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Health Service Excellence Awards 2018

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Health Service Excellence Awards 2018 Winners Announced

Six innovative projects from HSE staff honoured at the awards

322 projects from all over the country entered the 2018 Health Service Excellence Awards, which are open to all staff working in the publicly funded health system. Six innovative projects got through to the final shortlist after a rigorous selection process. These projects highlight how so many HSE staff are working to deliver better services with easier access and higher quality care for patients. The winners were announced at an awards ceremony at Farmleigh in Dublin’s Phoenix Park on Thursday 13th December, 2018.

The Innovation in Services Delivery Award went to Laboratory Service dramatically improves outbreak investigation

New cutting edge technology introduced in 2018 into the VTEC reference laboratory at the Public Health Laboratory (PHL), Cherry Orchard Hospital, has significantly improved its capacity to identify potential disease outbreaks and resulted in substantial cost savings.

Verotoxigenic E. coli (VTEC) is a bacteria that can cause potentially life threatening illness. It is transmitted through contaminated food or water, contact with infected animals, from contaminated environments or from person to person.

The PHL introduced whole genome sequencing (WGS) to its National Reference Laboratory (NRL) service to protect the public from illness caused by VTEC. WGS improves outbreak investigation which contributes significantly to risk reduction strategies for this pathogen by facilitating early detection of potential outbreaks, and allowing faster public health interventions. In 2018 this service was used for the characterisation of strains from more than 700 VTEC cases, and in the investigation of more than 280 potential VTEC outbreaks.

In 2017, all human VTEC isolates were sent to Public Health England for sequencing at a cost of €255,200 with a turnaround time of greater than 21 days. Performing WGS at NRL-VTEC in 2018 will cost €85,000, saving €170,200 with a shorter turnaround time of 10 days. Rapid public health actions protect consumers from foodborne illness resulting in improved patient outcomes.

This use of this novel technology has provided Ireland with public health microbiology capabilities comparable to the USA and other major European countries, and allows Ireland to fulfil its obligations to the EU strategy of strengthening VTEC public health management capabilities.

This new quality assured WGS enhanced VTEC reference service was prompted by the need to devise a public health microbiology initiative that contributes to managing and reducing the disease burden associated with severe VTEC infection. WGS can be used for investigation of infections in both acute care and community settings. WGS data was shared rapidly with multidisciplinary outbreak control teams including colleagues in Public Health Departments, the Environmental Health Service (EHS), the Health Protection Surveillance Centre, and often the Food Safety Authority of Ireland, the Department of Agriculture, Food and the Marine investigating VTEC food/water borne incidents in a ‘one health’ approach.

Outbreak investigations now rely on this new data to decide whether cases are part of an outbreak. This optimises the use of limited HSE resources for more targeted investigations. Colleagues appreciate the value of sequencing data to focus outbreak investigations for public health benefit.

Public Health laboratory HSE, Dublin, Incorporating the National Reference Laboratory (NRL) - Verotoxin E. coli (VTEC) service, CHO 7.

Championing Mental Health across our Health Services Award went to ‘Access to Psychological Services Ireland (APSI)

Access to Psychology Services Ireland (APSI) is based in Co Roscommon and provides stepped-care, low intensity interventions in a primary care setting for adults with mild-to-moderate mental health presentations.

The development of APSI (a primary care psychology service) was based on some key principles:

  • Swift provision of psychological support to adults in distress (i.e. a ‘no waiting list’ approach).
  • Free to everyone at the point of contact.
  • Available at a base local to the user.
  • Easily accessible (i.e. accepting self-referrals/walk-ins)
  • The service should be rigorously evaluated, including feedback from service users, with the data published in public journals.

Building upon a 3-year pilot of a predominantly one-to-one Cognitive Behaviour Therapy-based service, APSI was launched in October 2012 as a fully funded HSE primary care service.

Since then, APSI has provided empathic, non-judgemental, evidence-based psychological treatments to the adults in county Roscommon. With six bases throughout the county, the service is highly accessible accepting professional and self-referrals. The service uses a ‘stepped care’ model using Assistant Psychologists, overseen by a Senior Psychologist, and has demonstrated to the community that psychological support can be swiftly available when required. The project is proactive in promoting positive mental health in the local community and has worked with local media (newspapers and radio) and taken stands at local events to promote positive mental health within the community.

APSI has supported a high volume of individuals in significant emotional distress over this time. It’s commitment to rigorous evaluation has also meant that it’s published regular papers on the clinical effectiveness of the service and on the experience of service users who use the service. To further include the voice of the service user in the service, APSI has created a ‘consumer panel’ of past service users. These individuals generously assist the APSI service in better understanding the experience of current service users and help informs ongoing service development.

APSI provides one model of how, with care and vision, the high, and growing, mental health needs of our local communities can be met.

Project submitted by CHO Area 2 Roscommon Primary Care Psychology Service – APSI.

Improving the Patient Experience Award went to ‘Frail Older People Rapid Improvement Programme’

Ireland East Hospital Group (IEHG) facilitated, promoted and supported the Regional Hospital Mullingar to introduce a Frailty Intervention Team (MFIT) for patients aged over 75 years attending their Emergency Department.

At triage patients are screened for frailty and if found to be frail a Comprehensive Geriatric Assessment (CGA) is completed and appropriate priority referrals are made to Health and Social Care Professionals in the hospital and in the community.

There have been many benefits since the introduction of the programme. These include the following:

  • Discharges in first 7 days of care rose by 22%
  • Discharges to convalescence reduced by half
  • Discharges to Long Term Care reduced by 39%
  • Discharges home increased by 22%
  • Due to improved communication between hospital and community staff, there is now a seamless transition for our frail older patients moving from the acute hospital to the community and vice versa

Unique features of the programme include:

  • Acute hospital and community staff working together to provide the best service for frail older adults
  • Seamless communication between hospital & community staff when arranging care of frail patients
  • Admissions avoided, length of stay reduced, increased discharges to home, reducing the use of convalescence which has a financial saving and significant benefits to the care of the patient.

Other benefits from the programme include:

  • The development of frailty education and training booklet for all staff which has facilitated improved management of our older patients.
  • Families report that their family members were up, dressed and moving every day and as a result their conditions improved more rapidly psychologically and physically.
  • Frail patients have presented with dysphagia and malnutrition and as a result we broadened the selection of foods available to address this.

Feedback from patients and staff both before and after the introduction of MFIT has enabled us to design a programme to meet the needs of our frail older patients attending the Regional Hospital Mullingar. The programme has supported shared learning across the IEHG.

Regional Hospital Mullingar, Ireland East Hospital Group

Excellence in Quality Care Award went to ‘The Sepsis Programme – a quality improvement initiative’

A quality improvement initiative led by the National Sepsis Programme succeeded in reducing sepsis mortality by 22.2% over a four year period and there was a 28% decrease in the average length of stay for patients.

Sepsis is a potentially life-threatening condition triggered by infection that affects the function of the organs. It is treated most effectively if recognised early.

The sepsis programme is the implementation arm of National Clinical Guideline No. 6: Sepsis Management. The aims of the programme are to decrease mortality, acuity and length of stay in patients with sepsis.

Sepsis recognition improved by 67% between 2015 and 2016 and by a further 15% by 2017. This does not represent an increase in the number of cases but rather the application of the correct diagnosis to these seriously ill patients.

This improved recognition led to earlier treatment with the Sepsis 6 treatment bundle, a suite of oxygen, fluids and antimicrobials titrated to patient need and guided by local empiric antimicrobial guidelines. The bundle also includes the blood tests required to aid diagnosis - cultures and organ function tests and an assessment of urinary output.

Sepsis mortality decreased by 22.2% over the four years of the programme with a 28% decrease in average length of stay.

There was no increase in the use of anti-biotics but they were used earlier in the patients’ hospitalisation. There was also no increase in antimicrobial resistance and no increase in outbreak of Clostridium difficile.

The mortality from sepsis in Ireland is 18.2%, averaged since 2016, which benchmarks favourably with other high income countries that are publishing.

Antimicrobial stewardship which includes careful clinical diagnosis, compliance with empiric antimicrobials and de-escalation according to clinical and microbiological assessment is fundamental to an effective and sustainable sepsis care pathway.

A national hospital-wide awareness and education initiative was commenced to improve awareness and knowledge of sepsis amongst healthcare workers and to introduce time-dependant pathways for recognition, treatment and escalation of care in 2015. This was supported by a network of dedicated sepsis Assistant Directors of Nursing appointed in 2016, who supported the education process, including e-learning and performed audit and feedback to individual hospitals and hospital groups.

Hospital Sepsis Committees took on the role of supporting sepsis guideline implementation in their hospitals and acted on the feedback from audits by interfacing with the clinicians, medical and nursing who took on the quality improvement initiative and effected the change that has led to improved patient outcomes. For more information on sepsis visit here.

Improving our Childrens’ Health Award went to ‘Public Health Nurse Oral Health Early Intervention Initiative’

The goal of this project is to improve the dental health of young children and reduce the demand for dental extractions under general anaesthesia.

The aims are:

  • Educate public health nurse’s (PHN’s) on the causes and impact of tooth decay, including the common risk factors with other diseases
  • Update PHN’s knowledge on how to support parents in preventing dental decay and ensure optimum oral health of their young children
  • Provide PHN’s with training in the identification of children with dental decay
  • Provide a referral pathway for those who have been identified as having dental decay through the ‘lift the lip’ exam
  • Offer advice and preventive treatments to young children referred to the dental service by PHN’s.

The project offers an integrated service for users using a common risk factor and holistic approach to oral and general health. It recognises the importance oral health has on general health and attempts to engage parents at a key life stage to take up healthy behaviours to improve their children’s oral and general health. Nutritional support at an early age offers both benefits in terms of oral health but also in the reduction in childhood and adult obesity.

This project involves a multidisciplinary approach. The Public Health Nurse Department and Dental Services of Waterford have worked collaboratively on this project since 2016

In less than two years the PHNs have referred 315 pre-school children and these children have been seen by the Dental Service.

This early intervention initiative can produce lifelong benefit to clients and significant savings for the HSE. As such early intervention offers the potential to improve children's oral and general health, their quality of life and wellbeing and reduce the burden on the health services.

This is an additional service to pre-school children only in the Waterford Community Services area. Tooth decay is a major public health problem for children and it is the most common chronic disease of childhood.

An initiative from Waterford Community Services, South East Community Healthcare (CHO 5).

Supporting a Healthy Community Award went to ‘Inclusion Health – A Primary Care Team with a difference’

Homeless people are among the most marginalised in society and they have among the highest health care needs. The Homeless Primary Care Team is a model of inclusion health, which removes barriers to care.

The Safetynet Homeless Primary Care Team is funded by HSE Social Inclusion. Safetynet Primary Care is a medical charity.

Staffed by GPs, nurses and clinic support workers the Safetynet model comprises the following:
- In Reach clinics in emergency accommodation
- Outreach (using a mobile clinic)
- Hostel (home) visits
- Open access clinics

St James Hospital, the Mater Misericordiae University Hospital, HSE mental health teams, and homeless charities meet weekly with the Safetynet Homeless Primary Care team to coordinate care for people experiencing homelessness.

The HSE Values of care and compassion drive the model for those most vulnerable in our society. The team follows a principle that ‘goes further’ to engage those on the margins to improve health and wellbeing. Outreach GP and nursing services are provided to entrenched rough sleepers in a van converted into a mobile clinic.

The team culture exhibits dignity and respect for those on the margins who frequently expect little for themselves. The design of the service is based on equity and inclusion and deep understanding of health seeking behaviours among vulnerable groups.

The service model is appropriate for all urban centres with a homeless population. A web based electronic medical record system is shared among over 20 services engaging homeless clients. This is transferrable to other parts of the health care system where patients use multiple services.

Nine fully equipped GP and nurse clinics are provided weekly in homeless hostels and services providing care to approximately 500 homeless people monthly. Health problems encountered frequently include respiratory difficulties, mental illness, addiction and chronic and acute illness . The model includes open access clinics for others stigmatised in society without access to health care including Roma, drug users and migrants without means.

The project ‘s unique features include primary and secondary care multi-disciplinary team meetings,
follow up of all patients where ever they are rough sleeping and the web based electronic medical record system .

The service aims to treat individuals who have otherwise not engaged with health care services while breaking down barriers and building trust with homeless people who often have negative experiences in health services.

This project has successfully adapted the Primary Care model to meet the health seeking behaviour of homeless people, providing out of hours outreach services via mobile health units and
offering placements for GP trainees.

Homeless Primary Care Team (HPCT) which is part of Safetynet Primary Care, a medical charity, and funded by HSE Social Inclusion.

Special Recognition Award
 
In addition a Special Recognition Award was presented to Kieran Henry, Emergency Medical Services (EMS), Cork  by Rosarii Mannion, HSE National Director of Human Resources. This Award was in recognition of  The Gathering, an annual event for those working in the front line of emergency services which attracts personnel from home and abroad to share and learn from best practice.
 
Outstanding Employee Awards

A dozen HSE employees were nominated by colleagues for an Outstanding Employee Award. One of these was awarded posthumously to the late Tony Leahy who died earlier this year. Tony was a General Manager who worked in the HSE’s Mental Health Service and played an important leadership role in realising many of the innovations in mental health and reform which took place in recent years.
 
Popular Choice Award

A Popular Choice Award was one of the features of the Health Service Excellence Awards 2018 competition. Health Service staff members were encouraged to vote for their favourite project from the final list short-listed projects. The project to receive the most votes was the ‘Frail Older People Rapid Improvement Programme’ which also won the Improving the Patient Experience Award.

The Excellence Awards enable the HSE to identify new and creative service developments that can be shared and implemented, as appropriate, in different parts of our health system.

More information about the Health Service Excellence Awards 2018