Irish Medical News
Monday 20 February 2012
Marie Feely reports on two innovative programmes that recently received national recognition
The future of healthcare
If it is awards season, and while Hollywood is busy attending the Golden Globes, the BAFTAs and the Oscars, members of the medical profession look to the Astellas Changing Tomorrow Awards for recognition of innovative health practices.
The awards were held last month at the RCPI and among the winners were services provided by Cork University Maternity Hospital (CUMH) and Tallaght Hospital, Dublin.
In Tallaght Hospital, the Cardiac Risk in the Young (CRY) Centre won for its work with individuals and families who have inherited cardiac conditions.
Dr. Deirdre Ward, head cardiologist at CRY, spoke to IMN about what the Centre has achieved since it was set up in 2007.
“it was a virtual centre initially, and it was set up to address the problem of inherited cardiac diseases and sudden cardiac death (SCD) in the young,” she explained.
“If someone dies suddenly at a young age, there is about 50 per cent chance that the cause of their death is an inherited problem, therefore there is 50 per cent chance that their first degree relative, such as parent, child or sibling, could be at risk and should be prepared.
“So (first degree relatives) need to be investigated for cardiac conditions. Before CRY, there hadn’t really been any huge support system for that.”
CRY was first set up in 2002 by a couple who had lost their 15-year-old son to SCD, and had experienced a lack of support and specialist services in the area.
“The couple had no support information so they wanted to change that,” Dr Ward said.
Meanwhile, Tallaght Hospital was receiving more and more referrals of patients with cardiac conditions from GPs, and the hospital began to plan a service that would offer support specifically for these patients.
“Tallaght had plans to set up such a service, then they were approached by the CRY service,” Dr Ward said.
“The two groups were obviously very well suited, and CRY signed an agreement with Tallaght hospital to provide funding for equipment and staff, for initially the first three years. That’s how it came to be.”
Dr. Ward joined the centre in 2007. “When I started, I didn’t have any particular facilities to use. I would end up bringing people in after a clinic, at the evening or weekend.”
The centre got a dedicated building in 2008.
“We need to do all the basic tests on the same day, then people discuss the results with us and see whether or not they have anything to worry about, and if so what are we going to do about it.”
The people who use the service include parents who are concerned for their children and young people who might not have a family history of cardiac problems, but have been referred by their GP as there is some cause for concern.
“We assess them and if they’re not affected, we can allay their fears, then they go back to normal life,” she explained.
“The vast majority don’t have problems so we are often just providing some peace of mind.”
Dr Ward told IMN that the centre normally sees about 1,450 patients a year, but numbers have fallen recently.
“We’re hoping to get back up to 1,450 a year,” she said.
Awareness about SCD has improved in recent times, and in general, about 20 per cent of patients investigated are found to have a condition, said Dr Ward.
Access to defibrillators has also improved, she noted, adding that schools and communities are very well served.
However, she advised people in more rural communities to determine how long it would take for an ambulance to reach their community if a patient had a cardiac episode.
“It doesn’t matter if the patient is 80 years of age or 20 years of age, if it takes more than five minutes you probably need a defibrillator in the community.”
In the south of the country, Northgate Public Services and CUMH won the Astellas Changing Tomorrow Award for their delivery of the Newborn Hearing Screening Programme (NHSP)>
Mr. Peter O’Sullivan, ENT consultant at South Infirmary Victoria University Hospital (SIVUH), Cork, and Cork University Hospital spoke to IMN and about the programme, which was introduced in CUMH in April 2011.
“Since then, we’ve screened around 6,500 babies and seven of these had significant hearing problems,” Mr O’Sullivan explained.
“You would expect to pick up about one child per 1,000 screened, so that’s roughly what’s happening in Cork.”
In the vast majority of cases the screening which involves two non-invasive tests is provided before the infant leaves the maternity hospital.
Should the screen not be completed within that time, an outpatient appointment is offered within a matter of weeks.
“The programme allows us to fast-track the process. At the most, it takes six weeks between birth and diagnosis (of a hearing problem), where previously, a child might not have been diagnosed until they were three.”
Mr. O’Sullivan, who is also the Chairperson of the Cork Newborn Hearing Screening Implementation Group, stated that early screening has a massive impact.
“Children do better socially and emotionally, and they have a better chance schooling –wise, if a problem is picked up early,” he said.
“There’s a huge knock-on-effect.”
Furthermore, the roll out of the programme means that the need for hearing screening tests by public health nurses will be gradually removed.
These tests are carried out at eight months after birth and, according to Mr O’Sullivan, are “non-sensitive, not specific and don’t really give an answer”.
“I think the NSHP is probably one of the most exciting things to happen to health in this country in the last few years,” Mr O’Sullivan said, emphasising the importance of having the programme rolled out across the whole country.
“My understanding is that it is going to go nationwide in a few months time. Half a million euro has been made available nationwide, and my understanding is that that went up recently to €2 million,” he said.
“We need to do all the basic testes on the same day, then people discuss the results with us and see whether or not they have anything to worry about, and if so what are we going to do about it”
Dr Deirdre Ward