Surgery efficiencies give Cavan General the cutting edge

Story by Seamus Enright

Thursday, 11th January, 2018 4:49pm

Surgery efficiencies give Cavan General the cutting edge

Minister Simon Harris pictured with Mr Pawan Rajpal, consultant surgeon, Cavan General Hospital, during his recent visit to the hospital. Photo: Lorraine Teevan

A senior consultant at Cavan General Hospital (CGH) has claimed that Irish health care waiting lists are “inaccurate” with up to 30% of “phantom” cases that are clogging up the system.

As a result, Mr Pawan Rajpal believes that, for the most part, the Irish Healthcare System is letting itself in for “needless bad press”.
The consultant surgeon confidently supports his argument by pointing to a revolution of sorts led by surgical staff at Cavan Hospital, which began almost a decade ago. In more recent times, this has resulted in efficiencies at the local medical facility and has also impacted on the overall average waiting time for patients across the RCSI Hospital Group.
Just this week it was announced there had been 26% drop in the number of persons waiting on hospital trolleys at CGH last year.
According to final year figures from the Irish Nurses and Midwives Organisation (INMO), throughout 2017, the nurses’ union recorded 480 patients left without beds. The figure is down from 770 patients counted in 2016.
According to Mr Rajpal, up to the end of October last year, the hospital received more than 4,000 surgical referrals. In his modest endoscopy ward office, he flits from a desktop computer on one side of the table to his own laptop. He leans forward enthusiastically, pointing excitedly to the screen. “This is what I’m talking about. This is what it’s all about. Results. And who benefits at the end of the day if we improve results? The patient!” he declares.
The sea-change has come about in how patient referrals are managed, all contained under the CGap Project - Central Command Control, Group Matching Capacity with Capability, Administrative Validation and Pooling Resources within the group.
By participating, CGH were provided with 2,500 referrals for endoscopy and 200 procedures for various operations from other hospitals over a 10-month period in 2017.
On the day he speaks to the Celt, the endoscopy department had dealt with 25 cases, more than a quarter of which were referrals from Beaumont.
The cumulative savings, with the cost of sending patients for a scope to the private sector estimated at around €1,500, are in the millions of euro.
Such savings and efficiencies achieved have not gone unnoticed. When Minister for Health Simon Health last visited the local medical facility, he gave particular praise to the staff at all levels at CGH.
“We are only working within our own capacity, nothing more,” Mr Rajpal tells the Celt. “We have received not one penny more from the government, yet with a few small changes, look at what we’ve been able to achieve. All we are doing is managing our resources appropriately.”
The results speak for themselves, he says. CGH no longer has any waiting list for surgery or endoscopy. The waiting list for general surgery across the RCSI Hospital Group is down by 40%, with nobody waiting longer than six months to be seen by a consultant.
What particularly piques Mr Rajpal’s interest is where more than 30% of patients waiting, when contacted by CGH, did not want or need the procedure carried out immediately, meaning a refocus on targeting higher priority patients.
“We are contacting them and they are saying they don’t want the surgery now. They either don’t need it or have had it done elsewhere.
“So right now, it is a pseudo list of what it could be in reality. It’s all here on paper. CGap is telling Government that we need to look into this with more detail, look at how we can turn these numbers into a true reflection,” surmises Mr Rajpal.
He adds: “We are using all of the capacity that is available to us to drive down these waiting lists, eliminating the waste, and focusing on treating the patients. [CGH] are working in collaboration to show how the Group as a whole can change the dynamics of how patients’ quality of care can improve. Cavan is now playing a central part of the group in driving this change.”

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