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Needs assessment for dedicated inpatient beds for CF patients in Beaumont Hospital

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Cystic Fibrosis Association of Ireland

A needs assessment for dedicated CF inpatient beds in Beaumont Hospital

Report

TSA Consultancy | June 2011


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Table of contents ACKNOWLEDGMENTS ......................................................................................................................... 4

ACKNOWLEDGEMENTS FROM THE RESEARCHERS ............................................................................................... 4

ACKNOWLEDGEMENTS AND THANKS FROM CFAI ............................................................................................. 4

1 INTRODUCTION AND BACKGROUND ........................................................................................... 5

1.1 OBJECTIVES OF RESEARCH ................................................................................................................ 5

1.2 METHODOLOGY ............................................................................................................................. 6

1.3 FORMAT OF REPORT ....................................................................................................................... 7

2 CYSTIC FIBROSIS IN IRELAND ....................................................................................................... 8

2.1 CYSTIC FIBROSIS ............................................................................................................................. 8

2.2 CF PROFILE AND DATA – THE CYSTIC FIBROSIS REGISTRY OF IRELAND ........................................................ 8

2.3 FACTORS AFFECTING PATIENTS NUMBERS AND TRENDS ......................................................................... 12

3 CF PROVISION IN BEAUMONT HOSPITAL .......................................................................................... 16

3.1 PATIENT NUMBERS AND DEMOGRAPHIC PROFILE ................................................................................. 16

3.2 CURRENT AND PROJECTED INPATIENT NEED FOR CF PATIENTS IN BEAUMONT HOSPITAL ............................. 18

4 OPTIONS FOR THE DELIVERY OF DEDICATED CF INPATIENT BEDS .............................................. 21

4.1 INTRODUCTION ............................................................................................................................ 21

4.2 SPECIFICATIONS FOR DEDICATED CF INPATIENT SPACE .......................................................................... 21

4.3 CURRENT INFRASTRUCTURE DEVELOPMENTS IN BEAUMONT HOSPITAL .................................................... 23

4.4 PROVISION OF DEDICATED CF INPATIENT BEDS THROUGH NEW BUILD ..................................................... 24

4.5 PROVISION OF DEDICATED CF INPATIENT BEDS THROUGH WARD REFURBISHMENT ..................................... 25

4.6 PROJECTED CAPITAL AND STAFFING COSTS ......................................................................................... 26

4.7 POTENTIAL SOURCES OF FUNDING .................................................................................................... 29

5 CONCLUSIONS AND RECOMMENDATIONS ................................................................................ 32

REFERENCES AND BIBLIOGRAPHY ..................................................................................................... 34

APPENDICES ..................................................................................................................................... 35

APPENDIX 1 | POLLOCK REPORT STAFFING REQUIREMENTS FOR CF SERVICES AT 50, 120 AND 150 PATIENTS AND

CURRENT STAFFING LEVELS IN CF UNIT, BEAUMONT HOSPITAL .......................................................................... 35

APPENDIX 2 | PROPOSED LAYOUT WARD RE-PLANNING BEAUMONT HOSPITAL (THIRTEEN-BED SINGLE ROOM WARD) . 38

APPENDIX 3 | PROPOSED SINGLE ROOM DETAILED LAYOUT (WARD REPLANNING) BEAUMONT HOSPITAL .................. 39

WARD LAYOUT (MAU BUILDING) BEAUMONT HOSPITAL ................................................................................. 40


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Index of tables

Table 1-1 Consultations undertaken ........................................................................................................ 6

Table 2-1 People with CF by county of residence (2010) ........................................................................ 11

Table 2-2 Frequencies of the most common CF mutations in living CFRI enrolees, 2010 ..................... 12

Table 2-3 Total number of dedicated inpatient beds for CF patients in operation or in development . 13

Table 2-4 Hospitalisations, exacerbations and complications amongst adults with CF, 2010 ............... 14

Table 3-1 CF inpatient admissions statistics Beaumont Hospital 2008-2011......................................... 17

Table 4-1 Summary of strengths and weaknesses – options for additional beds ................................... 27

Table 4-2 estimated exclusive ward staffing requirements for a 13 bed ward (single rooms) ............... 28

Table 4-3 estimated ward non-pay costs for a 13 bed ward (single rooms) ........................................... 28

Table 4-4 Total estimated wage and non-wage costs for a 13 bed ward .............................................. 29

Index of figures

Figure 2-1 Ratio of adult to paediatric census-identified people with CF 2004-2010 .............................. 9

Figure 2-2 Age and gender distribution of people with CF by age band, 2010 ...................................... 10

Figure 2-3 Cumulative number of hospital and home IV antibiotic days, 2010 ..................................... 15

Figure 3-1 Counties of residence (percentages) for current CF patients in Beaumont Hospital ........... 16

Figure 3-2 Age profile of CF patients in Beaumont Hospital .................................................................. 17

Figure 4-1 Aerial image of Beaumont Hospital indicating potential new build option .......................... 24


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Acknowledgments

Acknowledgements from the Researchers

The researchers would like to thank the individuals who agreed to be consulted

and gave of their time, in particular, to the staff of Cystic Fibrosis Association of

Ireland, Beaumont Hospital (medical and management), and CF Hopesource

who provided invaluable information and for sharing their expertise.

Thanks in particular to Philip Watt for his support and guidance in completing

the report.

We are also grateful to family members of cystic fibrosis and cystic fibrosis

patients who gave us an insight into their experiences and how they consider an

inpatient Cystic Fibrosis unit should be designed and operated.

A list of the individuals consulted is contained in the report on page 6.

Acknowledgements from CFAI

The Cystic Fibrosis of Ireland (CFAI) wishes to thank and acknowledge the

quality of this report written by Tanya Lalor assisted by Ger Doyle of TSA

Consultancy. We further wish to thank the Beaumont Hospital CF inpatient

working group which includes:

Mr Liam Duffy, CEO Beaumont Hospital; Professor Gerry McElvaney, CF

Consultant, Beaumont Hospital; Dr Cedric Gunaratnam, CF Consultant,

Beaumont Hospital; Paul Dempsey, CF Hopesource; Christine Drummond, CFAI

Eastern Branch; Philip Watt, CEO CFAI; Ann Marie O Grady, Head of Clinical

Services and Business Planning, Beaumont Hospital; Maeve Mullin, CF

Hopesource/CFAI Eastern Branch; Hilary Walshe, CF Hopesource/CFAI Eastern

Branch and the CF nurses Anne Marie Lyons and Helen Burke. We thank those

who contributed to this report, in particular those who agreed to be interviewed

who are listed on page 6 or who provided advice and information.

Thanks to the Board of the CFAI, chaired by Mr John Coleman and the Chair of

the Staff and Finance Committee, Mr David Fitzgerald, which provided support

and the necessary funding for this needs assessment.

Philip Watt, CEO CFAI


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1 Introduction and background

This report has been commissioned by Cystic Fibrosis Association of Ireland

(CFAI) in order to identify the current and projected needs for dedicated

inpatient beds for Cystic Fibrosis (CF) patients in Beaumont Hospital. CFAI is

part of a working group that includes the CFAI, CF Hopesource, clinicians and

Beaumont hospital management. The report was requested by Hospital

management.

Ireland has the highest incidence of CF in the world1. Beaumont Hospital is one

of the most important adult Cystic Fibrosis centres in Ireland. At present, there

are four dedicated inpatient beds that are prioritised for use by CF patients in

Beaumont Hospital.

TSA Consultancy has been contracted to undertake the needs assessment.

1.1 Objectives of research

The terms of reference document identifies the following questions to be

addressed in the needs assessment:

Are more dedicated inpatient rooms needed in Beaumont Hospital for

adult patients with Cystic Fibrosis (CF)?

If yes, how many rooms are required, based on present and projected

patient numbers and clinical need?

What options are available to provide such dedicated rooms within the

hospital (e.g. refurbishment of an existing ward or new build)?

What is the optimum general specification for the design of such rooms?

What are the minimum and optimum levels of staff cover needed as a

consequence of the expansion of inpatient services in Beaumont

compared with the present level?2

What is the approximate cost of providing additional rooms? (Figures

should be disaggregated to show main costs.)

How can this project be funded? (A range of possible sources to be

explored.)

1 Farrell, P., Joffe, S., Foley, L., Canny, G.J., Mayne, P., Rosenburg, M. (2008). ‘Diagnosis of cystic fibrosis in the Republic of Ireland: epidemiology and costs.’ Irish Medical Journal; 100(8):557-60. Dublin: IMJ 2 Staff means the members of the multi-disciplinary team required to treat people with CF.


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1.2 Methodology

In addressing the above questions, desk research and interviews with key

informants were undertaken. Desk research included studying a number of

published reports on CF, as well as data and statistics on the incidence of CF in

Ireland. Documents consulted included:

The Pollock Report

Health Service Executive (HSE) CF Services Report

European Cystic Fibrosis Society (ECFS) standards of care

Cystic Fibrosis Registry data/patient numbers and projected numbers

in Beaumont

Strategic plans of Beaumont Hospital

Interviews were conducted with people with CF and with patient advocacy

organisations, clinicians, hospital management, technical experts in the built

environment and others. Those consulted are outlined in the table below.

TABLE 1-1 CONSULTATIONS UNDERTAKEN

Dr Cedric Gunaratnam Consultant, CF and Respiratory Medicine, Beaumont Hospital

Philip Watt Chief Executive Officer, CFAI

Caroline Heffernan CFAI patient advocate, PWCF attending Beaumont Hospital

Thomas Fynes PWCF attending Beaumont Hospital

Tomás Thompson CFAI advocate and PWCF

Manfredi Anello Architect, CFAI facility in Our Lady of Lourdes Hospital, Drogheda

Anne Marie O’Grady Head of Clinical Services and Business Planning, Beaumont Hospital

Liam Duffy Chief Executive Officer, Beaumont Hospital

Paul Nadin Head of Projects and Estates Management, Beaumont Hospital

Maeve Mullin CF Hopesource Foundation/CFAI

Elmarie Walsh CF Hopesource Foundation/CFAI

Jane O’Donoghue Baxter Healthcare

Mark Butler Clinical Nurse Specialist, the London Chest Hospital (Barts Health NHS Trust)


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1.3 Format of report

Section 2 provides an overview of CF in Ireland, including statistics on the

incidence, outcomes, provision of services and key policy provisions.

Section 3 describes the current provision of services and need for CF inpatient

services in Beaumont Hospital.

Section 4 discusses potential options and costs for the delivery of dedicated

inpatient beds for CF patients in Beaumont Hospital.

Finally, Section 5 provides a series of recommendations for meeting the needs of

CF patients.


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2 Cystic Fibrosis in Ireland

2.1 Cystic Fibrosis

Cystic Fibrosis (CF) is Ireland's most common life-threatening inherited disease.

Approximately 1 in 19 people in Ireland are carriers of the CF gene (compared to

1 in 25 in the UK3) and where two carriers parent a child together, there is a 1

in 4 chance of the baby being born with Cystic Fibrosis.

CF damages many organs including the lungs, the pancreas, the digestive tract

and the reproductive system. It causes a thick, sticky mucus to be produced,

blocking the bronchial tubes and preventing the body's natural enzymes from

digesting food. Cystic Fibrosis primarily affects the lungs and the digestive

system.

A build up of mucus can make it difficult to clear bacteria and leads to cycles of

lung infections and inflammation, which can eventually lead to damage of the

lungs. CF can also make it difficult to digest and absorb adequate nutrients from

food. Mucus blocks the duct of the pancreas, preventing enzymes from reaching

the intestines to digest food.

As a result, persons with CF must consume artificial enzymes with food to help

them absorb adequate nutrition. They must also follow a demanding daily

routine of physical therapy to keep the lungs free of congestion and infection.

There is no cure for CF, but, as therapeutic options have expanded over the last

decade, significant advances have been achieved in both life expectancy and

quality of life. Life expectancy has increased steadily over the past twenty years,

and today CF is no longer exclusive to childhood. The symptoms and severity of

CF vary from person to person. However, CF usually becomes more severe with

age and affects both males and females in equal proportions.

2.2 CF profile and data – the Cystic Fibrosis Registry of Ireland

It is acknowledged that better treatment strategies and management of CF can

be developed using patient registries, which gather information on all aspects of

a CF patient’s conditions. Detailed analysis of this information can yield

significant findings about the most effective treatments for CF.

3 Lowton, K. and J. Gabe (2003). ‘Life on a slippery slope: perceptions of health in adults with cystic fibrosis.’ Sociology of Health and Illness 25(4): 289-319.


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The Cystic Fibrosis Registry of Ireland (CFRI) was established to keep relevant

medical records of each patient with Cystic Fibrosis in a central computer

system. It has been funded by the Department of Health and Children and the

Health Service Executive (HSE) since its establishment in 2001. Over 300

clinical details are recorded each year for each person.

Each year CFRI publishes an annual report. According to its 2010 annual

report, there were 1,044 of enrolees on the register:4 57.1% were male, 42.9%

were female, and 52.7% were aged 18 years and older.

The age profile of CF patients has increased in recent years as patient outcomes

and treatments and facilities have improved. In this section, a profile of CF

patients according to the CFRI Annual Report 2010 (the most recent report

available at the time of conducting the research) is provided, and factors that are

likely to impact on future outcomes for patients are outlined.

RATIO OF ADULT TO PAEDIATRIC CF PATIENTS

According to CFRI, the ratio of adult to paediatric identified CF patients has

increased each year since 2004 at a rate of approximately 2% per annum. In

2010, 54.5% of patients with CF identified were adults (aged over 18 years). The

rate of increase is illustrated in Figure 2-1 below.

FIGURE 2-1 RATIO OF ADULT TO PAEDIATRIC CENSUS-IDENTIFIED PEOPLE WITH CF 2004-2010

Source: CFRI Annual Report 2010

4 A census recording the numbers of people with CF registered at CF centres and clinics in Ireland was performed by the CFRI in early 2010. A total of 1,160 people with CF were identified (of whom 1,044 had enrolled with the CFRI by the end of that year). This suggests that 90% of the known CF population in the Republic of Ireland has enrolled on the CFRI.


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The increase in the ratio of adult to paediatric patients is believed to be an

outcome of better treatment for CF in Ireland.5 The lower mortality rate of CF

patients is reflected in registry figures, which tell us that the annual number of

deaths from CF has been reduced each year since 2007.

AGE AND GENDER DISTRIBUTION FOR CF PATIENTS

In 2010, the average age of CF patients was 19.6 years. Females have a lower

age profile compared with males; this is attributed to poorer health outcomes for

female patients with CF. The age profile of CF patients in 2010 is outlined

below.

FIGURE 2-2 AGE AND GENDER DISTRIBUTION OF PEOPLE WITH CF BY AGE BAND, 2010

Source: CFRI Annual Report, 2010

According to CFRI, the median age at death in 2010 for CF patients increased to

28.5 years from 25 years in 2009. The registry cautions about using this as a

measure of CF survival as it describes the duration of life only in those patients

who have died. Moreover, the HSE also notes that while life expectancy is

constantly increasing, median age at death will invariably underestimate

median survival.6

5 Factors which may impact on patient outcomes are outlined in section 2.3 below. 6 HSE (2009). Services for People with Cystic Fibrosis in Ireland – Conclusions of a Working Group established by the Health Service Executive. Dublin: HSE (21).


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COUNTY OF RESIDENCE

The prevalence of CF patients is highest in Dublin: in 2010, 27% of CF patients

(282 patients) were from Dublin. Cork had the next highest frequency of CF

patients (13.2%, 138 patients). The table below outlines the number of patients

with CF by county in 2010.

TABLE 2-1 PEOPLE WITH CF BY COUNTY OF RESIDENCE (2010)


FREQUENCY OF CF GENOTYPE

The most commonly detected genotype of CF patients in Ireland is delta F508

homozygous (57.3% of patients in 2010). Delta F508 G551D (10.8%) and delta

F508 R117H (3.6%) are the next most frequently identified genotypes. 90.3% of


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CFRI enrolees have at least one delta F508 allele7, and these people tend to have

more severe symptoms.

TABLE 2-2 FREQUENCIES OF THE MOST COMMON CF MUTATIONS IN LIVING CFRI ENROLEES, 2010


2.3 Factors affecting patients numbers and trends

The prognosis for Cystic Fibrosis has improved significantly in recent years, and

patients have recorded greater longevity. Part of the reason for this is improved

patient care, particularly through the establishment of dedicated CF centres.8

Research has indicated that differences in healthcare provision may be an

important factor in CF survival.9

7 An allele is one of two or more forms of a gene or a genetic locus (generally a group of genes). 8 According to Kerem et al, centre care is associated with better survival of CF patients. The authors note that there is moderate evidence from respected authorities, clinical findings, descriptive studies, or reports of expert committees to support this. Kerem, E., Conway, S., Elborn, S., and Heijerman, H. (2005). ‘Standards of care for patients with cystic fibrosis: a European consensus.’ Journal of Cystic Fibrosis, 2, (2005), 7-25. 9 Fogarty A., Hubbard R., Britton J. (2000). ‘International comparison of median age at death from cystic fibrosis.’ Chest. Jun 2000;117(6):1656-60. Cited in CFAI’s Current trends in quality improvement for cystic fibrosis care.


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INCREASED AVAILABILITY OF SPECIALIST FACILITIES

In recent years, the availability of specialised CF centres has ensured that a

greater number of patients with CF have access to dedicated services necessary

for good patient outcomes and consistent with consensus standards for CF care,

including multi-disciplinary teams. There are eighteen CF centres in Ireland, of

which five are adult CF centres with inpatient facilities. The centres with

dedicated inpatient beds are based in St Vincent’s University Hospital (Dublin),

Cork University Hospital, Mid-Western Regional Hospital (Limerick), Beaumont

Hospital (Dublin) and Galway University Hospital.

Since 2010, developments that have taken place have improved access to both

day facilities and inpatient facilities. At the time of writing this report, a

number of these were nearing completion, including a day (ambulatory) facility

with three (outpatient) treatment rooms in Our Lady of Lourdes Hospital,

Drogheda; a facility in the Mid-Western Regional Hospital, Limerick, which will

provide nine inpatient beds; and a development in St Vincent’s University

Hospital which will result in thirty-four dedicated inpatient beds for CF

patients. At present, the total number of CF beds completed or in development

in the country is sixty-one, as outlined in Table 2-3 below.

TABLE 2-3 TOTAL NUMBER OF DEDICATED INPATIENT BEDS FOR CF PATIENTS IN

OPERATION OR IN DEVELOPMENT

CF centre No of dedicated inpatient beds

St Vincent’s University Hospital 3410

Mid-Western Regional Hospital, Limerick 911

Cork University Hospital 1112

Beaumont Hospital 4

University Hospital Galway (UHG) 3

Total 61

AGE-RELATED COMPLICATIONS FOR CF PATIENTS

As there is no cure for CF, patients rely on ongoing health services for

treatment. Moreover, as people with CF age, their health needs become more

complex and the rate of hospitalisation increases. According to CFRI:

10 In development, due to be completed by end June 2012 11 In development 12 In development


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As people with CF age, their condition becomes more complicated. Adult

PWCFs13 therefore have on average a greater number of hospitalisations,

respiratory exacerbations and complications than their paediatric

counterparts ... for adult PWCFs, hospitalisations, respiratory

exacerbations and complications have increased in 2010. (p.23)

CFRI includes data on hospitalisation for 412 adult patients in their annual

report for 2010.14 The incidence of hospitalisations, exacerbations and

complications are all higher for adults than for children with CF.

TABLE 2-4 HOSPITALISATIONS, EXACERBATIONS AND COMPLICATIONS AMONGST

ADULTS WITH CF, 2010

Number Average per

person with CF15

Number of hospitalisations 493 1.2

Number of respiratory exacerbations requiring IV antibiotics

741 1.8

Number of complications 1,637 4.0


The number of days’ treatment for patients requiring IV antibiotics is illustrated

in Figure 2-3 below. This indicates that a disproportionately high number of

adults (18+ years) with CF were hospitalised in 2010 compared with CF patients

under the age of 18, even when the age profile of all CF patients is taken into

account. The number of hospitalisations amongst adult patients is 1.6 times the

number of hospitalisations of paediatric patients, while the size of the adult

population is 1.15 times the paediatric population.

This disproportionate relationship is underscored by the consideration that a

higher proportion of people with CF aged over 18 years can administer IV

antibiotics at home, compared with those aged under 18.

13 People with Cystic Fibrosis 14 This is based on clinical information (annual assessment data) gathered. The number of CF patients for whom data is available is reflective of different data collection systems in hospitals and limited availability of data. 15 Based on a sample of 412 adults.


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FIGURE 2-3 CUMULATIVE NUMBER OF HOSPITAL AND HOME IV ANTIBIOTIC DAYS, 2010



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3 CF PROVISION IN BEAUMONT HOSPITAL

3.1 Patient numbers and demographic profile

Beaumont Hospital is one of three major centres in Ireland for adult CF care.16

120 adults with CF attend the clinic in Beaumont Hospital. The gender

breakdown of this caseload is 54% male, 46% female. This figure represents a

50% increase in patients since 2008 when there were eighty adult patients. Each

year since then, there has been an average increase of ten patients per year, and

according to CF consultants, there is an anticipated increase of ten to fifteen

patients per year for the medium term.17

COUNTY OF RESIDENCE OF PEOPLE WITH CF ATTENDING BEAUMONT

CF patients in Beaumont Hospital predominantly reside in Dublin, Meath,

Louth and Kildare, with additional patients from Donegal, Galway, Mayo and

Clare, as well as other counties. The map below indicates the counties of

residence for CF patients in Beaumont Hospital.

FIGURE 3-1 COUNTIES OF RESIDENCE (PERCENTAGES) FOR CURRENT CF PATIENTS IN BEAUMONT HOSPITAL

Source: CF centre, Beaumont Hospital

16 The other two major centres are St Vincent’s University Hospital and Cork University Hospital. 17 These are net increases in patient numbers, and take into account any deaths that may take place each year.

% of patients’ county of residence

61 (Dublin)

10 (Meath)

9 (Louth)

7 (Kildare)

4 (Clare, Mayo, Donegal)

2 (Galway, Kilkenny, Laois, Wicklow)

1 (Carlow, Waterford, Leitrim, Roscommon, Monaghan, Westmeath)

White: 0


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AGE PROFILE OF PATIENTS

The age profile of patients is illustrated in Figure 3-2 below: the predominant

age group is 20-27 years (accounting for 59 patients). The smaller number in the

16-19 years age group reflects the fact that patients may not make the transition

from paediatric to adult care until the age of eighteen.

FIGURE 3-2 AGE PROFILE OF CF PATIENTS IN BEAUMONT HOSPITAL

INPATIENT ADMISSIONS AND DEMAND FOR INPATIENT BEDS

In the past few years, there has been a marked increase in demand for inpatient

beds for people with CF in Beaumont Hospital. Figures from 2008–2011 are

shown in Table 3-1 below, which provides data for 143–153 separate admissions,

as confirmed by Beaumont Hospital.

According to the CF unit at Beaumont Hospital, the figures are an

underestimate of the demand and probably also an underestimate of the

admissions in the hospital: a patient’s admission may not be captured as a CF

admission unless the patient is specifically coded as a CF patient, which may or

may not occur, depending on what beds they access and how they are included in

the hospital’s coding system.

TABLE 3-1 CF INPATIENT ADMISSIONS STATISTICS BEAUMONT HOSPITAL 2008-2011

2011 2010 2009 2008

Bed days (inpatient only) 1,916 1,910 1,732 1,523

Average length of stay (days) 13.5 13.3 11.3 12.1

% increase on previous year 0.3% 10.3% 13.7%

This is in the context of a maximum of 1,460 bed days for the four dedicated

beds (based on 365 occupation x four beds).


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According to Beaumont Hospital CF consultants, the lack of beds can mean that

those who require inpatient stays may not access them, and may instead wait at

home until a bed becomes available. This has been confirmed by a CF patient

who required a bed for IV medication and could not access it as there were no

single beds available.

3.2 Current and projected inpatient need for CF patients in

Beaumont Hospital

The projected needs of beds in Beaumont Hospital are related to increasing

patient numbers and increasing severity of disease as patients gets older. In this

section, an outline of current and projected inpatient beds is provided.

STANDARDS OF CARE FOR INPATIENT BEDS

According to CF standards of care (European consensus):

A CF specialist centre must have sufficient beds available at all times for

immediate admission. Each centre should have a clear infection control

policy. The beds should be in single rooms, mainly to prevent cross

infection, and preferably with private, en suite toilet and bathroom ... there

should be no patient interaction allowed inside the hospital ...

separate rooms for each patient are also necessary in order to promote

adherence to physiotherapy and facilitate the inhalation of antibiotic

drugs.18

There is also consensus amongst clinicians and advocates that in order to

facilitate immediate admission to inpatient beds, the number of dedicated beds

should equal 10% of all CF patients.19 On the basis of the current CF caseload in

Beaumont Hospital, this would equate to twelve dedicated inpatient beds.

CURRENT PROVISION FOR DEDICATED INPATIENT BEDS IN BEAUMONT

HOSPITAL

At present, there are four inpatient beds for people with CF. These are located

within St Paul’s Respiratory Ward and are prioritised for CF patients.

These inpatient beds are prioritised for CF patients through an unwritten

agreement between Beaumont Hospital and the CF centre, and this provision

18 Kerem, E., Conway, S., Elborn, S., and Heijerman, H. (2005). ‘Standards of care for patients with cystic fibrosis: a European consensus.’ Journal of Cystic Fibrosis, 2, (2005), 7-25. 19 The provision of 10% of inpatient beds is also referenced in Pollock, R. (2005): Towards a better service: the treatment of cystic fibrosis in Ireland: problems and solutions 2005. Dublin: CFAI


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has been in place for the past two years. However, as it is an unwritten

agreement, and in the experience of the CF unit, there are competing interests

for these beds. Admissions are requested through the ward sister who passes it

with bed management before accepting the patient.

The current provision of beds is not sufficient to meet demand, according to CF

consultants in the hospital. According to current accepted standards of care,

eight more beds are required to cater for current patient needs.

IMPACT OF LACK OF INPATIENT BEDS

Discussions with CF consultants and people with CF attending Beaumont have

indicated that, if there is no dedicated bed available, patients have to access a

bed on a ward, for example within a surgical ward where the likelihood of cross-

infection or MRSA infection is limited. However, beds in such wards may not be

available.

The point was made that access to beds through A&E is rarely, if ever, pursued

by CF patients, given the risk of cross-infection.

In some instances, where there is a lack of beds, patients may remain at home

and self-administer IV antibiotics. However, CF patients stated that there are a

range of reasons why this arrangement is not appropriate and that it can

compromise patient outcomes. These include risk of allergic reaction as well as a

need for extra care from the multi-disciplinary team members to ensure full

compliance with treatment.

The limited number of beds can mean that the most sick or severe patients with

CF are prioritised, and those with a more moderate condition or less severe

symptoms rarely get access to the intervention they require, thus negatively

impacting on their condition.

PROJECTED NEED FOR CF INPATIENT BEDS IN BEAUMONT HOSPITAL

The projected caseload of CF patients in Beaumont is anticipated to follow the

same trajectory of demand as it has since 2008, and consultants project that it

will increase by 10–15 new patients each year. The factors giving rise to an

increase in adult patients are outlined in Section 2.3 above.

Moreover, because of a lack of multi-disciplinary teams and facilities in other

parts of the country and the need for a small number of centres with at least a

caseload of fifty patients each20, reliance on Beaumont as a centre for CF care is

likely to continue on the same scale as at present, especially for inpatient care.

20 As outlined in the Pollock report (2005), Op Cit., and in Kerem, et al (2005), Op Cit.


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According to the European consensus on standards of care for CF patients, ‘there

is no place for doctors working in isolation and caring for small numbers of

people with CF.’21

Consultations with clinicians, patients and patient advocate groups indicated

that there is an immediate need for twelve dedicated inpatient beds, and a

medium term need (2–5 years) for fifteen beds, based on projected demand. In

the longer term (beyond five years), the projected need for dedicated inpatient

beds for CF patients is up to twenty.

There was a consensus that these beds must be provided in a dedicated CF ward

in order to enable access to specialised and experienced staff. All beds should be

located in single rooms with en suite facilities, and in a location that is close to

the main hub and ancillary services of the hospital. The specific infrastructure

requirements and options for the delivery of these additional beds are discussed

in Section 4 below.

21 Kerem et al (2005), Op. Cit.


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4 Options for the delivery of dedicated CF inpatient beds

4.1 Introduction

The previous chapter identified an immediate need for twelve dedicated CF

inpatient beds in Beaumont Hospital, a medium term need for fifteen beds, and

a longer term need for twenty. From a project planning perspective, given the

lead time of facility development, a minimum of fifteen beds should be sought.

In this chapter, specifications for this provision as well as options for delivery in

Beaumont Hospital are given consideration.

There are a number of key issues, including whether the beds should be

provided through existing ward refurbishment or through a new build.

Developments in other CF centres in Ireland, for example, Cork, Limerick and

St Vincent’s in Dublin, have taken the form of new build projects. Feasibility is

considered in terms of overall developments taking place within Beaumont

Hospital as well as the views of those consulted.

4.2 Specifications for dedicated CF inpatient space

SINGLE EN SUITE ROOMS AND SPECIFICATIONS

For people with CF, single room wards, each with separate en suite facilities are

minimum requirements, given risks of cross-infection.

According to Health Building Notes (HBN)22 standards for single rooms for

intensive treatment units, which have been adopted by the HSE23, each single

room should be at least 19 SqM in size, with an additional 6 SqM provided for en

suite facilities (totalling 25 SqM). These are universal specifications which have

been observed since 2005. They are used by Beaumont Hospital in all new single

room developments.

There are additional HBN provisions for isolation rooms, e.g. additional space

for lobbies at the entrance to single en suite rooms.

22 The Health Building Notes (HBN) are a series of publications that set the UK Department of Health's best practise standards in the planning and design of healthcare facilities. They inform project teams about accommodating specific department or service requirements. They have been adopted by the HSE. These specifications are based on HBN No. 4. 23 And which are used as standard in single rooms with en suite facilities in Beaumont Hospital.


22

INFECTION CONTROL PROVISIONS

Infection control provisions (in terms of facility specifications) for CF inpatient

rooms must be of a higher specification than other patients, particularly in

respect of air conditioning and ventilation. There are no Irish standards for

specialised ventilation and air management systems: recommendations for

specialist air conditioning laid out in the UK’s Health Technical Memorandum

(HTM2403-01) Specialised Ventilation for Healthcare Premises (formerly

HTM2025) are specifications used in Ireland in infection control environments.

While there are no guidelines for air exchange for CF inpatients, consideration

could be given to including an air exchange system of twelve air changes per

hour (this is the number of air exchanges per hour in the CF clinic in

Beaumont).25 Similarly, a HEPA26 air filtering system would be a preferred

option for inpatient rooms.

In order to limit risk of infection, anti-microbial paint and anti-bacterial surfaces

and devices should be included in all equipment and fit-out specs.

ADDITIONAL SPECIFICATIONS

According to those CF advocates and people with CF consulted, the duration and

frequency of stays in hospital are generally greater for those with CF than for

the general hospital population. While in hospital, CF patients try to continue

day to day activities and functions. This, as well as the risk of cross infection,

necessitates some additional considerations when designing single en suite

rooms. These include:

Provisions for communication with other CF patients (for example,

internet facilities to enable video-conferencing, etc).

Colour scheme of room to include bright colours to avoid a clinical

environment

Consideration of privacy needs of patients as well as supervision

requirements: for example, provision of glass doors to facilitate

supervision, with screens or blinds that can also be used for privacy.

Privacy was a particular consideration for CF patients.

24 Health Technical Memorandum, published by the Department of Health in the UK. This HTM focuses on the design and validation of specialised ventilation systems, specifically in healthcare premises. 25 It compares with an air exchange of approximately four per hour in general hospital rooms and twenty per hour in hospital operating theatres. 26 HEPA is an acronym for ‘high efficiency particulate arrestance’.


23

LOCATION OF ROOMS

There was a consensus that inpatient CF beds must be located in a centralised

space in the hospital, in close proximity to specialised medical expertise,

including access to multi-disciplinary teams.

Dedicated CF beds should also be within a single and dedicated CF ward, rather

than being dispersed throughout the hospital. This took precedence over

preferences for either new build or ward refurbishment.

4.3 Current infrastructure developments in Beaumont Hospital

DRAFT DEVELOPMENT CONTROL PLAN

Beaumont Hospital has recently completed a draft development control plan,

which maps out infrastructure proposals for the hospital for the forthcoming ten

years. The document is expected to be approved by the hospital board of

management and by the Minister for Health.

The plan includes proposals for the redevelopment of the hospital on a phased

basis including the demolition of the main hospital building in order to achieve

improved ward and single room specifications.

The hospital redevelopment cost is estimated to be approximately €400 million,

and development will take place over a ten year period, subject to availability of

finance and approval of the proposals by the Minister for Health. It is also

subject to a potential merger of Beaumont Hospital and James Connolly

Memorial Hospital in Blanchardstown which could conceivably impact on

location of certain services.27

CURRENT INFRASTRUCTURE PROJECTS AT BEAUMONT HOSPITAL

The hospital undertakes ward refurbishment and reconfiguration each year. An

average of four wards have been refurbished each year: however, current

budgetary constraints have reduced this number to two. The latest

refurbishment project is the transplant ward.

27 This merger proposes a single governance structure for the two hospitals and may have implications for location of certain services. It has recently been approved by the HSE and will be considered by the Minister for Health.


24

With respect to meeting the needs for dedicated inpatient beds for CF patients,

the relative merits and feasibility of both new build and refurbishment is

discussed in the next section.

4.4 Provision of dedicated CF inpatient beds through new build

The main hospital building in Beaumont Hospital is configured in the form of

two four-storey buildings linked by a corridor which is perpendicular to the main

buildings. This gives the hospital the appearance of a H-shaped building.

A precedent for new build has been set by the development of a new three storey

modular building located within the H-shape of the main hospital building (the

Medical Assessment Unit). This project was completed in 2009 (see Figure 4-1

below).

The consultation process indicated that that replicating this building, on the

opposite side of the hospital link corridor, could facilitate a purpose-built CF

ward. It would be a joint project with other hospital departments requiring

space, as the building would comprise three floors. Figure 4.1 below provides an

aerial view of the existing hospital and newer building, and identifies where a

new building could be located.

Main hospital building (H shape) and link corridor

MAU Building Identified new build potential site

FIGURE 4-1 AERIAL IMAGE OF BEAUMONT HOSPITAL INDICATING POTENTIAL NEW BUILD OPTION


25

The ward capacity of a new build project, based on the specifications of the MAU

building, would be fourteen single rooms, all with en suite facilities, on a single

floor of 632 SqM. A ward layout is outlined in the appendices.

EVALUATION OF NEW BUILD AS AN OPTION

The new build option was preferred by clinicians in Beaumont Hospital, as new

build would allow for greater flexibility of design in order to accommodate

maximum number of beds. The MAU building provides a good model for ward

design for single rooms. Moreover, new build can facilitate particular design

specifications, notably specialised ventilation systems and air handling units

which can have significant space requirements.

New build would require planning permission, but it is estimated that the

timescale for developing a new building (based on the MAU building) would be

approximately six months, as it is a modular building. However, as this would be

a large development, involving different hospital clinical departments and a

significant capital budget, it would be likely to be a longer term project to

deliver. Moreover, in light of proposals for the reconfiguration of the entire

hospital complex, including phased demolition of buildings and possible merging

of Beaumont Hospital with James Connolly Memorial Hospital Blanchardstown,

a new build project of this scale is less likely to be achieved within this context.

At a minimum, it is advisable that a new build option might be pursued within

the provisions of the development control plan, as a longer-term option. Within

this provision, a twenty-bed CF ward should be pursued.

4.5 Provision of dedicated CF inpatient beds through ward

refurbishment

The second option for the provision of additional inpatient rooms is within the

existing footprint of the main hospital building, through ward re-planning and

refurbishment.

There is only one ward in the hospital currently not in permanent use. It is used

as temporary accommodation for wards while refurbishment is taking place, and

for this reason it would not be suitable for use as a dedicated CF ward. However,

Beaumont Hospital management anticipates that one ward will be closed within

the next twelve months, and that this could conceivably be reconfigured for use

as a dedicated CF inpatient ward.

SUITABILITY OF WARD REFURBISHMENT FOR CF INPATIENT BEDS

A typical ward in Beaumont Hospital contains thirty-four beds, of which four are

single en suite rooms. The remaining beds are contained in five open plan ward

rooms, each of which contains six beds. The size of the average ward is 750 SqM.


26

This includes ancillary rooms and facilities such as nurses’ station, storage,

kitchen/tea station space, sluice rooms, treatment space, visitors’ space, etc.

Beaumont Hospital has undertaken a feasibility study on the re-planning of a

thirty-four-bed ward into single en suite rooms. A reconfigured ward could

provide 13–14 single rooms, all with en suite facilities. A floor layout plan for a

ward of this kind, including ancillary provisions, is included in the appendices.

As it would not require planning permission, the refurbishment of an existing

ward would be quicker than a new build, and would take approximately a year

to complete once a ward becomes vacant.

EVALUATION OF WARD REFURBISHMENT AS AN OPTION

One of the benefits of ward refurbishment is that it could be completed in a

relatively short period of time. It is, however, dependent on confirmation that a

ward is likely to become available within twelve months and also that there are

no demands for the use of the next available ward. One of the drawbacks of

refurbishment is that it can facilitate less flexibility in design, layout and use of

space.

Refurbishment may be more likely as an achievable outcome, given that a new

build (in parallel to the development control plan) is unlikely to be favoured as a

realistic option given the timeline for the redevelopment of the hospital site as a

whole.

However, ward refurbishment will not meet the long-term or even the medium-

term inpatient bed needs of CF patients, and so if it is to be pursued, it should

be accompanied by a longer-term plan for bed spaces to be secured in the overall

hospital redevelopment.

4.6 Projected capital and staffing costs

CAPITAL COSTS FOR WARD REFURBISHMENT AND NEW BUILD

The costs of ward refurbishment are estimated to equal those for new build: an

estimated cost of approximately €2,500 per square metre, based on a medical

facility build cost. This figure would include provision for air ventilation and

exchange systems, oxygen infrastructure, etc. (typically referred to as group 1


27

equipment28). This estimate includes all project costs, including professional

fees.29

Costings for the refurbishment of a 750 SqM ward in Beaumont Hospital for use

as a transplant unit had a total build cost of €1,875,000.30 Fit-out costs

amounted to an additional €625,000 bringing the total cost to €2,500,000.

Taking this build cost for a thirteen-bed unit (based on the same size of 750

SqM) of €1,875,000, this represents an estimated cost per bed of €144,230.

A new build facility based on replicating the MAU building and including a ward

layout for 14 single rooms with en suite facilities (as outlined in the appendices),

would cost €1,666,667 (based on a single floor size of 632 Sq M, and a total build

cost over three floors of €5million, which has been an estimated cost identified

by the hospital. This represents an estimated cost per bed of €119,047.

TABLE 4-1 SUMMARY OF STRENGTHS AND WEAKNESSES – OPTIONS FOR ADDITIONAL BEDS

New Build Ward Refurbishment

Strengths Strengths

Template for new build is in place (MAU building)

New build has capacity to meet optimum specifications and design features easily in a smaller overall size (632 SqM)

Could facilitate 14 single rooms

Modular building could be built in short period of time

Refurbishment could be achieved in a relatively short timescale

Would not have to go through planning permission

There is likely to be ward closure within the next twelve months that could be available for CF patients

Weaknesses Weaknesses

May be harder to make the case for a new building over three storeys unless it is part of the development control plan

Would have to be part of a larger scale/ more expensive project with other departments involved (could impact on time)

At 14 beds, falls short of projected need (15 beds)

Reconfiguration of wards can present some difficulties in achieving optimal design specifications

A maximum room availability of 13 single rooms. Falls short of projected need (15 beds).

Has a higher overall project cost in terms of cost per bed.

28 Where the contractor supplies and installs the equipment. 29 This cost is consistent with other project costs: in Drogheda, a refurbishment project developing three CF patient rooms had a project cost of approximately €2,500 per SqM. The estimated cost of the hospital extension (outpatients department) according to the Construction Information Services website is €1,716,957 for 738 SqM (cost per SqM: €2,326.50). The cost of the St Vincent’s University Hospital facility (at €22,000,000 for 7900SqM) indicates a higher cost per Sq M (€2,785); however, it is not known if this includes provision for fit-out. 30 This includes all project costs and professional fees.


28

PROJECTED ADDITIONAL WARD CORE STAFFING COSTS

Staffing and other costs for a 13 bed ward facility are estimated below, based on

calculations from the finance department in Beaumont Hospital.

TABLE 4-2 ESTIMATED EXCLUSIVE WARD STAFFING REQUIREMENTS FOR A 13 BED

WARD (SINGLE ROOMS)

Role No.

positions Cost of

position31

Clinical Nurse Manager (CNM) 2 1 €75,259

Staff nurses (RGN) 14 €779,184

Health Care Assistants 3 €138,464

Phlebotomist 0.3 €13,977

Ward clerk 0.5 €18,411

Pharmacy technician 0.5 €23,107

Catering assistant 1 €26,170

Total annual wage costs €1,074,571

Non-wage projected costs for a 13 bed ward are outlined in the table below.

TABLE 4-3 ESTIMATED WARD NON-PAY COSTS FOR A 13 BED WARD (SINGLE ROOMS)

Category Estimated cost

Medicine €110,266

Medical surgical supplies €48,727

Cleaning costs €50,920

Laundry costs €76,698

Heat, power and light €29,457

Waste €28,127

Meals for patients €6,787

Total annual non-pay costs €350,981

The total combined wage and non-wage costs therefore is estimated at

€1,425,552 per annum.

31 These are annual costs that have been estimated on the basis of salaries at the mid-point on the HSE salary, plus provision for non-pay costs, provision for allowances, employers’ PRSI, and provision for locum cover.


29

TABLE 4-4 TOTAL ESTIMATED WAGE AND NON-WAGE COSTS FOR A 13 BED WARD

Category Estimated cost

Total wage costs €1,074,571

Total non-wage costs €350,981

Total €1,425,552

The existing multi-disciplinary team in Beaumont’s CF clinic would continue to

attend to Beaumont’s CF patients (whether inpatient or outpatient). However,

the CF unit is already under-staffed, and staff numbers fall below levels

identified in the Pollock report for all positions across the multi-disciplinary

team.

The staffing levels as recommended by Pollack for current (120 patients) and

projected (150 patients) compared with current staffing levels in the CF unit are

outlined in the appendices. As the current under-staffing will become more acute

as patient numbers increase, it is appropriate that this issue be addressed in the

context of the provision of dedicated inpatient beds in Beaumont hospital, as

these patients will be reliant on the services of the multi-disciplinary team

members.

4.7 Potential sources of funding

EVALUATION OF POTENTIAL SOURCES OF FUNDING FOR CAPITAL COSTS

HSE capital budgets

Capital projects in Beaumont Hospital are generally funded either entirely from

HSE sources or entirely from other sources, rather than a combination of both.

The CF outpatient facility in Beaumont, completed in 2010, cost €3.2 million and

was entirely funded by the HSE.

Budgetary difficulties will limit opportunities for capital funding from the HSE.

However, the deferral of the National Children’s Hospital may mean that the

HSE will have an under-spend in its annual exchequer capital allocation for

2012–2013. While there is likely to be a highly competitive environment for

seeking capital funding32, the project could be pitched to the HSE as an

expansion of a national service, and this option possibly represents the most

viable opportunity for capital costs.

32 For example, Beaumont Hospital is currently seeking funding from the HSE for €30 million for equipment costs.


30

Fundraising activities

Funding for projects in other areas of the country has come from a combination

of HSE funding and donations or fundraising activities. For example, the CF

facility in Limerick has been part-funded by a contribution from JP McManus.

CF Hopesource and CFAI have both contributed to capital costs through their

individual fundraising activities: CFAI contributed to a capital project in Our

Lady’s Children’s Hospital, Crumlin; Mid-Western Regional Hospital, Limerick;

Our Lady’s Hospital, Drogheda and a facility in Castlebar. CF Hopesource

contributed towards a facility in Temple Street (which opened in 2011).

Some funding may also be sought through the Beaumont Hospital Foundation

which provides grants towards capital and equipment costs.33 According to its

website, in 2011, €100,000 was donated by the foundation to St Claire's Oncology

Ward.34

Partnerships with the private sector

Public-private partnerships involving companies operating in the private sector,

such as pharmaceutical companies, is an emerging practice albeit in private

sector contexts. The healthcare company Baxter has developed joint projects

with hospitals in many countries, including Ireland: Baxter funded the purchase

of equipment in the renal unit of the Beacon hospital. The arrangement usually

involves Baxter committing finance at the outset in return for a guarantee of

supply of pharmaceuticals for a period of five to ten years. In the case of a CF

facility, Baxter estimates that it currently supplies approximately 90% of home

antibiotics, and would seek the supply of compounded antibiotics for a period of

time as a clawback arrangement. However, according to Beaumont Hospital,

this practice is generally not favoured by the Department of Finance as it is

regarded as an expensive way to secure initial finance and it can undermine

public procurement processes. This is therefore an unlikely source of capital

funding.

EVALUATION OF SOURCES OF FUNDING FOR OPERATIONAL COSTS

Beaumont Hospital

There would be limited opportunities for additional staffing costs from

Beaumont hospital, which would meet the full staff requirements for a 13-14 bed

ward.

33 No consultation took part with the hospital fundraising department. 34 http://www.bhf.ie/whatwedo/76-grants-2011.

http://www.bhf.ie/whatwedo/76-grants-2011


31

When ward closures take place, staff savings are generally not passed on to

other facilities and wards.

HSE funds

Applications for additional funding for staff and operational costs could be made

to the HSE – again, the case would have to be made that this is a national

service which requires expansion. It was on this basis that the transplant ward

in Beaumont Hospital has been allocated additional staffing. If this was

approved by the HSE, savings in staffing made elsewhere (either in Beaumont

Hospital itself or other parts of the country) could enable additional staff to be

recruited in the new facility. An approach would need to be made to the HSE

Clinical Care Programme.

Fundraising activities

While organisations such as Hopesource CF have funded or part-funded

individual posts, including positions in Beaumont Hospital, it is unlikely that

individual fundraising activities could meet the costs of staffing required for all

beds in a new facility.

Private sector

As mentioned above, Baxter has expressed an interest in funding staffing or

operational costs under a similar arrangement to that outlined above. Such an

arrangement is unlikely to be approved by the Department of Finance and so

this is unlikely to be a viable option.


32

5 Conclusions and recommendations

This report has outlined the current and projected need for dedicated inpatient

beds for CF patients in Beaumont Hospital. On the basis of current and

projected patient caseload, and drawing from European consensus on standards

of care, there is a current need for 12 dedicated inpatient beds in Beaumont

Hospital. This need will increase to 15 beds in the medium term and 20 beds in

the long-term.

With this in mind, a number of proposed options for meeting these dedicated

inpatient beds have been outlined. These outline as a minimum requirement

certain specifications which include single rooms with en suite facilities for all

patients, the establishment of a dedicated CF ward, rather than individual

rooms located throughout different hospital wards, and air management systems

to achieve optimum infection control.

All parties consulted as part of this needs assessment expressed their

commitment to meeting the needs for dedicated inpatient beds for CF patients.

New build and ward refurbishment as two options for meeting the need have

been considered, particularly in terms of external factors that may have a

bearing on their feasibility.

It is proposed that two strategies be developed:

1. A dedicated ward for CF patients which would provide at least 13 single en

suite rooms, should be sought as a short to medium term solution. This could

be achieved through a reconfiguration and refurbishment of a vacant ward

in the main hospital building. While new build may be preferable, it is less

likely in the current context of the development control plan for Beaumont

Hospital. However, the status of development plans should be monitored in

case a new build project becomes viable option. In the event that a ward

refurbishment is the only viable option, the following actions should be

undertaken:

Funding from HSE should be pursued on the basis that the new CF

facility is prioritised by the HSE as an expansion of a national service,

and on the basis that there may be an under-spend of HSE funds

arising from delays in the siting of the National Children’s Hospital.

Funding from the HSE’s Clinical Care Programme for operational and

ward staffing costs should be sought on the same basis (i.e., expansion

of a national service), using the precedent of the transplant ward in

Beaumont Hospital which has accessed additional staff.

Confirmation should be sought that a ward will become available within

a twelve month period and that this will be earmarked for CF patients

once it becomes available.


33

2. Continued emphasis on a dedicated ward for CF patients as part of the

redevelopment of the hospital as a medium- to longer-term plan (scheduled

for completion in three to six years). This would seek the following:

A dedicated, twenty-patient CF ward, to be specified in the development

control plan.


34

References and bibliography

Chotirmall, S.H., Smith, S.G., Gunaratnam, C., Cosgrove, S., Dimitrov, B.D.,

O'Neill, S.J., Harvey, B.J., Greene, C.M., McElvaney, N.G. (2012): ‘Effect of

Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis.’

New England Journal of Medicine (10.1056/NEJMoa1106126)

Cystic Fibrosis Registry of Ireland (2011). Annual Report 2010. Dublin:

CFRI

Cystic Fibrosis Foundation (2003). Cystic Fibrosis Foundation Patient

Registry, Annual Data Report, 2002. Bethesda, MD: Cystic Fibrosis

Foundation.

Farrell, P., Joffe, S., Foley, L., Canny, G.J., Mayne, P., Rosenburg, M. (2008).

‘Diagnosis of cystic fibrosis in the Republic of Ireland: epidemiology and

costs.’ Irish Medical Journal; 100(8):557-60

HSE (2009). Services for People with Cystic Fibrosis in Ireland Conclusions

of a Working Group established by the Health Service Executive. Dublin: HSE

Kerem, E., Conway, S., Elborn, S., and Heijerman, H. (2005). ‘Standards of

care for patients with cystic fibrosis: a European consensus.’ Journal of

Cystic Fibrosis, 2, (2005), 7-25.

Lowton, K. and J. Gabe (2003). ‘Life on a slippery slope: perceptions of

health in adults with cystic fibrosis.’ Sociology of Health and Illness 25(4):

289-319.

Pollock, R. (2005). Towards a better service: the treatment of cystic fibrosis in

Ireland: problems and solutions 2005. Dublin: CFAI

Sun, L., Jiang, R., Steinbach, S., Holmes, A., Campanelli, C., Forstner, J.,

Sajjan, U., Tan, Y., Riley, M., & Goldstein, R. (1995). ‘The emergence of a

highly transmissible lineage of cbl+Pseudomonas (Burkholderia) cepacia

causing CF centre epidemics in North America and Britain’. Nature

Medicine 1, 661 - 666 (1995)


35

Appendices

Appendix 1 | Pollock report staffing requirements for CF services at 50,

120 and 150 patients and current staffing levels in CF unit, Beaumont

Hospital

The proposed staffing of CF centres, as outlined in the Pollock report, is based

on whole time equivalents (WTEs) exclusively allocated to CF care, for 50

patients. This is outlined in the table below.

These staffing levels are used as a basis for identifying staffing requirements for

current CF patient numbers (120 patients) and projected patient numbers

(projected at 150 patients in the next two years).

RECOMMENDED MINIMUM NUMBER OF WHOLE TIME EQUIVALENTS

(WTE) FOR CF CENTRES (POLLOCK REPORT)

Staff member No. per 50 patients (WTEs)

Consultant 1 0.8

Consultant 2 0.5 – 0.6

CF specialist registrar 0.5

CF nurse 1 - 1.5

Physiotherapist 2

Dietician 0.4

Social worker 0.4

Psychologist 0.4

Secretary 1

Data clerk 0.3

Pharmacist 0.3

The table below applies these recommended staffing levels, and indicates the

staffing deficit at current patient levels.


36

RECOMMENDED MINIMUM NUMBER OF WHOLE TIME EQUIVALENTS FOR CF CENTRES (POLLOCK REPORT) BASED ON CURRENT PATIENT NUMBERS (120 PATIENTS) AND COMPARISON TO CURRENT STAFFING

LEVELS

Staff member No. per 120

patients (WTEs)35 Current staffing

numbers (WTEs)36 Current deficit

(WTEs)37

Consultant 1 1.9 0.25 1.7

Consultant 2 1.2 - 1.4 0.5 0.7 - 0.9

CF specialist registrar 1.2 0 1.2

CF nurse 2.4 - 3.6 2 0.4 - 1.6

Physiotherapist 4.8 1.5 3.3

Dietician 1.0 1.0 0.0

Social worker 1.0 0.5 0.5

Psychologist 1.0 0.5 0.5

Secretary 2.4 1 1.4

Data clerk 0.7 0 0.7

Pharmacist 0.7 0.15 0.6

Pulmonary function technician

-- 0.5 --

The table below projects the staffing deficit at 150 patients. This increase in

patient numbers is projected to occur in approximately two years.

35 Figures are rounded up to one decimal point. 36 There is also a Pulmonary function technician allocated to the CF unit (0.5 WTE). This does not correspond to a specified role identified in the Pollock report. 37 Figures are rounded up to one decimal point.


37

RECOMMENDED MINIMUM NUMBER OF WHOLE TIME EQUIVALENTS FOR CF CENTRES (POLLOCK REPORT) BASED ON PROJECTED PATIENT NUMBERS (150 PATIENTS) AND COMPARISON TO CURRENT STAFFING

LEVELS

Staff member No. per 150

patients (WTEs)38 Current staffing

numbers (WTEs) Projected deficit

(WTEs)39

Consultant 1 2.4 0.25 2.2

Consultant 2 1.5 - 1.8 0.5 1 - 1.3

CF specialist registrar 1.5 0 1.5

CF nurse 3 - 4.5 2 1 - 2.5

Physiotherapist 6.0 1.5 4.5

Dietician 1.2 1.0 0.2

Social worker 1.2 0.5 0.7

Psychologist 1.2 0.5 0.7

Secretary 3.0 1 2.0

Data clerk 0.9 0 0.9

Pharmacist 0.9 0.15 0.8

Pulmonary function technician

-- 0.5 --

38 Figures are rounded up to one decimal point. 39 Figures are rounded up to one decimal point.


38

Appendix 2 | Proposed layout ward re-planning Beaumont Hospital (thirteen-bed single room ward)

Source: Beaumont Hospital ward replanning feasibility study (O’Briain Beary Architects)


39

Appendix 3 | Proposed single room detailed layout (ward replanning) Beaumont Hospital

Source: Beaumont Hospital ward replanning feasibility study (O’Briain Beary Architects)


40

Ward layout (MAU building) Beaumont Hospital