Delivered by Dr Colin Doherty, Epilepsy Clinical Lead, Health Service Executive at the IPHA Annual Meeting 2010 during the Session entitled "Ensuring the best health outcomes for Irish patients while securing value for money".

1. The development of national
programmes of care
Colin Doherty MD
National Clinical Lead in the
Epilepsy programme
DQCC HSE

3. Journey
Hospital A
Hospital C
Hospital B
Private H
GPA
GPB
A&E
A&E
Hospital D
Nursing
Home A
Nursing
Home B
GPC

4. What are the consequences of
such fragmented care?

5. Example 1. Patient Safety
• Studies done since the 1970's have shown the high
incidences of medical errors and deaths resulting from
them.
• The Harvard Medical Practice Study (1991) estimated
iatrogenic injury contributed to 180,000 deaths in US
annually, more recent figures suggest 98,000.
• A recent study suggested that 17% of hospitalized patients
are the victim of an error
• Yet, today only 3% of physicians believe that medical
errors are a principal health concern. There is more
concern with car accidents!

6. Comparisons

7. Alarming Medical Safety Stats
• The total number of medical errors and deaths equals three jumbo
jets crashing every 2 days (note in 1998 no domestic airline
fatalities)
• The error rate of ICU's (Intensive Care Units) 1.7% would be like the
post office losing over 16,000 pieces of mail every hour of every
day.
• Or like our banks wrongly cashing 32,000 checks every hour of
every day, every year!
• 7,000 patients die each year because of sloppy handwriting.
• 7.5 million unnecessary medical and surgical procedures are
performed annually.
• More than half of the U.S. population has received unnecessary
medical treatment.

8. Now for the Good News
• There is a way to reform the health system to
create a high quality, low cost system that fair
and equitable for all citizens.
• A proper system of Chronic Disease
Management is central to this process.
• 2. Principles:
1. Align all funding and payment incentives to
encourage integrated care of chronic disease:
Centralize when necessary; decentralized when possible.
2. Promote value conscious consumption of HC.
Provide quality, cost effective, transparent care backed by evidence and
outcomes.

9. Objective of Quality and Clinical
Care Directorate & the National
Programmes
Dr. Barry White

10. What is the mission of the
Directorate of Quality & Clinical
Care?
• Better care and better use of resources
• If patients get the right treatment we can save
lives and money

11. 2. Why take a programmatic
approach to change?
•The advantages of developing chronic disease management
programs are:
– Structured approach
– Change is led by experienced clinicians.
– Generates clinical buy-in and ownership from the start
– Engages Colleges and professional bodies.
– Enables greater organisational responsiveness i.e.
frontline staff can access the top of the organisation in
one step via the national lead.
– Sustained focus

12. 4. What are the clinical programs
& initiatives?
• 2. Chronic disease management programs
– Stroke
– Acute coronary syndrome
– Heart failure
– Asthma/COPD
– Diabetes
– Epilepsy
– Mental health
• 3. Outpatient management programs
– Dermatology
– Neurology
– Rheumatology
– Orthopaedics
• 4. Emergency function related programs
– Acute Medicine
– Elective surgery
– Diagnostic Imaging
– Care of the elderly
• 5. Key Quality Safety and Risk initiatives
– Governance
– Underperforming clinician process
– Patient safety bundles
– Incident reporting
– Audit
• 6. Other Clinical program areas
– Obstetrics
– Paediatrics
– ICU
– HCAI
– Palliative care
– Neurorehab
• 7. Enabling programmes
– Development of a resource allocation
model
– Pharma strategy
– Implementation of Clinical Directorates
– Defining a standard approach to
delivering change
1.PrimaryCarePro

13. 4. Overall principles
• Set goals that achieve gains in cost, quality, access and
compliance
• Set goals that are simple and meaningful – e.g. prevent
300 stroke deaths
• Target what is achievable
• Nationalise existing local good practice - do not reinvent
the wheel
• Ensure local ownership (authority, accountability and
responsibility)
• Ensure patient involvement

14. Hospital B
Private H
GPA

15. Example of care pathway for chronic disease: epilepsy
Prevention Managed Primary
Care (PC)
Secondary
hospital Care
SC
Tertiary
Hospital care
regional (RC)
centre
National
Specialist
centre
Antenatal care
Alcohol abuse
Stroke prevention
-HTN
-Cholesterol
-Afib
-smoking
Brain trauma
-Speeding
-Alcohol
General Epilepsy Care
-Diagnosis
-Classification
-Treatment and first AID
-Prognosis
-Life style triggers
-SUDEP
AEDs
-Choice
-Side effects
-Interactions
-Long Term Illness card
Women’s Issues
-Contraception
-Pregnancy
-Breastfeeding
Social issues
-Driving
-Employment
-safety
Psychology
-Cognitive effects
-Mood effects
General Epilepsy Care
-First Seizure
-Acute management
of refractory seizures
-Status Epilepticus
Diagnostics
-Brain imaging
-EEG (if possible)
-Classification
-Initiate Treatment
Referral
-Primary Care
-Regional Epilepsy
Centre Rapid Access
Clinic
-Mobile phone
-E-mail
-Video Link
-Phone
-Community
Epilepsy nurse
clinic
General Epilepsy Care
-First Seizure
-Acute management
of refractory seizures
-Status Epilepticus
Diagnostics
-Brain imaging
-EEG
-Classification
-Initiate Treatment
-Treatment review for
Refractory epilepsy
-Prognosis
Access from PC and SC
-Rapid Access Clinic
-Subspecialty Epilepsy
Clinic
-A&E
-Video-Consultation
-E-mail/phone/fax
-Self management Prog
Counselling
-Epilepsy Nurse
specialist
-Nurse Led clinic
-Brainwave CRO
Pre-Surgical
Diagnostics
-Brain imaging (3T)
-EEG
-Video-EEG
-Classification
-Neuropsychology
-Neuropsychiatry
Access from PC, SC and
RC
-Rapid Access Clinic
-Subspecialty Epilepsy
Clinic
-A&E
-Video-Consultation
-E-mail/phone/fax
Counselling
-Epilepsy Nurse
specialist
-Nurse Led clinic
-Brainwave CRO

16. National Epilepsy Service of
Ireland (NESI)
Dublin
1 Paediatric
1 National
Centre
1 Adult
Cork
1 Paediatric
1 Adult
Sligo
1 Adult
Galway
1 Adult
Limerick
1 Adult
1-5 years
5-10 years
EPR Networks
and Videolinks

17. Centres
The National Epilepsy Service of Ireland.
Welcome to the NESI web portal. Our mission is to provide
our patients with epilepsy, their families, doctors and carer’s
with the most comprehensive access to specialist epilepsy
opinion, advice, and service in Europe.
We guarantee access to one of our centres within two weeks
of first seizure and once registered we provide state of the art
disease surveillance and management according best national
and international practice.
www.nesi.ie/standardsofcare
Specialist
centres near
you
Staff
Teaching
Research
Nursing
Community
support
GP access
Patient
Resources
NESI
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Nov 25th 2015
Epilepsy Services in Ireland