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model of CAre for ACute surgery
he Minister for Health, Dr James Reilly officially
launched the Model of Care for Acute Surgery
at RCSI recently. Professor Frank Keane, Past
President RCSI, Retired Consultant Surgeon and
Mr Ken Mealy, Council Member of RCSI, General
Surgeon, are the Joint Leads of the National Clinical
Programme in Surgery (NCPS) which developed the Model. They
share their insights with
Surgical Scope, outlining the context for
the Model's development and its objectives.
The Model of Care for Acute Surgery published by the NCPS has been
developed to address the circumstances whereby up to 60 per cent
of the work undertaken in many surgical departments is on patients
requiring acute surgical care. These patients are frequently the sickest,
or are elderly, and have co-morbidities which often result in poorer
the challenges
There are many constraints currently impacting on Ireland's health
and hospital services increasing attendances, an ageing population
and exacting fiscal constrictions. At the same time, these services
have to meet the challenge of new technological developments,
the changes implicit in new hospital groupings and configurations
and more exacting standards in practice and governance, as well
as government policies including `money follows the patient' and
Universal Healthcare.
Professor Keane, Joint Lead of the NCPS, notes that the matrix of
challenges are not exclusive to this country: "There is a consensus
within the developed world that acute surgical patients are not
managed consistently well and that there are often poor and variable
outcomes across institutions. Important causes of these include
delayed access to senior decision makers and dedicated teams,
delayed access to diagnostics and theatres (being put on at the end of
an elective list) and the haphazard distribution of these patients into
scattered, often non-specialist, beds and wards."
Unique to Ireland, the Surgery Programme, including its Elective and
Acute components, provides the framework for a national response
to these challenges that can provide better and safer care to patients
while improving efficiencies and strengthening cost containment.
Patients first:
the nAtionAl CliniCAl progrAmme in surgery
lAunChes trAnsformAtive model
the national
clinical Programme
in surgery (ncPs)
the nCPS, a joint initiative between the HSe's Clinical
Strategy and Programmes directorate and the Royal
College of Surgeons in ireland, is one of a number of
specific programmes developed by the directorate
in collaboration with postgraduate training bodies
to deliver change initiatives in the area of patient
care. the nCPS, specifically, aims to provide a
framework for the delivery of safer, more timely, more
cost-effective and efficient care, as well as greater
accessibility, for all surgical patients.
it commenced in 2010 with an initial focus on the
delivery of a Model of Care for elective Surgery. this
Model, published by the nCPS in 2011, advocated
appropriately used Pre-admission Assessment
Clinics, day Surgery, day of Surgery Admissions and
discharge Planning, which has, the nCPS states,
already had a significant positive impact on the
efficient delivery of surgical care to patients in ireland.
the nCPS works closely with the other national
Clinical Programmes, notably the Programme in
Anaesthesia, as well as the Special delivery Unit
(SdU), patient advocacy groups and all relevant
stakeholders across the health system. it reports
directly to both RCSi Committee for Surgical Affairs
(CSA) and the director of Clinical Strategy and
Programmes directorate of the HSe. this CSA
committee meets monthly and its membership
includes the Programme Leads, Professor Keane,
Mr Mealy, as well as representatives from RCSi
department of Surgical Affairs and 16 surgical
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