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  Paediatric and Neonatology Clinical Programme: Review of Paediatric and Neonatology Services and Framework for Future Development Review of Paediatric and Neonatology Services and Framework for Future Development National Clinical Programme for Paediatrics and Neonatology Clinical Strategy and Programmes Directorate, HSE Royal College of Physicians of Ireland July 2013  NATIONAL CLINICAL PROGRAMME FOR PAEDIATRICS & NEONATOLOGY 2 Contents Foreword ............................................................................................................................................... 5   1. Executive Summary ........................................................................................................................... 7   Overall Reflections from the Site Visits ......................................................................................... 7   Ten Pillars/Principles to Underpin the Future Care of Children and Young People in Ireland ....... 8   Develop Good Practices as the Norm ........................................................................................ 10   Implementation / Next Steps ...................................................................................................... 11   2. Introduction ...................................................................................................................................... 12   3. Summary of Recommendations Neonatology and Paediatrics Patient Pathway .............................. 14   4. National Statistics ............................................................................................................................ 23   5. Clinical Governance ......................................................................................................................... 27   Recommendations ..................................................................................................................... 29   6. Patient / Family Consultation ........................................................................................................... 30   7. The Child Presenting to the Emergency Department ....................................................................... 31   7.1 Background / International experience ................................................................................. 31   7.2 Reflections from Site Visits ................................................................................................... 32   7.3 Suggested Future Directions ................................................................................................ 33   7.4 Performance metrics ............................................................................................................ 33   7.5 Recommendations ............................................................................................................... 33   8. Paediatrics in Primary Care ............................................................................................................. 34   8.1 Background / International Experience ................................................................................. 34   8.2 Reflections from Discussions with Doctors in Primary Care .................................................. 34    Access ........................................................................................................................................... 36   8.3 Suggested future directions .................................................................................................. 36   8.4 Performance metrics ............................................................................................................ 37   8.5 Recommendations ............................................................................................................... 37   9. Care of the Newborn ........................................................................................................................ 38   9.1 Introduction .......................................................................................................................... 38   9.2 Description of the three categories of Neonatal Care in Ireland ............................................ 38   9.3 Neonatal Consultant Manpower ........................................................................................... 39   9.4 Neonatal NCHD Manpower .................................................................................................. 41   9.5 Neonatal Nurse Workforce ................................................................................................... 42   9.6 Neonatal Allied Health Professionals Services ..................................................................... 43   9.7 Neonatal Unit Design and Capacity ...................................................................................... 44   9.8 Neonatal Discharge Planning ............................................................................................... 45   9.9 The Newborn Clinical Examination ....................................................................................... 45   9.10 Screening for Developmental Dysplasia of the Hip (DDH) .................................................. 46   9.11 Therapeutic Hypothermia for Neonatal Encephalopathy ..................................................... 47   9.12 Neonatal Networks ............................................................................................................. 48   9.13 Recommendations ............................................................................................................. 50   10. The Paediatric Intensive Care Service in Ireland ............................................................................ 51   10.1 Introduction ........................................................................................................................ 51   10.2 Paediatric Intensive Care in Ireland .................................................................................... 51   10.3 Reports on the Irish PICU Services .................................................................................... 52   10.4 Recommendations ............................................................................................................. 53   11. Retrieval ........................................................................................................................................ 54   11.1 Neonatal Retrieval .............................................................................................................. 54   11.2 Current Irish Service ........................................................................................................... 54   11.3 The Retrieval Care Pathway ............................................................................................... 55   11.4 Governance........................................................................................................................ 55   11.5 Limitation of Current NNTP ................................................................................................ 55   11.6 Retro transfers ................................................................................................................... 56   11.7 The Acute Paediatric Retrieval Service .............................................................................. 56   11.8 Recommendations ............................................................................................................. 57   12. Non Specialist Paediatric Surgery .................................................................................................. 58    NATIONAL CLINICAL PROGRAMME FOR PAEDIATRICS & NEONATOLOGY 3 12. Non Specialist Paediatric Surgery .................................................................................................. 58   12.1 Background / international experience................................................................................ 58   12.2 Reflections from the site visits ............................................................................................ 59   12.3 Performance metrics .......................................................................................................... 60   12.4 Recommendations ............................................................................................................. 60   13. Community Child Health ................................................................................................................ 61   13.1 Background / international experience................................................................................ 61   13.2 Reflections from visits ........................................................................................................ 62   13.3 Performance metrics .......................................................................................................... 63   13.4 Recommendations ............................................................................................................. 63   14. Outpatient Care ............................................................................................................................. 64   14.1 Background/ International Experience ................................................................................ 64   14.2 Reflections from visits ........................................................................................................ 65   14.3 Suggested Performance Metrics ........................................................................................ 66   14.4 Recommendations ............................................................................................................. 66   15. Specialty Clinics ............................................................................................................................. 67   15.1 Background / international experience................................................................................ 67   15.2 Reflections from visits ........................................................................................................ 70   15.3 Key Performance Indicators ............................................................................................... 70   15.4 Recommendations ............................................................................................................. 71   16. Dublin Paediatric Hospitals 16.1 Background / international experience ..................................... 73   16.2 Reflections from discussions with relevant specialists ........................................................ 74   16.3 Suggested future directions ................................................................................................ 76   16.4 Recommendations ............................................................................................................. 78   17. Training and Manpower Issues in Paediatrics ................................................................................ 80   17.1 Background / national and international experience ........................................................... 80   17.2 The trainee perspective ...................................................................................................... 81   17.3 Suggested future directions ................................................................................................ 81   17.4 Conclusions / Recommendations ....................................................................................... 81   18. Palliative Care for Children with Life-Limiting Conditions ................................................................ 82   18.1 Background / National and International Experience .......................................................... 82   18.2 Developing a National Plan for Palliative Care for Children ................................................ 83   18.3 Recommendations ............................................................................................................. 85   19. Best Health for Children Revisited ................................................................................................. 86   19.1 Background and context: .................................................................................................... 86   19.2 Best Health for Children Revisited ................................................................................... 88   19.3 Current position and future recommendations: ................................................................... 89   20. Rethinking Health Care for Infants and Children ............................................................................ 90   20.1 Background / international experience................................................................................ 90   20.2 Towards a National Service Framework for children and young people in Ireland .............. 93   20.3 Overall reflections from visits .............................................................................................. 93   20.4 Suggested future directions ................................................................................................ 94   20.5 Quality indicators of national paediatric health care ............................................................ 96   20.6 Recommendations ............................................................................................................. 96   21. References / Links ......................................................................................................................... 98   22. Individual Site Reports ................................................................................................................. 103   Cavan General Hospital ........................................................................................................... 103   Children’s University Hospital, Temple Street  ........................................................................... 105   Children’s University Hospital, Temple Street ICU  .................................................................... 106   Coombe Women and Infants University Hospital ..................................................................... 108   Cork University Hospital ........................................................................................................... 110   Cork University Maternity Hospital ........................................................................................... 117   Our Lady’s Children’s Hospital, Crumlin  ................................................................................... 119   Crumlin ICU ............................................................................................................................. 120   Kerry General Hospital, Tralee ................................................................................................. 122   Letterkenny General Hospital ................................................................................................... 127    NATIONAL CLINICAL PROGRAMME FOR PAEDIATRICS & NEONATOLOGY 4 Mayo General Hospital ............................................................................................................. 131   Midwestern Regional Hospitals, Limerick ................................................................................. 135   Mercy University Hospital ......................................................................................................... 139   Midlands Regional Hospital, Mullingar ...................................................................................... 142   National Maternity Hospital ...................................................................................................... 145   Our Lady of Lourdes Hospital, Drogheda ................................................................................. 147   Portiuncula Hospital, Ballinasloe .............................................................................................. 150   Portlaoise General Hospital ...................................................................................................... 154   Rotunda Hospital...................................................................................................................... 157   Sligo Regional Hospital ............................................................................................................ 159   South Tipperary General Hospital, Clonmel ............................................................................. 163   St. Luke’s Hospital, Kilkenny  .................................................................................................... 166   Tallaght Hospital ...................................................................................................................... 169   University Hospital Galway ....................................................................................................... 170   Waterford Regional Hospital .................................................................................................... 174   Wexford General Hospital ........................................................................................................ 176   Paediatric Services in the Southeast ........................................................................................ 179    Appendix 1  –  Glossary ....................................................................................................................... 182    Appendix 2  –  List of algorithms being developed ............................................................................... 183  

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Apr 18, 2019
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