there will be a very significant cohort of the population who will fall into the screening range. The Endoscopy Department has recognised that the ability of the entire sector to cope with this demand is going to be challenged and that only the units which are achieving the highest standards are going to be able to rise to this challenge. With recent and planned developments in the department, the endoscopy department will be in an excellent position to meet these challenges.

ENDOSCOPY DEPARTMENT OPENING TIMES Monday to Friday 8.30am – 8pm Occasional Saturday Clinics CONTACT NUMBERS Tel: 01-8065491 01-8065492 01-8065348 Fax: 01-8065346

BON SECOURS HOSPITAL

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LABORATORY DEPARTMENT

Laboratory Bon Secours has a comprehensive laboratory service on site providing a 24 hour service to the hospital. Pauric Reilly, Laboratory Manager explains.

THE TEAM The laboratory team at the Bon Secours Hospital is consultant led and consists of 29 scientific, assistant, clerical and phlebotomy staff, servicing 18 nursing units in the hospital daily, including cardiology, endoscopy, surgery, medicine and oncology.

The laboratory receives a significant number of samples for processing on a daily basis both from both inpatients and outpatients. Outpatient specimen numbers continue to increase since the launch of a free walk-in phlebotomy service in the hospital. The service is available from 8.30am to 3.30pm Monday to Friday with many patients dropping in on their way to work or over their lunchtime and throughout the day. Pathology results are available to GPs via Healthlink , a much appreciated development.

The laboratory service on offer is across five major disciplines: 1. Chemical chemistry 2. Haematology 3. Blood transfusion 4. Histology 5. Microbiology The laboratory is fully INAB accredited and offers a full range of diagnostic services to in-house consultants and also external parties who wish to use the service including the Eccles Clinic and the Clonmel Healthcare Group. There is a rapid turn around time forblood tests, generally taking less than four hours from the time the specimen is received to the issuing of the final full profile report.

has been automated, histopathology had significant replacement of equipment and is a top performing service using national metrics for quality and turnaround time. Microbiology has also seen recent investment. Future developments being pursued will see an electronic test requisition system being placed at ward level which will mean a move away from menu based requesting to care pathway based requesting. For example, if a patient were to come in for a colonoscopy, the laboratory testing is automatically mapped out for the patient’s journey which will take the burden off the nursing and clinical staff who usually have to request this on paper. It all becomes much more predictive, supporting consistency across patient groups.

EQUIPMENT The laboratory has state of the art equipment. The biochemistry suite has been recently upgraded with Abbott architect analysers; blood transfusion

WARFARIN CLINIC The hospital operates a very busy Warfarin Clinic which is provided as a point of care test. The Clinic operates on a walk-in basis whereby the test

is completed and the prescription is issued with the minimum of delay to the patients. The Warfarin clinic is very busy and includes patients suffering from certain heart conditions, those at risk of stroke or those who have developed clots post-operatively. As they tend to visit the clinic once every three to four weeks, the efficiency and smooth running of the service is of paramount importance and patient feedback about the service is excellent. We will make significant improvements to this service in 2015 to both enhance the quality of the service and the experience for the patient.

LABORATORY DEPARTMENT CONTACT DETAILS For appointments and additional information please call 01-8065308 Phlebotomy: Walk-in service daily from 8am - 3.30pm

BON SECOURS HOSPITAL

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MEDICAL ASSESSMENT UNIT

Same Day Medical Assessment Service The Medical Assessment Unit gives patients and GPs same day access to consultant review, diagnostic tests and treatment.

T

he Medical Assessment Unit (MAU) provides patients with same day access to a General Medical Consultant following referral by their GP. The unit is an extension of the Rapid Access Service and is run by Dr Colette Barry. Dr Barry joined the Bon Secours as one of the consultants in the Rapid Access Service. This experience combined with her background in acute medicine at the Mater and Beaumont Hospitals, led to the development of the Medical Assessment Unit, which is run in parallel with the Rapid Access Service.

The distinguishing factor between the Medical Assessment Unit and the Rapid Access Service is that the patient in most cases is reviewed and discharged on the same day from the Medical Assessment Unit whilst Rapid Access Service patients

generally require admission to the hospital.

As Dr Barry explains, “The MAU naturally grew from the Rapid Access Service. We identified a certain cohort of patients who were being referred to the Rapid Access Service who did not necessarily require over-night admission. These patients could be more appropriately managed as day cases with same day investigations, management and initiation of treatment. The MAU has proven to be the ideal setting for the management of these patients and is extremely popular amongst patients and their GPs.�

The Bon Secours is well positioned to provide this service with excellent laboratory, radiology and non invasive cardiology diagnostic services. The critical advantage for patients and their

"The Medical Assessment Unit has proven to be the ideal setting for their management and is extremely popular amongst patients and their GP's "

BON SECOURS HOSPITAL

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MEDICAL ASSESSMENT UNIT

The critical advantage... is the speed with which the patient is seen and necessary tests performed, when the alternative may be a series of multiple hospital attendances or potential referral to a local emergency department where they may experience delays and heightened anxiety.

PATIENT SUITABILITY The MAU is suitable for stable, ambulatory patients requiring immediate assessment, investigation and treatment for a broad spectrum of medical conditions. These include patients presenting with the following conditions: Cardiology • Non specific chest pain • Dyspnoea Respiratory • Respiratory tract infection • Exacerbation of asthma/COPD • Persistent/recurrent cough • Pleuritic chest pain/dyspnoea • Suspected pulmonary embolus Gastroenterology • Dysphagia • Weight loss • Melaena • Change in bowel habit • Jaundice • Nephrology • UTI/Pyelonephritis Other • Endocrine/Diabetes • DVT • Cellulitis • Patients with abnormal blood results including anaemia/raised LFTs • Anaemia/Raised LFTs • Patients with collapse • Palliative care

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GPs is the speed with which the patient is seen and necessary tests performed, when the alternative may be a series of multiple hospital attendances or potential referral to a local emergency department where they may experience delays and heightened anxiety.

MAU ADMISSION PROCESS The GP will contact the MAU with their patient’s details and the admitting consultant will indicate whether the patients condition is suitable for referral to the MAU. On referral from their GP, the patient is admitted to the dedicated four bedded unit and has an initial consult with the General Medical Consultant on duty who arranges the appropriate investigations and treatment. The aim is to complete all tests and investigations on the same day with a view to the patient being discharged with a treatment plan or alternatively being admitted to the hospital through the Rapid Access Service for further investigations and treatment.

FEE STRUCTURE The cost of the service is structured into packages depending on the level of investigations required. The initial attendance fee at the MAU is 195 which includes the consultation with a general

medical consultant, baseline bloods, ECG and chest x-ray. The maximum fee charged in the MAU is 495 which includes further laboratory investigations, ultrasound, CT and non invasive cardiology investigations as required. The service is currently offered on a self-pay basis and is not covered by medical health insurance.

CONTINUED CARE PATH Following the diagnostic and assessment process in the MAU the patient will be discharged back to the care of their GP or if required patients will be admitted to the hospital via the Rapid Access Service. The early success of the MAU and the positive feedback from patients and the GP community are very encouraging. We are exploring how we may expand the service further to meet the increasing demands from our referring GPs.

HOURS OF OPERATION The MAU is currently operational between Monday and Friday from 9am to 3pm.

CONTACT DETAILS: Call: 01 8065498 / 086 2098380 Fax: 01 8065405 Web: www.bonsecours.ie

BON SECOURS HOSPITAL

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ONCOLOGY DEPARTMENT

Oncology at Bon Secours The Oncology Department at Bon Secours offers both inpatient and outpatient care.

Dr Oscar S. Breathnach, Consultant Oncologist explains.

transfusions, bone strengthening agents • Palliative medicine, for pain control, breathlessness, low energy, etc.

Before commencement of each therapy, patients are re-assessed and necessary adjustments to care are made.

The care is predominantly outpatient based, via the dedicated oncology day unit.

However, inpatient care is provided for those patients who become unwell either from their cancer or from side-effects of their therapies and require more intensive care. Inpatient care is provided for by the Medical Oncology Service, with daily ward rounds, seven days a week.

QUALITY CARE A quote from a Bon Secours patient sums up the care and compassion of the team: "The team in the Bons are brilliant - kind, efficient, great listeners. They treat the person first, then the symptoms. This is so refreshing. The oncology ward is bright, small and cheerful, and all the staff are wonderful."

THE SERVICE The Medical Oncology Service at Bon Secours Hospital provides care through both the inpatient and dedicated outpatient units.

Patients receive care under the direction of Prof Liam Grogan, Dr Oscar S. Breathnach or Dr Patrick Morris, all of whom are affiliated with the Cancer Centre in Beaumont Hospital. Bon Secours benefits greatly from this integration as Beaumont Hospital is one of the country's eight designated Cancer Centres of Excellence.

TREATMENT Generally, when a patient is referred

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to the Medical Oncology Service they would have a pre-existing diagnosis of cancer and their clinical situation would have been assessed by the various other physicians and surgeons involved in their care.

Once the patient has been assessed and educated regarding their condition by the consultant medical oncologist and the medical oncology nurses, a plan is developed for their care. This may include one or more of the following treatments: • Systemic chemotherapy • Radiation therapy • Future surgical intervention • Supportive medications, such as blood

TEAMWORK As with all services at Bon Secours Hospital we are supported by the allied health professionals in the hospital, such as the dietetic service, physiotherapists and pastoral care.

DEPARTMENT OF ONCOLOGY • Dr Oscar Breathnach • Prof Liam Grogan • Dr Patrick Morris CONTACT DETAILS Tel: (01) 806 5409

BON SECOURS HOSPITAL

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OPHTHALMOLOGY DEPARTMENT

Vision Science at Bon Secours The Ophthalmology Department at Bon Secours provides the best and latest treatments for its patients. Dr Susan Fitszimons, Consultant Ophthalmologist outlines the importance of ophthalmic health.

THE TEAM Ophthalmology and vision science has seen rapid technological advances in recent years. These new technologies and treatment modalities have revolutionised the field, making treatment less invasive and much more accurate. Specialist patient care is provided by the consultant ophthalmologists here at the Bon Secours Hospital. The ophthalmologists are dedicated to providing the very best and most up-to-date patient care.

There are six ophthalmologists currently working here at Bon Secours. Each of them covers general ophthalmology but

also have sub-specialty interests. These specialty areas include cataract and refractive surgery, anterior segment, glaucoma, strabismus, paediatrics and medical retina. Three Consultants have clinics on site and run regular outpatient appointments and one medical ophthalmologist focuses on the medical assessment, investigation, diagnosis and management of disorders affecting vision.

RANGE OF SERVICES Conditions covered by the ophthalmology specialists at Bon Secours are not limited to ‘eye diseases’ but include broader conditions

affecting ophthalmic health. Many of the patients seen by the ophthalmologists are referred by other specialists in the hospital, which greatly improves the service to each individual inpatient. Conditions such as multiple sclerosis, diabetes, rheumatologic disorders and general medical problems are among the most common referrals.

Consequently the service to the hospital is quite extensive, with the ophthalmologists on staff providing up to a dozen various and different medical consultations each week.

From a surgical perspective, each ophthalmologist admits their own patients for different surgical procedures. In

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OPHTHALMOLOGY DEPARTMENT

addition to cataract operations, many other procedures are also offered to patients including: • Assessment and treatment of cornea and ocular surface disease • Eye lid and anterior segment surgery • Glaucoma medical and surgical treatment • Assessment and management of age related macular degeneration • Assessment and management of uveitis, vitreous and medical retinal disorders • Strabismus assessment and surgery • Diabetic Retinopathy screening and management.

CATARACTS The most common procedure performed here is cataract surgery. This is the most common procedure in ophthalmology worldwide. It is the removal of the natural lens of the eye which has lost transparency due to the development of an opacification known as a cataract.

Following the removal of the natural lens, an artificial intraocular lens is implanted.

This is known as phacoemulsification or small incision surgery whereby the lens implant is folded up into a scroll and inserted through a keyhole incision. Due to advances in technology this incision can be less than 2mm in length and self seals without the need for sutures.

Computer controlled fluidics in a modern phacoemulsification machine causes less trauma to the eye. This results in safer surgery, rapid patient rehabilitation, fewer post-operative complications and a superior refractive outcome. The eye theatre and clinical eye room are well equipped with all the instrumentation and nursing expertise to facilitate the very best of modern eye care.

DIABETIC EYE DISEASE According to the Association of Optometrists Ireland ‘diabetes related eye disease is the leading cause of vision loss in adults of working age (20-65) in industrialised countries’. Both type I and type II diabetes can cause severe, vision threatening damage to occur inside the eye. Currently, one in 20 people in Ireland suffer from diabetes and one in 8 of those over 60 have the disease. Unfortunately 74 per cent of those who have diabetes for 10 years or more will develop diabetic eye disease.

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These figures are quite staggering and really highlight the importance of ophthalmic health. If diabetes goes undiagnosed for a number of years, changes in the retina or diabetic retinopathy may occur. As the disease develops, blood vessels at the back of the eye leak causing macular oedema and slow deterioration of vision, or may proliferate causing intraocular haemorrhage and sudden loss of vision. Damage to the eye can be seen directly by the ophthalmologist long before symptoms begin to emerge.

If left untreated, both leakage and proliferation will cause permanent vision loss.

As always, prevention in the form of regular eye check-ups for diabetics is better than remedial treatment in the form of an operation. Here at the Bon Secours, diabetic retinopathy screening and treatment is available to both outpatients and inpatients. When treatment is performed in good time, vision can be preserved or restored and visual results can be excellent.

CO-OPERATION IN THE FIELD Each ophthalmologist at Bon Secours also attends at least one other eye department or hospital. This fosters strong links with teaching hospitals and develops excellent relationships. Good communication between other hospitals and departments results in good standards of practice and the best use of resources. On-going teaching by the ophthalmologists of junior hospital staff, in association with the RCSI, maintains an academic environment which is so important to ensure that the education of our next generation of doctors is top notch.

OPHTHALMIC SURGEONS • Ms Yvonne Delaney • Ms Susan Fitzsimons • Ms Patricia Logan • Mr Paul Moriatry • Ms Brid Morris OPHTHALMOLOGIST • Dr Aisling Foley Nolan

BON SECOURS HOSPITAL

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ORTHOPAEDIC DEPARTMENT

Orthopaedic Surgery at Bon Secours The Orthopaedic Department at Bon Secours is at the forefront of modern orthopaedic care. Mr Philip O’Connor, Consultant Orthopaedic and Spinal Surgeon explains.

THE ORTHOPAEDIC TEAM The Orthopaedic Department at Bon Secours includes eight orthopaedic surgeons, four of who have consulting rooms on-site. All eight perform inpatient orthopaedic surgery. There is one laminar flow operating theatre for performing joint replacement surgery.

All orthopaedic subspecialties are represented including: • spine • upper limb and shoulder • lower limb • arthroplasty • foot and ankle surgery The hospital is fully equipped to provide the best orthopaedic care for our patients.

There is also a dedicated orthopaedic ward that has been recently refurbished and

which is staffed by a very experienced and compassionate team of nurses.

The Department also benefits from extensive medical backup from the large number of experienced medical consultants on hand here at the "Bons".

We pride ourselves on our diligence and our patient centred approach. We believe that a caring and supportive environment goes a long way to ensure patient satisfaction and peace of mind.

RECENT DEVELOPMENTS The Orthopaedic Department at Bon Secours is at the forefront of modern orthopaedic medicine. Continuous advancements in technology and continued education amongst our consultants is what sets us apart from the rest and ensures that we are leaders in our field. Recent

technological advancements include the installation of a digital templating system (TraumaCad®) in the operating suite and the kingmark™ calibration of all orthopaedic x-rays performed which virtually eliminates all errors in positioning calibration markers on patients. Calibrating x-rays eliminates the effect of magnification and allows for accurate measurements to be made.

The kingmark™ system easily allows the placement of markers behind and in front of the pelvis, from which magnification calculation can be made. In conjunction with the TraumaCad® software, surgeons can precisely plan joint replacement surgery; measure expected bone cuts and view a digital image of the joint replacement components superimposed on the x-ray. Pre-operative digital templating

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ORTHOPAEDIC DEPARTMENT

Some of the general orthopaedic services and surgery provided include: SPINE • All aspects of adult degenerative spine conditions • Anterior cervical decompression and fusion (ACDF) • Posterior spinal decompression and instrumentation • Lumbar discectomy • Lumbar decompression and instrumented fusion • Lumbar fusion (PLIF/TLIF/DLIF) • Lumbar dynamic stabilisation • Minimal access spinal fusion • Epidural and selective nerve root injections • Discography • Facet joint injections HIP • Total hip arthroplasty – all types • Revision total hip arthroplasty • Soft tissue surgery

also allows the orthopaedic surgeon to plan osteotomies and complex joint reconstruction.

In addition to accurate pre-operative planning, orthopaedic patients at Bon Secours are now availing of new technology aimed at improving the accuracy of total knee replacements.

In conjunction with Smith and Nephew™, MRI images of the patient’s knee are used to create a customised cutting block that is then used in the subsequent surgery. The “Vissionaire” system reduces the inventory requirements in the operating room, facilitates more accurate placement of joint replacement components and can reduce operating time.

Pre-operative planning is a key step in successful joint replacement surgery and the high degree of accuracy of the

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kingmark™ and TraumaCad® systems together with the ‘Vissionaire” system used at Bon Secours hospital continue to place it at the leading edge of orthopaedic surgery.

The hospital's dedicated orthopaedic ward has recently been refurbished.

SPINAL SURGERY Spinal surgery is reputed as being quite an invasive and risky procedure. Often the implants used in spine surgery are small but traditionally involved long incisions, which resulted in lots of muscle destruction and bleeding, just to get to the area of the spine involved.

However, new Minimal Access Surgical Techniques (MAST) allows for access to the spine through much smaller incisions, resulting in much less muscle damage and consequently less bleeding.

KNEE • Total knee arthroplasty • Patient matched instrumentation for total knee arthroplasty • Revision total knee arthroplasty • Uni-compartmental knee arthroplasty • Patello-Femoral knee arthroplasty • Arthroscopy and meniscal repair FOOT AND ANKLE • Total ankle replacement surgery • Authrodesis surgery • Bunion corrective Surgery • Treatment of paralytic disorders affective the ankle and foot

ORTHOPAEDIC CONSULTANTS • Mr Darragh Hynes • Mr Patrick Kenny • Mr Peter Keogh • Mr Paul McNamee • Mr Philip O'Connor • Mr James (Shea) O'Flanagan • Prof Michael Stephens

BON SECOURS HOSPITAL

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PODIATRY DEPARTMENT

Podiatry Foot and Ankle Clinic Podiatry is an up and coming specialty and Bon Secours is getting in on the ground of this exciting new field of practice. Niall Donohue, Podiatrist explains.

UP AND COMING Podiatry specialises in the management of diseases and disorders associated with the foot and lower limb. It is very much an up and coming specialty here in Ireland with NUI Galway launching the first degree course in podiatry four years ago.

The need for a course here was evident and its establishment reflects the growing demand for the specialty in Ireland.

The foot is a highly complex structure; problems with which can greatly affect the overall health of patients. Podiatry promotes and maintains mobility which can significantly improve patients quality of life. With this in mind it is very much a branch of medicine which is going to continue to grow over the coming years. The Bon Secours is dedicating considerable time and resources into establishing a top class podiatry service for its patients. Podiatry is a far reaching specialty as clients vary widely, as do treatment modalities. It is also a specialty where preventative care is key. Many issues which arise with the foot and lower limb can be prevented with continuous upkeep and care.

closely with diabetic patients at risk from foot disease, implementing management plans to prevent problems occurring.

Education plays a pivotal role in diabetic foot care as often patients are unaware of the risks and consequently neglect to take the proper steps to ensure problems do not arise.

For patients presenting with established foot complications such as infections or

necrotic tissue, podiatrists will provide wound care and dressings, offer advice on footwear or prescribe orthotics to reduce pressure on the foot which will greatly improve the patients' quality of life. The use of orthotics is critical to combat the risk of ischemia, ulcers and neuropathy in diabetic patients. However, such measures could often have been prevented with a timely visit to our podiatry service.

DIABETES The importance of podiatry as a preventative measure is none the more evident than in diabetic care.

Unfortunately, foot care of patients is often one of the most overlooked aspects of diabetes management. Diabetes causes nerve damage known as peripheral neuropathy, it also causes poor circulation and stiff joints. These are complex foot problems which can lead to episodes of infection, foot ulceration and in some cases amputation. Podiatry is vital for the prevention of such problems.

Patients suffering from diabetes need close monitoring and ongoing podiatric care. The podiatrists at Bon Secours work

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PODIATRY DEPARTMENT

ORTHOTICS One of the more advanced podiatric services which we offer our patients is podiatric biomechanics. This is the study of the way the lower limb and foot moves, inclusive of the muscles and soft tissue as well as the anatomical structure and movement of the bones and joints.

Podiatrists will perform gait analysis on the individual patients to get an understanding of why particular injuries are occurring within the musculoskeletal system. Once the podiatrist identifies what is causing the problem then they can prescribe the necessary care. This can range from stretching exercises, specialist footwear advice or functional foot orthoses.

Here at the "Bons", we have advanced equipment that has revolutionised the manufacture of our orthotics.

Our Computer-Aided Design/ComputerAided Manufacturing (CAD/CAM) machine renders traditional Plaster-of-Paris methods of orthotic manufacture obsolete.

We use a laser scanner to visualise the foot enabling the creation of a 3D design of the finished orthotic on our computer.

We use this design in conjunction with each patient’s bio-mechanical assessment to manufacture orthotics. Each finished product is a one hundred per cent unique custom design for an individual patient and will enable the rehabilitation of patient's symptoms.

ELDERLY PATIENT CARE We also offer services in the area of routine palliative foot care. This is particularly important when it comes to elderly patients. Palliative care encompasses nail debridements, corn and callous removal – plantar and inter-digital – and also onycochryptosis procedures, veruca treatments and the removal of plantar warts through use of a caustic or cryotherapy.

The importance of good foot-care becomes all the more evident in elderly

patients. Feet carry us throughout the day and throughout our lives. If the feet aren’t comfortable, nothing is comfortable. This is why the service we provide here at the Bon Secours is so important. The simplest tasks begin to get more and more difficult as we age and often elderly patients find that foot care and maintenance becomes increasingly unmanageable. If foot care is neglected, problems are sure to arise.

Poorly looked-after nails can cause pain and discomfort and make it difficult to move.

Good nail care and nail management is essential for older patients and can have very positive effects on mobility. Mobility is one of the key factors when maintaining health and strength in the older patient.

PODIATRY DEPARTMENT For appointments call: 01-5545699

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PLASTIC SURGERY DEPARTMENT

Plastic Surgery at Bon Secours The Plastic Surgery Department at Bon Secours Hospital provides a wide range of services to its patients. Mr Nadeem Ajmal, Consultant Plastic Surgeon explains.

THE FIELD Plastic surgery is concerned with the correction or restoration of form and function. There is a misconception that plastic surgeons are cosmetic surgeons only but in fact most of plastic surgery is not cosmetic. It is a vast field which includes: • Reconstructive Surgery • Hand Surgery • Microsurgery • Cosmetic Surgery • Cleft and Craniofacial Surgery • Surgery for treatment of burns THE SERVICE At Bon Secours we provide a wide range of plastic surgery services. Most of our workload is dealing with skin cancers and their sequelae. We also perform hand surgery, aesthetic and reconstructive breast surgery and facial aesthetic surgery.

The team consists of four consultant plastic surgeons; Mr Nadeem Ajmal, Mr Brian Kneafsey, Mr Anthony Ryan and Mr James Small. Patients are referred directly by their GPs or dermatologists.

We also see patients referred from other departments within the hospital.

SUB-SPECIALTY "My main field of interest is skin cancer and reconstructive breast surgery.

I was the first person in Ireland to set up a service to do DIEP flaps for breast reconstruction. This is a form of breast reconstruction in which microsurgical techniques are used to transfer abdominal skin and fat. This is an advanced technique in own tissue transfer as it utilises the blood vessels, fat and skin from the abdomen allowing for the preservation of abdominal strength and integrity," says Mr Ajmal.

THE FACILITIES "In the Bon Secours we are lucky to have a very dedicated and efficient day minor theatre where we can perform procedures for skin cancer in a very efficient way. There is a dressing clinic run by an experienced nursing team along with consultants to see post operative patients and organise their suture removal and dressings. Furthermore we have a dedicated and very experienced theatre staff," concludes Mr Ajamal.

PLASTIC SURGEONS • Mr Nadeem Ajmal • Mr Brian Kneafsey • Mr Anthony Ryan • Mr James Small

BON SECOURS HOSPITAL

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DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE

Respiratory and Sleep Medicine at Bon Secours The Department of Respiratory and Sleep Medicine at Bon Secours strives to deliver the highest standard of care to its patients. Prof Pat Manning, discusses the importance of respiratory care.

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he respiratory department at Bon Secours Hospital Dublin was one of the first to be established in Ireland.

The laboratory possesses state-of-theart equipment with procedures being continually updated to reflect the latest in testing standards. This service is available to consultants for inpatients, and outpatients and for referrals from general practitioners. It has been providing an efficient respiratory testing service, for inpatients, outpatients, referrals from consultant and general practitioners since the early 1990s.

The department is one of the biggest in the country and a number of prominent

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consultant Dublin respiratory physicians refer patients for testing including, Prof Shane O’Neill, Prof Conor Burke, Prof Gerry McElvaney, Prof Richard Costello, Dr Ross Morgan, Dr John Faul, and Dr Liam Cormican.

The department is comprised of two labs: 1. Sleep Diagnostic Testing 2. Respiratory Diagnostic Testing SLEEP DIAGNOSTIC TESTING The Departments Sleep Lab provides the following investigations and treatments: • Nocturnal Polysomnogram (PSG) • Cardio Respiratory studies • CPAP/BiPAP titration studies • CPAP/BiPAP compliance studies

• Multiple Sleep Latency Tests (MSLTs) • Maintenance of Wakefulness Tests (MWTs) • Actigraphy • Overnight Oximetry Studies • Insomnia Services iCBT Patient education is provided on an individual basis and includes troubleshooting and an advisory service through helpline from patients on a range of CPAP problems.See feature on Sleep Apnoea in the following section.

PULMONARY FUNCTION LAB The pulmonary department is responsible for testing the performance of the lungs.

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DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE

It compares the function of the lungs against what would be expected from the normal lungs of a person of similar age, weight, sex and height. Pulmonary Function Tests are essential in diagnosis, initiation and monitoring of respiratory drug therapy and in continuous clinical assessment of chest symptoms such as cough, dyspnoea, lung conditions such as chronic obstructive pulmonary disease (COPD), asthma, sarcoidosis, pulmonary fibrosis, lung cancer and pneumonia. It allows the assessment of the potential effects or response to environmental or occupational exposure and evaluation of sleep disordered breathing such as obstructive sleep apnoea (OSA), with a flexible sleep diagnostic service available to suit the patients’ needs.

PULMONARY FUNCTION TESTING SERVICE The department provides a comprehensive range of lung investigations: 1. General Respiratory Tests Referrals are accepted from GPs and Consultants. Most tests are covered by the majority of insurance companies.

2. Full Pulmonary Function Testing includes: • Spirometry with Bronchodilator Response Testing • Static Lung Volumes • Diffusing Capacity • Body Plethysmography (including Thoracic Gas Volume, Airways Resistance) • Maximum Respiratory Pressures (MIPs and MEPs) 3. Skin Prick Allergy testing for Atopy • Histamine and Mannitol Inhalation Tests for Asthma • Cardiopulmonary Exercise Testing • Exercise Provocation Test for Exercise Induced Asthma • Assessment for Long-Term Oxygen (ABGs, 6 minute walk tests and overnight oximetry) Bronchial Challenge Testing includes • Histamine • Methacholine • Mannitol • Exercise Challenge Cardiopulmoary Exercise Testing (CPET) 6 Minute Walk Testing

REPORTING & TURN AROUND A prompt reporting service is available for all outpatient/general practice referrals.

Preliminary results are available on the day of testing. An interpreted report by a Consultant Respiratory Physician usually follows in 48 hours.

RAPID ACCESS INPATIENT RESPIRATORY SERVICE This successful consultant led service has been in operation now for several years and accepts patients who have respiratory difficulties such as exacerbation of COPD, pneumonia/ chest infections or suspected pulmonary embolus directly from GPs or consultants. This service provides a direct admission under a respiratory consultant.

Conditions that are not accepted through Rapid Access include: • Acute chest pain/MI • Collapse • Lacerations/burns • Stroke patients

OTHER RESPIRATORY SERVICES 1. Fiberoptic bronchoscopy service including transbronchial needle aspiration.

2. Radiology including chest x-rays, high resolution CT Scan and CT pulmonary angiogram.

3. Access to multidisciplinary diagnostic and therapy oncology services for lung cancer patients INSURANCE COVERAGE Most tests carried out in the department are covered by the main private health insurance companies.

DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE Telephone: 01-8065479 Fax: 01-8065480 Email: respiratory@bonsecours.ie

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RESPIRATORY AND SLEEP MEDICINE

Sleep Medicine and Sleep Apnoea at Bon Secours Sleep medicine has evolved over the last fifty years based on major developments in the science of sleep and circadian rhythms.

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dvances in both clinical testing and research have identified how prevalent sleep disorders are and also the significant negative impact they can have on health and public safety. Sleep disorders are conditions that prevent a person from obtaining restful sleep and as a result, can cause daytime sleepiness and dysfunction.

They have also been associated with a range of adverse health conditions including increased risk of hypertension, diabetes, obesity, depression, heart attack and stroke.

WHAT IS OBSTRUCTIVE SLEEP APNOEA SYNDROME ?

Obstructive sleep apnoea syndrome (OSAS) is a very common sleep disorder that is characterised by recurrent episodes of partial or complete upper airway collapse during sleep. This collapse results in pauses in breathing which cause oxygen levels to drop leading to frequent brief awakening and interruptions from sleep. With time and left untreated, obstructive sleep apnoea (OSA), can cause many serious health and social problems including excessive daytime sleepiness resulting potentially in accidents in the home, at work or whilst driving.

There are two main types of sleep apnoea: 1. Obstructive Sleep Apnoea - this is the most common form and occurs when the throat muscles relax.

2. Central Sleep Apnoea - this occurs when the brain does not send proper signals to the muscles that control breathing.

Risk Factors for the condition: • Obesity • Increased collar size • Small upper airway • Large tongue

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• Snoring • Age • Gender OSA – THE FACTS • It is estimated that almost 100,000 people suffer with OSA in Ireland and up to 60% of these are undiagnosed.

• About 70% of those with OSA are obese.

• Up to 60% of patients with OSA may have hypertension (high blood pressure).

• People with OSA are 15 times more likely to have a road traffic accident due to excessive daytime sleepiness.

• Cardiovascular complications include hypertension, coronary artery disease and OSA has also been identified as an independent risk factor for stroke.

• There is an increased risk of metabolic disturbances, such as insulin resistance (Diabetes) in patients with OSA. HOW TO GET TESTED STEP 1: SPEAK TO YOUR GP The first step is to discuss your symptoms with your GP who will refer you to a

consultant who specialises in sleep disorder medicine.

STEP 2: CONSULTATION AND TESTING The consultant will assess you and decide whether you will require an over night sleep study to confirm the diagnosis of OSA. The sleep study is carried out on an overnight inpatient basis.

Nocturnal Polysomnogram (PSG) is the gold standard test for overnight sleep assessment. This involves measuring EEG (electroencephalography), EOG (electrooculography), EMG (electromyography), respiratory effort, abdominal effort, airflow, oxygen saturation levels, snore vibrations, body position and leg movements. These signals are then analysed in order to assess sleep patterns.

STEP 3: RESULTS AND TREATMENT. The results of the over night sleep study are reported on in a timely manner by the consultant who will then decide what treatment options you may need.

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SYMPTOMS OF OBSTRUCTIVE SLEEP APNOEA SYNDROME MAJOR DAYTIME SYMPTOMS • Excessive daytime sleepiness(EDS) • Fatigue • Unrefreshed sleep • Difficulty concentrating and • reduction in short term memory • Morning headache • Morning dry mouth • Depression, irritability, mood changes

MAJOR NIGHT TIME SYMPTOMS • Snoring • Witnessed apnoea • Restless/fragmented sleep • Nocturia – excessive urination at night and/ or enuresis (Bed-time wetting) • Night time sweats • Nightmares/unpleasant dreams • Nocturnal choking/gasping (often identified by bed partners) • Thirst during the night • Impotence

TREATMENT OPTIONS CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) CPAP is a well established treatment most suitable for patients with moderate to severe OSA. This involves wearing a mask on the face which is attached to the CPAP device via a tube. The device blows air at an increased pressure in order to keep the airway open while sleeping, allowing normal breathing and preventing dips in oxygen levels. This in turn allows the individual to have a normal and refreshed sleep. CPAP is the recommended treatment for OSA. WEIGHT LOSS Loss of excessive weight can improve the severity of OSA and in some cases even to the point where treatment may no longer be needed.

MANDIBULAR ADVANCEMENT DEVICES AND SIMILAR MOUTH APPLIANCES These are devices that fix inside the mouth at night and holds the lower jaw in a forward position. This option is only suitable for certain people, mostly with mild OSA.

SURGERY This involves major surgery with the removal of a large portion of the soft tissue at the back of the throat. Success rate is generally poor.

DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE AT THE BON SECOURS HOSPITAL The departments sleep lab is one of the busiest in Ireland with a highly qualified team. Since 2008, it has performed over 4,500 diagnostic sleep procedures. It consists of multi disciplinary staff with access to dieticians, cardiologists, respiratory consultants, ENTs, neurologists, orthodontists and endocrinologists. Over 600 patients have commenced CPAP titrations within the hospital in the last 5 years.

As well as diagnosis and treatment of OSA, the department also carries out a full range of diagnostic and treatment procedures for an extensive range of sleep disorders including: • Narcolepsy • Sleep walking • Night terrors

• Body clock issues • Restless leg syndrome • Insomnia • Central Sleep Apnoea Procedures carried out include: • Nocturnal Polysomnogram (PSG) • Cardio Respiratory studies • CPAP/BiPAP titration studies • CPAP/BiPAP compliance studies • Multiple Sleep Latency Tests (MSLTs) • Maintenance of Wakefulness Tests (MWTs) • Actigraphy • Insomnia Services ICBT

DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE CONTACT DETAILS Bon Secours Hospital Glasnevin Dublin 9 Phone: 01 8065479 Fax: 01 8065480 E mail: respiratory@bonsecours.ie

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RHEUMATOLOGY DEPARTMENT

Rheumatology at Bon Secours The Rheumatology Department at Bon Secours offers a broad spectrum of treatment to its patients. Dr Maurice Barry, Consultant Rheumatologist discusses.

THE TEAM Four rheumatologists provide a consultant service - Dr Susan Sant, Dr Paul O'Connell and Dr Maurice Barry. Drs Sant and Barry hold on-site outpatient clinics twice weekly and all provide inpatient care and see consults.

THE SERVICE The spectrum of conditions seen includes inflammatory arthritis, osteoarthritis, osteoporosis and soft tissue rheumatic conditions such as tendinitis and fibromyalgia.

The vast majority of imaging investigations required can be carried out on site including MRI, CT, DEXA and ultrasound and a full array of laboratory investigations can be ordered with a very rapid 'turn around' time for results.

A broad range of specialties are represented at the hospital which is reassuring when complex or multi-system cases require input from other disciplines.

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The broad range of specialties also results in the rheumatology department being consulted on a large variety of rheumatic conditions arising e.g. in oncology, orthopaedic and geriatric patients.

THE TREATMENT The treatment options available to rheumatologists have changed dramatically in the last decade. This is especially true of inflammatory arthritis.

There are now at least ten biologic agents which are highly effective, well tolerated and have revolutionised the quality of life for those with conditions such as rheumatoid arthritis and ankylosing spondylitis. Some of these agents are infused in the day ward in the hospital by an increasingly knowledgeable and experienced staff.

Experience also counts in Physiotherapy and the therapists are extremely efficient at assessing, treating and rehabilitating a range of rheumatic

conditions within an increasingly short time-frame.

QUALITY NURSING CARE For some rheumatic patients the key to the success of their hospital stay is the quality of the nursing care. This is often multi-faceted and includes understanding the patient and their condition; controlling their symptoms and caring for them in a holistic way; and organising investigations and treatment to minimise their time in hospital. The nursing staff at Bon Secours work very hard and are very effective at all of the above.

CONSULTANT RHEUMATOLOGISTS • Dr Maurice Barry • Dr Ruth Lee • Dr Paul O'Connell • Dr Susan Sant

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SURGERY DEPARTMENT

Surgery at Bon Secours The Surgical Department at Bon Secours Hospital provides a full range of services for its patients. Ms Deborah McNamara, Consultant General and Colorectal Surgeon discusses.

With our 4 bed High Dependence Unit and its specialist highly trained nursing team we provide a full range of surgical services to all patients including those with multiple co-morbidities and in more high risk patients.

INFECTION CONTROL We have an extremely well developed infection control programme with a stateof-the-art decontamination facility for sterility of equipment. Bon Secours has invested in both staff and processes to ensure that every patient is thoroughly screened at admissions, thereby greatly reducing the risk of hospital acquired infection.

THE TEAM Bon Secours Hospital provides excellent surgical care to its patients. We offer a full range of general surgical services and have specialist colorectal, vascular and gastro intestinal surgeons on staff. This highly experienced team performs both open and laproscopic procedures as well as providing a surgical endoscopy service.

Other specialties include orthopaedics, gynaecology, ENT, plastic surgery and spinal neurosurgery.

As a longstanding institution, the 'Bons' has developed an excellent skill mix in both consultant staff and nursing.

This allows patients to benefit from the latest techniques but also to receive the personalised care that only experienced doctors and nurses can provide.

FACILITIES The surgical department consists of four major operating theatres and two minor operating theatres. Bon Secours has invested in modern laparoscopic equipment that allows more patients to receive minimally invasive treatment.

This greatly reduces recovery time and increases post-operative comfort. The state-of-the-art new theatres allow us to provide ambulatory day case surgery with minimum wait time allowing a patient to be home within an hour of their procedure. We have a very active day surgery programme whereby we deliver as much surgery as possible using short stays and enhanced recovery programmes. This means that patients recover faster and are in hospital for a much shorter period of time.

PATIENT NUMBERS The variety of procedures and the expertise, skills and reputation of our surgical team means that despite the downturn in private health insurance members, patients numbers are continuing to increase in the Bon Secours Hospital Dublin.

SURGICAL DEPARTMENT • Mr Mayilone Arumugasamy • Ms Ann Branigan • Mr Paddy Broe • Mr Joe Deasy • Prof Arnie Hill • Mr Parnell Keeling • Ms Deborah McNamara • Mr Eadhbhard Mulligan • Mr Martin O’Donohoe • Mr Kevin O’Malley • Mr Colm Power • Prof Tom Walsh

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UROLOGY DEPARTMENT

Urology at Bon Secours The Urology Department at Bon Secours continuously strives to provide top class treatment to its patients, Mr. Tom Creagh, Consultant Urologist explains.

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Referrals are made to the urodynamic service through the consultant specialists who receive a copy of the test results which are reported on and feedback given to the referring GP.

THE SERVICE The aim of the urodynamic service is to reproduce symptoms while making precise measurements to identify the underlying causes of the symptoms and to quantify the related pathophysiological processes.

By doing so it is possible to establish the presence of dysfunction, understand its clinical implications and either confirm a diagnosis or a new specifically urodynamic diagnosis.

THE TEAM There are seven urologists on staff, Mr Richard Power, Mr Hubert Gallagher, Mr Denis O'Sullivan, Mr Tom Creagh and Mr Ponnusamy Mohan. The gynaecologists include Dr Paul Byrne, Dr Barry Gaughan and Dr Nicolette Kroon. Adele Ross, clinical nurse manager, heads up the urodynamics teams. Mr Creagh has sub specialty interests in urinary incontinence, prolapse and urinary tract infection.

rology is the medical and surgical speciality that focuses on the urinary tracts of males and females.

Common problems include prostate and bladder cancer, infection, incontinence and prolapse.

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TREATMENTS All aspects of general urology are catered for at Bon Secours. The urology department is continuously introducing new treatments such as minimally invasive sling procedures for incontinence. There is also an excellent rapid access service available for investigation and treatment.

UROLOGY DEPARTMENT • Mr Tom Creagh • Mr Hubert Gallagher • Mr Ponnusamy Mohan • Mr Denis O’Sullivan • Mr Richard Power • Mr Kashif Siddiqui • Mr Gordon Smyth

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HEALTH INSURANCE

Private Health Insurance and Self-Payer Packages The Bon Secours treats patients with private health insurance and those who opt to be self-payers. We are at hand to discuss your cover or payment options in relation to inpatient and outpatient treatment and tests.

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he Bon Secours Hospital Dublin has negotiated excellent health insurance coverage for patients with all of the health insurance companies. We have direct settlement with all health insurance companies and almost every plan covers the Bon Secours Hospital Dublin. Any potential shortfalls that may be associated with a plan are at a minimum. With new health insurance packages coming on-line almost on a weekly basis, our general recommendation is that you should check your plan on annual basis to ensure that you are getting the best value for your fee, that it is the right plan for you and your medical needs and also to ensure that you are covered for the Bon Secours Hospital Dublin. Changing an insurance provider and/or cover is simple and easy to do. Sites such as the Health Insurance Authority http://www.hia.ie/ have a simple comparison section and sites such as www.totalhealthcover.ie provide additional useful information.

The following steps will help your cover in relation to a procedure or outpatient tests: • Check the name / type of your plan • Check your policy number • Confirm the procedure name and code with your consultants secretary • Contact your insurance provider to make sure there are no exclusions under the terms and conditions of your policy • Call us to confirm the details: • Outpatient tests – 01 8082300 • Inpatient and day case procedures – 01 8065305 SELF-PAYER OPTIONS FOR PATIENTS WITHOUT HEALTH INSURANCE For patients who may not have health insurance, there is also a self-pay option available. For quotations on individual procedures, please contact our Credit Control Department on (01) 8065305. The amount quoted will be an estimate of the

cost of the treatment being proposed based on the normal length of stay and tests for your treatment.

In order to check the price please; • Confirm the name and procedure code with your consultants secretary • Call our credit control Department on 01 8065305 USEFUL HEALTH INSURANCE TERMS: Co-payment - this is a payment paid by a patient each time a specified medical service which is liable to a co-payment is used. It is a percentage or value payment up to an agreed certain limit as specified in the terms and conditions of a patients contract with the insurer. It is paid directly by the patient to the hospital and is not repayable under the patients’ plan of insurance.

Day-patient - Treatment received during a hospital stay in a day care bed which does not include an overnight stay.

Excess - This is the first part of any insurance claim that you have to pay yourself.

In-patient - Treatment received during an overnight stay in hospital.

Out-patient - Treatment which does not involve in-patient treatment or day care procedures.

Pre-existing condition - Any disease, illness or injury which started before you took out health insurance contract.

You need not have presented with any symptoms been diagnosed or have been aware of the presence of this condition for the condition to be pre-existing.

Private room - A private room will contain a single bed.

Schedule of benefits - This schedule details the amount an insurer will pay under the policy.

Semi-private room - A semi-private room will contain more than 1 and up to 5 beds.

Waiting periods - A waiting period is the amount of time that must pass from the start date of a health insurance policy

before full cover is available.

Period of cover - The Minimum Benefit Regulations set out the minimum payments that all health insurers must make. You are guaranteed to receive cover to the level of the minimum payments that are set out in the Minimum Benefit Regulations. - 180 days Participating and Non Participating Consultants - Consultants with whom the insurer has an agreement are referred to as “participating consultants”. Participating consultants accept the insurer payment in full settlement of their charges for performing the procedures and treatments listed in the Schedule of Benefits.

KEY INSURER DETAILS VHI Healthcare 1890 444 444, www.vhi.ie Laya Healthcare 1890 904 067, www.layahealthcare.ie Aviva Health 1890 714 444, www.avivahealth.ie Glo Health 1890 781 781, www.glohealth.ie ESB MPF 061 430581, www.esbelectricmail.com Garda Medical Aid 01 8991604, www.medicalaid.ie POMAS 01 8308963, www.pomas.ie KEY REGULATORS Health Insurance Authority 01 4060080, www.hia.ie Central Bank of Ireland 01 2246000, www.centralbank.ie National Consumer Agency 1890 432432, www.nca.ie COMPARISON AND GENERAL INFORMATION WEBSITES Health Insurance Authority 01 4060080, www.hia.ie Totalhealthinsurancecover.ie www.totalhealthcover.ie

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CONSULTANT DIRECTORY

Consultant Directory Consultant Name

Allergy

Dr Ranbir Kaulsay

Cardiology

Dr Angela Brown Dr Robert Kelly Dr Thomas Gumbrielle Dr Jonathan Lyne Dr Brendan McAdam Dr Richard Sheahan

Dermatology

Dr Callaghan Condon Dr Tony Egan Dr Fiona Keane Dr Sandra Kirke Dr Brigid O’Connell Dr Nicholas Walsh

Endocrinology Dr Margaret Griffin Dr Diarmuid Smith Prof ChrisTompson

ENT Surgery

Mr Rory McConn-Walsh Mr Kieran O'Driscoll Mr Tadhg O’Dwyer Mr Munish Shandilya Prof Michael Walsh Mr Peter Walshe

Gastroenterology

Dr Richard Farrell Prof Fergus Gleeson Dr Gavin Harewood Dr Jack Hollingsworth Prof Padraic MacMathuna Prof Frank Murray Dr Conor O’Brien Dr Cathal O’Keefe Prof Colm O'Morain Prof Stephen Patchett Dr Barbara Ryan Dr Shiobhan Weston

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Phone Fax (01) 833 8207

(01) 833 8225

087 900 4766 (01) 292 0510 (01) 836 0332 087 622 1793 (01) 857 3721 (01) 857 4744

(01) 890 1945 (01) 292 0512 (01) 837 6357 (01) 902 3932 (01) 857 1130 (01) 837 2503

(01) 288 0053 (041) 984 4489 (01) 857 5127 (01) 645 9444 (01) 644 9696 (01) 206 4223

(01) 283 5626 (041) 984 4490 (01) 885 8888 (01) 645 9568 (01) 644 9699 (01) 206 4230

087 753 1061 (01) 857 2979 (01) 837 6532

(01) 821 0072 (01) 857 2979 (01) 837 6501

(01) 837 3868 (057) 932 4870 (01) 885 8603 (051) 319 859 (01) 288 4073 (01) 899 7010

(01) 206 4229

(01) 884 4840 (01) 837 2721 (01) 837 5007 (01) 278 4363 (01) 830 0840 (01) 837 5155 (01) 676 3489 083 103 63330 (01) 4188 402 (01) 837 7538 (01) 645 9605 (01) 292 0552

(01) 646 5415 (01) 857 1520 (01) 837 5008 (01) 283 1471 (01) 830 0840 (01) 678 8025 (01) 678 8025 (01) 271 5210 (01) 4188485 (01) 837 7550 (01) 645 9606 (01) 2939301

NOTES

(01) 885 8838 (051) 319861 (01) 206 4518 (01) 899 7017

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CONSULTANT DIRECTORY

Consultant Name

Phone

Fax

General Medicine/Medical Assessment Unit Dr Colette Barry

Gerontology

Dr Joseph Duggan

Gynaecology Dr Paul Byrne Dr Barry Gaughan Dr Yahya Kamal Dr Nikki Kroon Dr Edgar Mocanu

Haematology

Dr Donald McCarthy Dr Philip Murphy Dr Peter O’Gorman

089 4041391

(01) 806 5405

(01) 884 1222

(01) 857 3041

(01) 836 7616 (01) 836 7610 087 362 5010 (01) 206 4637 (01) 878 2699

(01) 857 6835 (01) 857 6835 (01) 684 8913 (01) 283 6225

(01) 2213125 (01) 809 2622 (01) 850 0977

(01) 221 3968 (01) 836 9561 (01) 850 0962

(01) 8375111

(01) 837 5896

NOTES

Minor Surgery Dr Joe McKeever

Nephrology

Prof Peter Conlon

Neurology

Dr David Moorehouse

Neurosurgery Mr Martin Murphy

Oncology

Dr Oscar Breathnach Prof Liam Grogan Dr Patrick Morris

(01) 8379311 (01) 837 9411

(01) 8369043

(01) 5262310

(01) 809 3338 (01) 837 7547 (01) 8379299

Ophthalmic Surgery Ms Yvonne Delaney Ms Susan Fitzsimon Mr Paul Moriarty Ms Patricia Logan Ms Brid Morris

Ophthalmology

Dr Aisling Foley-Nolan

(01) 836 9045

(01) 838 6732 (01) 832 0248 (01) 418 8442 (01) 885 8622 085 8586822

(01) 809 2603 (01) 837 7550

(01) 868 4642 (01) 8572721 (01) 4188459 (01) 885 8224 (01) 295 1241

(01) 8320248

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CONSULTANT DIRECTORY

Consultant Name

Oral Surgery

Mr PJ Byrne Mr Gary Leonard

Phone (01) 269 2442 (01) 668 8441

Orthopaedic Surgery

Mr Michael Donnelly (01) 526 2380 Mr Darragh Hynes (01) 830 0797 Mr Patrick Kenny (01) 645 9585 Mr Peter Keogh (01) 645 9586 Mr Paul McNamee (01) 837 0600 Mr Philip O’Connor (01) 8372721 Mr James (Shea) O’Flanagan (01) 837 3007 Prof Michael Stephens (01) 885 8643

Pain Management Dr Josh Keaveny Dr Valerie Pollard

Palliative Care Dr Liam O’Siorain

Plastic Surgery

Mr Nadeem Ajmal Mr Brian Kneafsey Mr Anthony Ryan Mr James Small

Psychiatry

Dr Michelle Cahill Dr Ann Leader

(01) 857 1203 (01) 857 6939

Fax

Consultant Name

Respiratory Medicine

(01) 668 8478

(01) 526 382 (01) 860 0076 (01) 645 9589 (01) 645 9589 (01) 837 1624 (01) 8571520 (01) 837 7781 (01) 838 6795

(01) 857 1203 (01) 857 4637

(01) 885 8888

(01) 885 8541

(01) 645 9621 (01) 8571384 087 277 3116 (01) 219 6050

(01) 837 6130 (01) 837 6357 (01) 278 0354 (01) 219 6055

(01) 836 0100 (01) 836 0100

(01) 837 6616 (01) 837 6616

Prof Conor Burke Dr Liam Cormican Prof Richard Costello Dr John Faul Prof Patrick Manning Prof Gerry McElvaney Dr Ross Morgan Prof Shane O’Neill

Rheumatology

Dr Maurice Barry Dr Ruth Lee Dr Paul O’Connell Dr Susan Sant

Fax

(01) 837 1440 (01) 645 9540 (01) 809 3762 (056) 777 5280 (01) 837 2721 (01) 809 3764 (01) 851 1938 (01) 837 3430

(01) 837 0296 (01) 645 9543 (01) 809 3765 (01) 645 9543 (01) 857 1520 (01) 809 3765 (01) 851 1938 (01) 837 6104

(01) 837 3372 087 900 5451 (01) 837 6381 (01) 213 5632

(01) 857 3041 (01) 696 1071 (01) 884 4016 (01) 213 5613

Surgery

Mr Mayilone Arumugasamy 087 445 0990 Ms Ann Branigan (01) 885 8673 Mr Paddy Broe (01) 837 3646 Mr Joe Deasy (01) 836 9167 Prof Arnie Hill (01) 809 3760 Mr Parnell Keeling (01) 837 0001 Ms Deborah McNamara (01) 857 4885 Mr Eadhbhard Mulligan (01) 8374050 Mr Colm Power 087 233 8235 Prof Tom Walsh (01) 822 8954

Urology

Mr Tom Creagh Mr Hubert Gallagher Mr Ponnusamy Mohan Mr Denis O’Sullivan Mr Richard Power Mr Kashif Siddiqui Mr Gordon Smyth

Vascular Surgery

Prof Austin Leahy Mr Ciaran McDonnell Mr Daragh Moneley Mr Peter Naughton Mr Martin O’Donohoe Mr Kevin O’Malley

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Phone

(01) 850 0071 (01) 837 6719 (01) 837 6447 (01) 809 3758 (01) 857 0302 (01) 857 4885 (01) 836 9482 (01) 820 2284

(01) 837 9350 (01) 289 8834 (01) 835 0651 (01) 645 9690 (01) 837 4805 (01) 645 9618 (01) 835 0651

(01) 837 9355 (01) 289 8831 (01) 836 9312 (01) 645 9692 (01) 8376357 (01) 645 9616

(01) 809 3754 (01) 830 8241 087 615 3372 (01) 809 3816 (01) 806 0190 (01) 830 1077

(01) 809 3755 (01) 838 0851 (01) 857 1983 (01) 838 0851 (01) 830 1077

BON SECOURS HOSPITAL

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PATIENT INFO / ACCESS TO SERVICES

Patient Information As a patient or visitor to the Bon Secours Hospital, we would like to ensure that your visit or stay is as welcoming and comfortable as possible. The following information may help you before you attend the hospital. If you would like any additional information, please do not hesitate to contact us on (01) 8065300.

LOCATION & CONTACT DETAILS You can contact the hospital at: Bon Secours Hospital Glasnevin, Dublin 9 Tel: (01) 806 5300 Web: www.bonsecours.ie Email: info@bonsecours.ie GPS Co-ordinates: N 053° 22.528 W 006° 16.019 The number 83 bus from Dublin city centre passes just in front of the hospital.

The number 9 and number 4 buses go via St Mobhi Road which is a short walk away.

DRIVING DIRECTIONS FROM M50: • Exit M50 after Finglas (Junction 5).

• Take city centre direction.

• Go through 6 sets of traffic lights.

• At the next set of traffic lights turn left onto the old Finglas Road.

• Continue up the hill and through 5 sets of traffic lights.

• Bon Secours Hospital is signposted on the left shortly after the triangular Met office.

ADMISSIONS Please inform admission staff before registration if you have attended the hospital previously as an inpatient, day care, outpatient, or for any tests such as blood tests, X-ray, cardiac, breathing or physiotherapy. This will avoid duplication of records and ensure efficient registration.

INPATIENT Generally, admission time to the hospital for inpatients is between 13.30 and 15.30 hours. This includes surgical patients coming to the hospital on days prior to surgery. Patients for admission on the day of surgery will be advised of their

admission time by their consultant's secretary.

DAY CASE/ENDOSCOPY Admission time for Day Case/Endoscopy will be given to you by your consultant’s secretary.

ACCOMMODATION The type of accommodation is as booked by your consultant’s secretary. If you have cover for a single room, please highlight this to the secretary.

MEDICINES 1. Please bring all your medicines with you and do not put different medicines together in the same container.

2. Ask your pharmacist for a printout of all your medicines or bring in all of the

prescriptions your doctor has written for you.

3. If you have a Drug Payment Scheme card, please bring this with you. You will have to pay for any medication you take home.

4. Acceptable methods of payment include Mastercard, Visa, Laser, cash or a cheque with a valid banker’s card.

INSURANCE Bon Secours has direct payment insurance plans with the following insurers: • Vhi • Laya • Aviva • ESB/GMA and POMAS • Glo Health

BON SECOURS HOSPITAL

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PATIENT INFO / ACCESS TO SERVICES

restrictions on certain foodstuffs that can be taken from the restaurant.

SMOKING For a healthier environment, smoking is not permitted in or at the entrance to the hospital. There is a designated smoking area in the car park.

VISITING GUIDELINES Visitors are welcome between 10.00 and 21.00 but are encouraged to avoid mealtimes: Mid-day meal: 12:00 – 13:00 Evening meal: 17:00 – 17:30 Children under 10 years old are advised not to visit as the hospital can be a source of infection to small children.

Visitors under 16 years are not allowed to visit patient care areas. There may be occasions when visiting is restricted for reasons such as doctors consultations, routine daily procedures or to facilitate periods of rest deemed necessary by nursing or medical staff. When receiving visitors in shared accommodation, please show consideration for patients who may be resting. Please ask relatives not to visit should they have a cold, stomach bug or other contagious disease.

Before admission, we would encourage you to check directly with your insurance company that your policy covers you for the accommodation and / or treatments that you require and if a policy excess is payable. Patients are liable at the time of admission for any charges not covered by their insurance company. You will also be required to bring details of your insurance cover on the day of your admittance.

NON-INSURED PATIENTS Non-insured patients are required to pay for treatment in full on the day of their admission. Please contact patient accounts (01) 8065351 for an estimate of your treatment cost prior to admission.

72

HIGH DEPENDENCY UNIT Visiting times in the High Dependency Unit are: 10:00 – 12:00 14:00 – 16:30 18:30 – 20:00 The maximum number of visitors per patient at any one time in this unit is two.

CAR PARKING Pay and Display car parking is available throughout the grounds for patients and visitors. For security purposes, the hospital gates close each evening at 22:30.

A change machine is located just inside the main door should you require change.

SHOP The hospital shop is located on the ground floor, opposite the lift. A range of newspapers, magazines, soft drinks, confectionery and toiletries are available.

FLOWERS Flowers or potted plants are no longer allowed at the hospital for health and safety and infection control purposes.

THE RESTAURANT The hospital restaurant is located on the ground floor adjacent to reception and is open to patients, visitors and staff. restaurant opening hours are: Monday to Friday: 7.45 – 18.30 Saturday: 9.30 – 15.30 Sunday/Public Holidays: 9.30 – 18.30 In addition, vending machines are located on the ground floor of the hospital. Due to health and safety regulations, there are

SECURITY & SAFE KEEPING Valuables, jewellery, large sums of money or items of sentimental value should not be brought into the hospital and must be either returned to your home or immediately deposited in the hospital's safe for safekeeping. The hospital is not responsible for items kept in patients’ rooms. Please bring any personal items you may require for your hospital stay with you.

The hospital discourages the use of mobile phones as they can interfere with medical devices. Each patient is provided with a telephone for incoming and outgoing calls.

RELIGIOUS/PASTORAL CARE The hospital chapel is located on the ground floor at the end of St Laurences ward. The pastoral care team can be contacted on (01) 8065327 or through the wards or main reception. Arrangements can be made for patients of all denominations to receive visits by their respective clergy.

USEFUL NUMBERS Main Reception: Accounts - Patients: Admissions - Day Case: Admissions - Inpatients: Cardiology: Diabetic Care Centre: Diagnostic Imaging (X-ray, MRI, CT etc.)

Dietetics: Endoscopy- Direct Access: Laboratory: Medical Assessment Unit: Oncology: GP Liaison & Outpatient Booking Department: Fax: Phlebotomy: Physiotherapy: Podiatry: Rapid Access Dept: Respiratory & Sleep Medicine: Urodynamics:

(01) 806 5300 (01) 806 5351 (01) 806 5439 (01) 806 5355 (01) 806 5368 (01) 806 5300 (01) 806 5470 (01) 806 5488 (01) 806 5346 (01) 806 5320 (01) 806 5498 (01) 806 5409 (01) 808 2300 (01) 808 2309 (01) 806 5347 (01) 806 5339 (01) 806 5300 (01) 806 5498 (01) 806 5479 (01) 806 5484

BON SECOURS HOSPITAL

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Caring for Life since 1829 With a heritage dating back to 1829, Fannin has evolved into one of the leading suppliers of a wide range of pharmaceuticals and medical devices to the primary and acute care sectors in Ireland. Our range of products include Wound Care, Urology, Critical Care, Scientific and Pharmaceutical. Our longevity has been achieved through a passion for service excellence and innovation.

We deliver confidence and trust to our customers, underpinned by our dedicated workforce representing the best products in their class.

We look forward to our continued partnership with the Bons Secours Group of hospitals today and in the future.

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