Primary Care Centre Castlebar Case Study

Introduction 

About Mayo University Hospital & it’s Radiology Dept

The Problem

The demand for our existing  general radiography ( “x-ray” ) service  for GP referred patients in Mayo University Hospital was such that waiting times were approximately eight weeks for an appointment  in the main ( hub ) radiology department in MUH. The existing service in the main MUH radiology department was working at capacity and the infrastructural changes required to accommodate additional relevant capacity would result in significant disruption to the working of the department

The delay in accessing general radiography in a timely fashion from primary care was limiting timely diagnosis and treatment for patients in the community and was resulting in more patients having to present to acute services to access timely diagnostics.

There were already off-site ( Satelite ) general radiography ( “ x-ray” ) services  provided in Belmullet Community Hospital & Ballina District Hospital with studies performed on these sites  reported and coordinated from the main MUH radiology department. The existence of NIMIS ( National Integrated Medical Imaging System) PACS(Picture Archiving & Communication Systems) in MUH allowed image viewing & reporting of these radiographs ( “x-rays” ) by consultant radiologists in MUH.

The Solution

The inclusion of a general radiography room in the newly constructed Primary Care Centre in Moneen, Castlebar allowed the existing IT/PACS and consultant resources to be utilised to provide a general radiography service exclusively for GP referred patients that was totally integrated into the existing acute service. Bookings for this innovative new service are coordinated and booked centrally by the radiology administrative staff in the main MUH radiology department.

Number of GP referred patients awaiting general radiography

The Benefits

As can be seen from the graphs above the number of GP referred patients awaiting general radiography dropped dramatically once the primary care radiography service commenced in June 2017. Waiting times dropped from approximately 8 weeks to a “return of post” service.

Where required patients can still be facilitated in the main radiology department in MUH but the new satellite service offers a less congested/more structured  environment for patients and staff alike. Turnaround times for the reporting of these examinations are exceptionally low with the vast majority of examinations reported by a consultant radiologist on the day of the examination.

In short this new innovative service offers a faster, more efficient and higher quality service to patients & GPs while also releasing greater diagnostic capacity in the main department for patients with acute illnesses

The use of existing highly functional resources (radiologists, radiographers IT network, NIMIS, radiation safety resources and Radiology booking administrative staff etc) allowed for the very efficient and effective establishment of a totally integrated primary care general radiography service sited in the community

LEAN management principles were applied throughout and there was constructive support from across management in Primary Care and the Saolta University Healthcare Group.  Consultant Radiologists in MUH, radiographers, radiology administration staff, HSE IT and NIMIS working closely together also allowed this service to launch successfully.

This dramatic and immediate increase in general radiography capacity was realised without  any disruptive and expensive building and retrofitting of any section(s) of the main MUH radiology department.

Next Steps

This innovation is transferrable to any primary care or community facility in the country that can partner with a HSE Radiology Department live on the NIMIS PACS system - currently the vast bulk  of HSE hospital radiology departments are part of the NIMIS network.

This model is also transferrable to many other imaging modalities, particularly Ultrasound. The radiology department in MUH has already embarked on an additional project to facilitate an integrated Ultrasound service to the Primary Care Centre in Moneen, Castlebar in tandem with the general radiography service

The clever use of existing HSE governance structures, clinical oversight, IT infrastructure/knowhow and experienced clerical supported leveraged the capacity in the acute service to deliver a highly efficient and effective service in Primary Care. This in turn freed capacity and relieved pressure in the university hospital so that resources could be more optimally deployed.

Primary Care Strategy & Planning is committed to improving GP direct access to ultrasound and x-ray. The preferred model of service provision is an integrated primary and acute hospital model, with access to NIMIS, as evidenced by the excellent Castlebar example. This model will be rolled out at the following new sites in late 2018/early 2019:

• Monaghan Hospital in conjunction with Cavan Hospital Radiology Dept.

• Tuam PC centre in conjunction with Portiuncula Hospital Radiology Dept.

• Cashel Health Campus in conjunction with South Tipperary General Hospital Radiology Dept.

• St. Dympna’s Hospital Carlow in conjunction with St. Luke’s Hospital Kilkenny Radiology Dept.

• Tallaght Cross PC Centre in conjunction with Tallaght Hospital Radiology Dept.