Examining the COVID-19 impact on cancer surgery in Ireland using three national data sources.

Background: The healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources. Methods: A repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI & HIPE), and by four main cancer types (breast, lung, colorectal & melanoma for NCRI & HIPE data only). Results: The annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022. Conclusions: Cancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.

Enhancing efficiency in a cardiac investigations department by increasing remote patient monitoring.

OBJECTIVE: Remote monitoring (RM) of patients with cardiac rhythm management devices enables healthcare teams to effectively and efficiently monitor patients with heart problems without the requirement in-person patient visits. RM has been associated with safer and higher quality care but was not being used to its full potential in this setting. Cardiac rhythm management had observed an average implant rate of 295 devices per year over the past 13 years, resulting in a five-fold growth in patient follow-up in clinics. This increased demand was becoming unmanageable, with impacts on care quality. This study aimed to enhance the enrolment of eligible patients to RM. DESIGN: A pre-post design. SETTING: A 600-bed city centre teaching hospital in Dublin, Ireland. PARTICIPANTS: Hospital staff and patients eligible for RM. INTERVENTIONS: Lean Six Sigma methods were used to develop patient education materials on RM and the clinic area was redesigned to enable RM enrolment and monitoring. MAIN OUTCOMES MEASURES: Number of unscheduled attendances to clinic and RM enrolment. RESULTS: At baseline, the clinic was processing 102 RM follow-up checks with 140 unscheduled attendances on average per month. Following implementation, RM enrolment increased to 335 RM follow-up checks (194% increase), with 41 unscheduled attendances on average per month (70% decrease). These results were sustained one-year post-implementation. CONCLUSIONS: These process changes have streamlined workflow by reducing the number of unscheduled attendances to clinic and increased the use of RM among the eligible patient population. This has meant safer, more timely responses to cardiac events and enhanced care quality.