Marie Egan

Marie recently played a key role in the development of a new digital platform for patients called SMART CP (Chronic Pancreatitis).  Developed in partnership with the Irish start-up company My Patient Space this cutting-edge new digital app empowers patients with chronic pancreatitis to take control of their condition by facilitating ongoing and seamless communication with their Hospital team. Patients can use the app to monitor and report their symptoms daily and if their health begins to worsen the app immediately triggers an alert to inform the Hospital.

Marie says, “The idea for the app came about as a result of COVID when we were spending endless hours on the phone trying to contact patients remotely. We felt there had to be a quicker and easier way to communicate. Now by using the Smart CP app patients can report their symptoms daily. The app itself will escalate any concerns reported particularly if a patient’s health begins to worsen. Red alerts are created and I am informed if patients input symptoms that are suggestive of a new presentation of diabetes or pancreatic cancer.”

Patients can also use the app to message Marie directly with concerns or queries and receive a reply from her via SmartCP. In addition, the app contains a wealth of CP-specific education in the form of text, graphics and videos from the Hospital team. It also signposts TUH-area community resources, including useful information on the Tallaght Healthy Communities programme.

Motivation

Marie says, “The primary motivation for me was to try and improve patient care.  Chronic pancreatitis (CP) is a complex, progressive condition where pancreatic tissue is permanently damaged due to repeated inflammation. There is no cure and management focuses on dealing with symptoms and complications as they arise. Patients with CP suffer from debilitating gastrointestinal symptoms such as severe abdominal pain, bloating, nausea and vomiting. As the disease progresses, patients may develop type 3c (pancreatogenic) diabetes, osteoporosis and nutrient deficiency.”

Sometimes patients with pancreatitis become ill and require hospital care. Marie hopes this app will allow her and the team to identify these patients much earlier to help them avoid a presentation at the Emergency Department. Marie says “If patients do need hospital care we are lucky in TUH, that they can be directly admitted to the Acute Surgical Assessment Unit for review.”

Next innovation?

Marie says, “Patient Initiation review (PIR) is our next project through the SMART CP app.  This to our knowledge will be the first digitalisation of the process of PIR. This will enable patients to schedule their own follow-up appointments on an ‘as needed’ basis. This patient-centred approach differs significantly from the traditional ‘physician-driven’ model wherein patients are offered review appointments at routine intervals at outpatient clinics. Often, these pre-booked appointments occur at a time when the patient’s condition is relatively stable and little action is needed. Conversely, if a patient experiences sudden exacerbation of symptoms, urgent outpatient appointments may not be available, as outpatient capacity is reduced due to unnecessary follow-up appointments.”

 Marie believes strongly that against the backdrop of a steadily increasing prevalence of chronic diseases in Ireland and an ageing population, our healthcare system is ill-equipped to address the complex needs of individuals managing multiple comorbidities. She says, “It is therefore imperative to transform and modernise our healthcare system to ensure timely and efficient care for all.”

The development of the new Smart CP app was funded by the HSE and the Department of Public Expenditure.

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To mark the end of Childhood Cancer Awareness Month in September, Children’s Health Ireland is proud to announce the opening of a new Intrathecal Procedure Suite on St. John’s Ward in CHI at Crumlin.

Children and young people aged 0 to 16 years who have blood disorders and/or cancers may be admitted as inpatients to St. John’s Ward. Some of these patients need intrathecal chemotherapy – a treatment in which chemotherapy drugs are injected directly into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. This allows the medicine to reach the brain and spinal cord more quickly and effectively. It is often used to treat certain conditions, such as cancer, infections, or pain, especially in children who need targeted care.

Until recently, patients on St. John’s Ward who needed an intrathecal procedure were brought to theatre, but since Monday 19^th August 2024, they can now make a much shorter journey to the new state-of-the-art Intrathecal Procedure Room right on St. John’s Ward. This purpose-designed space will significantly improve the delivery of care for these patients. It will streamline treatments and ease the journey for children and their families during what is often a difficult and emotional period.

Ruairi was one of the first inpatients on St. John’s Ward to use the new intrathecal procedure room. Ruairi’s Mum, Orla, said:

“Ruairi and all of his friends on St. John’s Ward have been so well looked after. Since he was first diagnosed, the team here make difficult experiences as easy on him as possible with kindness, humour and play.”

Dr Jane Pears, Consultant in Oncology with Children’s Health Ireland, said:

 “The opening of this facility underscores Children’s Health Ireland’s ongoing commitment to recognising the strength and resilience of children who have cancer and enhancing their care and safety. This new procedure room represents a monumental step forward in the care we provide to our young patients. It allows us to perform intrathecal procedures in a setting designed specifically for children and young people, making the experience as comfortable and stress-free as possible.”

Director of Nursing in CHI at Crumlin, Karen McGuire, thanked everyone involved in bringing this facility to fruition:

“This new intrathecal procedure suite is more than just a new space; it is a testament to the dedication, hard work, and compassion of the entire staff in keeping the patient the focus for what we do. It is the result of the collaborative efforts of the St. John’s Ward team, anaesthetic and theatre teams, porters, healthcare assistants, and the operational team in CHI at Crumlin. Our team’s commitment to delivering exceptional care in the most compassionate manner is truly reflected in this new suite.”

September was Childhood Cancer Awareness month, a month where around the world people come together to raise awareness of childhood cancer and pay tribute to all those affected.

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Under the visionary leadership of Clinical Director of Surgery, Mr. David Mulvin, and Chairperson, Ms. Louise Veitch, who is ADON in charge of the robotic committee, SVUH’s commitment to pushing the boundaries of surgical innovation has been unwavering. Spearheading this transformative journey is Ms Sara Nicholson CNM3 and Ms. Maple Wu CNM2, alongside a highly skilled team of nurses, who ensure the seamless day-to-day operation of SVUH’s robotic theatre.

“Reaching the remarkable milestone of 2000 robotic surgeries underscores our relentless pursuit of excellence in patient care and outcomes,” says Mr David Mulvin. “With minimal cancellations and recognition as a high-volume centre, SVUH completed 443 cases last year, with an average of 240 cases per machine annually in the United States. At SVUH, we are dedicated to leveraging the latest advancements in robotic technology to provide our patients with the highest standard of care, tailored to their individual needs.”

Robot-assisted surgery stands at the forefront of a revolutionary shift in surgical care, characterised by its minimally invasive nature and soaring global adoption rates. Offering patients a multitude of benefits, including reduced scarring, minimal blood loss, negligible infection rates, diminished postoperative pain, and accelerated recovery times, it has redefined the landscape of modern healthcare. Moreover, the initial capital investment in robotic surgical systems proves to be a prudent expenditure, as it results in reduced hospital stays, fewer complications, and expedited returns to daily activities for patients. The unparalleled manoeuvrability of robotic arms, capable of 360-degree rotation, facilitates the swift and safe completion of increasingly complex surgeries.

Beyond its direct patient benefits, robotic systems usher in a new era of surgical innovation, equipped with advanced features such as machine learning, data analytics, eye-tracking navigation systems, and cutting-edge imaging capabilities. These advancements not only mitigate the trauma of surgery but also empower surgeons with unparalleled precision and efficiency in their procedures. As a result, robotic surgery transcends geographical boundaries, transforming the scope and impact of surgical interventions on a global scale.

With 12 consultant surgeons across six surgical specialties independently performing robotic surgeries, SVUH boasts an expert team with a wealth of experience and expertise. From Urology to Thoracic surgery, hospital surgeons are leading the way in utilising robotic technology to achieve optimal patient outcomes and revolutionise surgical care in Ireland.

As SVUH celebrates this monumental achievement, the hospital reaffirms its dedication to advancing research and innovation in robotic surgery, ensuring that patients continue to receive the highest quality of care. With a steadfast commitment to excellence, SVUH remains steadfast in its mission to lead the way in patient-centred care and surgical innovation.

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When the COVID-19 pandemic hit, it became harder for OPAT patients and their families to have in-person discussions with the hospital OPAT team due to face masks and visitor restrictions. There was no national online resource for OPAT patients available to learn about the program.  Responding to this need, OPAT Clinical Nurse Specialists Fiona Guidera and Liz Forde , used funding (HSE SPARK Innovation) to create an online resource. They partnered with the Creative Digital Media course at Cork College of Further Education. Dr Arthur Jackson, Infectious Disease Consultant & Clinical Lead for the OPAT Service CUH and MUH worked with the team to develop the resources.

The class of 2021/22 Creative Digital Media took on this extracurricular project during the year and after their end of year exams. Together we produced an online patient resource. Four videos provide information about OPAT for patients, families, and carers:

• OPAT-Your Path Home – A short animation
• OPAT – Before You Go Home – Video
• OPAT -When You Go Home – Video
• OPAT – Role of Infectious Disease Consultant – Video

You can view the videos here: https://www.cuh.hse.ie/our-services/our-specialities-a-z/opat/

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This new AI based diagnostic system can change how clinicians evaluate biopsies with a faster, less expensive, and objective assessment tool while being adaptable for a wider field of tissue applications in pathology worldwide.  Ulcerative colitis (UC) is a common chronic inflammatory bowel disease (IBD) that induces inflammation and ulcers in the digestive tract.  It can lead to a range of complications, ill health and suffering and has no known cure, although several treatments can help alleviate symptoms and reduce or eliminate inflammation. Clinical assessments use histopathology as the most effective means of detecting and identifying inflammation and remission.

Traditional UC assessment involving microscopic inflammation is typically complex, time and training intensive, expensive and subject to high interobserver variability.  In their analysis, the team used a sample of 535 biopsies drawn from 273 patients spread across 11 different international centres – providing the benefit of a large sample size and helping to optimise data fit and suitability for the computer model. Between 66%-75% of the biopsies were in histologic remission.

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The variety of activities being provided through Telehealth include Consultant Clinics, Interdisciplinary Team (IDT) assessment and intervention, individual and group treatment programmes and therapy sessions.

The NRH Outpatient Department worked through the COVID-19 management group to establish new protocols to allow services to reopen safely and stay open through subsequent severe pandemic restrictions. Since services initially reopened in June 2020 on a phased basis, there was no further need to fully shut down again and those patients who required in-person care were safely provided for in the Outpatient Department.

By the end of 2020 Outpatient services were running at pre-COVID levels using a hybrid model of in-person care where required and Telehealth. This is a significant achievement in maintaining access to rehabilitation services. The majority of services for NRH Outpatient Services were redesigned as a result of COVID-19. This also impacted the administration team who rapidly learned and adapted to new processes and technology in order to allow clinical work to be continued efficiently and ensure that any impact on services to patients was kept to a minimum.  Following the lifting of the pandemic restrictions, and the success of the telerehabilitation systems put in place, many patients attending the Outpatient Service have opted for a hybrid model of combined video-enabled and in-person care.

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Rehabilitation is an essential part of any modern healthcare system; it improves health outcomes, reduces disability, improves quality of life and reduces costs by reducing hospital stays. WHO Rehabilitation 2030 calls for global action to scale-up rehabilitation. Digital technology has the potential to transform rehabilitation by revolutionising how services are delivered.  ROSIA is ready to deploy a complete digital solution set for scale-up based on a model of integrated care and value-based care.

The ROSIA Project aims to enable the remote delivery of healthcare, telerehabilitation and supported self-care.

The NRH is one of the three organisations who aim to acquire the design of the future’s telerehabilitation services for remote areas.

Development of an ICT Innovation Ecosystem for telerehabilitation can integrate technology from third parties, with the potential to remotely address the need for: interaction with clinicians, evaluation, exercises definition, exercises performance, adherence and motivation, for a broad range of pathologies.

The ROSIA project focuses on the design and development of an intelligent platform for telerehabilitation services, and design and development of a catalogue of Applications and devices which will connect to this platform, allowing community supported and supervised self-care services to be integrated into patients’ care plans. ROSIA’s value-based model of integrated care can also open the door to rethinking new business models and incentives for providers, improve equity in access to rehabilitation resources and contribute to improving the sustainability of these services.

The NRH is also a pilot site for the testing the usability and feasibility of the ROSIA ICT Innovation Ecosystem’s catalogue and open platform in real-life situations. The testing is due to commence in June 2024.

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