National Rehabilitation Hospital

Clinical Directorship at the NRH

Clinical Director Role at the NRH

Professor Mark Delargy, NRH Clinical Director

Professor Mark Delargy, NRH Clinical Director

Clinical directorships, in a joint initiative between the HSE and the RCPI, have been developed to ensure that a senior medical clinician contributes to day to day hospital management at the highest level. The NRH have adopted the Clinical Director structure and the first NRH Clinical Director appointment was made in August 2015.

Clinical Directors are tasked with delivering a synthesis of clinical and managerial roles. One of the Clinical Director’s initial responsibilities includes engaging in managerial training which adds to the clinician’s existing skill set. The continuing Clinical Director education programme is delivered through the RCPI. In 2017 additional Clinical Director training was undertaken at the King’s Fund centre in London.

In addition, the Clinical Director works with the National Clinical Lead in Rehabilitation Medicine to make the case for increased rehabilitation services.  This includes increased bed capacity on a national basis to bring the volume of rehabilitation services in Ireland somewhat closer to international norms.

Clinical Directorship at the NRH

Since the appointment of Professor Mark Delargy as Clinical Director at the NRH in 2015, the Board of Management receives monthly reports on the contribution of this leadership role within the NRH. The Quality Safety and Risk (QSR) governance committee was developed in 2016, chaired by the Clinical Director.  In addition to strategic matters, the Clinical Director manages all medical resources and plans how services are delivered across Clinical Programmes, as well as retaining some clinical duties. The Board is very appreciative of the vital work being undertaken by Professor Delargy in this role.

Kieran Fleck, Chairman

Within the Quality Safety and Risk committee at the NRH, chaired by the Clinical Director, fostering the wellbeing of patients and supporting staff are paramount responsibilities. The QSR is developing a robust governance and reporting structure for quality and safety matters in the NRH which address clinical and operational activities.

Developing and reviewing robust data on clinical and operational matters will enable the NRH to more effectively analyse current clinical activity.  As a result the QSR will make recommendations to the hospital Executive Committee targeted to improve quality and safety and manage risk in the best interests of patients and staff.

The Clinical Director works closely with the NRH medical consultants to maintain and improve clinical services. Each Medical Director and Programme Manager of the 4 CARF accredited clinical programmes at the NRH meets with the Clinical Director to review and develop patient services.

For a further insight into the services we deliver at the NRH, read our Annual Reports

Read more about the New Hospital Development at the NRH

New Hospital Development

 

NRH Medical Board Highlights – 2016

Highlights from a Clinical Governance Perspective – 2016

2016 was notable for the establishment of the Quality, Safety and Risk Committee at the NRH with the support and guidance of the Clinical Director, Professor Mark Delargy; along with Ms Frances Campbell, Director of Nursing; Mr Derek Greene, CEO; Ms Bernadette Lee, Risk Manager and the expert advice of Dr Phillip Crowley and the team from the National Quality and Safety directorate.

Dr Áine Carroll continues exemplary work and leadership as National Clinical Director and with Drs Jacinta McElligott and Jacinta Morgan, Ms Edina O’Driscoll, Dr Eimear Smith and all the Rehabilitation Consultants who serve on the Clinical Advisory Committee for the National Clinical Programme for Rehabilitation Medicine.

National Highlights in 2016 included:

Dr Eimear Smith continued to serve as president of the Irish Association of Rehabilitation Medicine with the annual IARM meeting in 2016

Dr McElligott, Dr Aine Carroll, Dr Paul Carroll, Professor Mark Delargy and Dr Wallace participated with teaching in the RCSI Stroke Diploma course

Dr John MacFarlane presented at the South-South West Neuroscience meeting on ‘Rehabilitation in the Region’. Dr Macfarlane also presented in Grand Rounds at the Mercy and Cork University Hospitals.

Dr Aaisha Khan and Professor Delargy presented ‘Post stroke fatigue: point prevalence, characterisation, associations and radiological correlation in a rehabilitation hospital’ at the Irish Heart Foundation Stroke Day in Croke Park.

Highlights of international presentations in 2016 included:

  • Dr Aine Carroll’s platform presentation on ‘Cost effectiveness of integrated care in patients with acquired brain injury’ at the World Congress for Integrated care, in New Zealand.
  • Dr Eimear Smith had a number of presentations at the ISCoS scientific meeting in Austria including a presentation of ‘Epidemiology of Traumatic Spinal Cord Injury’.
  • Dr Angela McNamara, presented ‘Problems of fragmentation in the management of spinal cord injury’ at the European Academy of Rehabilitation Medicine (EARM) session at the Hungarian Rehabilitation Medicine Society, in Budapest.
  • Dr Aaisha Khan and Dr Paul Carroll presented a ‘Retrospective survey of epilepsy and anticonvulsant usage in patients with Acquired Brain Injury’ at the British Neuropsychiatry Association Annual meeting in London.

Higher Specialist Training (HST)

Dr Eimear Smith continues as the National Specialty Director for Higher Specialist Training in Rehabilitation Medicine. The Medical Board congratulates Dr Raymond Carson on his graduation from the Higher Specialty Training in Rehabilitation Medicine. Dr Aaisha Khan, Dr Kinley Roberts and Dr Sabrina McAllister continue in the NRH HST programme.

Undergraduate Medical Education

Clinical tutors Dr Daniela Stancila and Dr Aaisha Khan supported for the NRH as the primary teaching site for undergraduate and graduate education in the principles and practices of rehabilitation medicine.

Approximately 38 medical students from TCD and 72 medical students from RCSI had an opportunity to participate in two week clinical rotations, in addition 296 UCD medical students had an opportunity to interview patients at NRH as a component of the UCD Understanding Disability Module.

Medical Board Research Activities 2016

Dr Eimear Smith was awarded a grant through the Health Research Board to study the epidemiology of traumatic and non-traumatic spinal cord injury in Ireland. Dr Jacinta McElligott continued as Medical Board representative to the NRH Ethics Committee. The Medical Board commends the hospital Ethics Committee, and all the investigators and co-investigators for their dedication and support to advancing the science of interdisciplinary rehabilitation in the field of rehabilitation medicine.

Education Delivered to Medical Personnel in 2016

Speakers and Titles of talks delivered in the Diploma in Cerebrovascular and Stroke Medicine 2016:

  • Dr Paul Carroll: Predicting Outcome after Stroke
  • Dr Jacqui Stow: Post Stroke Pain
  • Prof Mark Delargy: Locked in Syndrome/ Disorders of Consciousness
  • Dr Jacinta McElligott: Shoulder Pain and Management in Hemiplegia
  • Dr Aine Carroll: Goal Setting and Rehabilitation
Minister Simon Harris, An Taoiseach Leo Varadkar, Mr Henry Murdoch, NRH Foundation Chairman, Mr Kieran Fleck, NRH Chairman and Professor Mark Delargy, Clinical Director

Minister Simon Harris, An Taoiseach Leo Varadkar, Mr Henry Murdoch, NRH Foundation Chairman, Mr Kieran Fleck, NRH Chairman and Professor Mark Delargy, Clinical Director

Medical Board Highlights 2015

Highlights in Educational activities of the Medical Board – 2015

 Dr Jacinta McElligott continued to serve as Chair of the Medical Board.

The Medical Board congratulates Professor Mark Delargy on his appointment as the first Clinical Director for the NRH.

Dr Aine Carroll continues as the National Director for Clinical Strategy and Programmes Division, HSE, providing outstanding leadership and direction to the National Clinical Programmes.

The development of the Model of Care (MOC) for Rehabilitation continued under the dedicated hard work of Dr Jacinta Morgan and Edina O’Driscoll.

Dr Morgan served on the Major Trauma Audit working group and also received her RCPI / RSA Certificate in Traffic Medicine.

The Medical Board congratulated Dr Morgan for her success in facilitating the inclusion of US trained Rehabilitation Consultants on to the Specialist Register in Rehabilitation Medicine in Ireland under the new (RCPI) evaluation mechanism.

Professor Mark Delargy was elected to Executive Council of the European Board of Physical and Rehabilitation Medicine (ESPRM) 2015 and continues to serve as National Manager for Ireland delegate on the European Union of Medical Specialties for Physical and Rehabilitation Medicine.

Professor Delargy also served on the Physiotherapy Registration Board (PRB) with CORU, the National Registration Council.

Dr Jacinta McElligott continued to serve as Medical Director of the Brain Injury Programme at NRH and completed a Diploma in Leadership through the RCPI. Dr McElligott also continues her role as a CARF surveyor and participated in surveys in Texas and Pennsylvania in 2015.

Dr Éimear Smith continued to serve as Medical Director to the NRH Spinal Cord System of Care (SCSC) Programme and served as the Chairperson of the Clinical Advisory Group for Rehabilitation Medicine National Clinical Programme.

Dr Smith is a member of the Rehabilitation Group for the Department of Health/HSE National Trauma Strategy, and she is also president of the Irish Association of Rehabilitation Medicine (IARM).

The NRH hosted the Irish Association of Rehabilitation Medicine annual general meeting in the Spring of 2015 with a number of platform and poster presentations from Consultants and Interdisciplinary teams from the NRH as well as teams from across the country and our colleagues in the North.

Dr Nicola Ryall, is Medical Director of the Prosthetic, Orthotic and Limb Absence Rehabilitation (POLAR) programme, and is also the Rehabilitation Medicine Programme representative on the HSE Orthotics, Prosthetics and Specialised Footwear advisory group.

Dr Jacqui Stow is commended for her excellent support, clinical and educational input to the POLAR programme and her expertise and support for the complex spasticity clinic and intrathecal baclofen service.

Dr Susan Finn, Paediatric Consultant continued her leadership and medical direction of the Paediatric Programme at the NRH.

Dr Eugene Wallace was the Rehabilitation Consultant lead in the establishment of a Concussion Clinic in St James Hospital and Dr Wallace has continued his work with the RCPI, Traffic Medicine and the Clinical Advisory Group for Stroke.

Dr John MacFarlane was appointed as lead regional Rehabilitation Consultant for the South, Cork and Kerry.

Medical Board Presentations at International and National Scientific Meetings

Dr Jacinta Morgan was the keynote speaker at the SPMFR (Portuguese PMR society) conference in Lisbon, speaking on Cognitive Rehabilitation in Traumatic Brain Injury.

Dr Morgan was also a keynote speaker at the International Congress of Neuropsychological Rehabilitation, presenting on ‘Comprehensive Integrated In-Patient Rehabilitation’ and leading a workshop on ‘Disorders of Consciousness: Legal and Ethical Issues across Borders’.

Professor Mark Delargy presented on Accreditation Systems for Rehabilitation Medicine – at the International Society of Physical and Rehabilitation Medicine (ISPRM) in Berlin.

Dr Éimear Smith and P Fitzpatrick presented a poster on the ‘Epidemiology of Spinal Cord Injury in Ireland. Part 1: Evaluation of record accuracy and results of a feasibility study’.

Dr Smith also presented her poster on a literature review of the effects of hydrotherapy in spinal cord injured patients at the ISCoS-ASIA joint meeting held in Canada in May 2015.

Dr Paul Carroll, Dr Aisha Khan, in conjunction with and Ms Bernadette Lee presented a poster on ‘Patient Absconsions; an evaluation of in-absconding episodes occurring at the National Rehabilitation Hospital’ at the British Society of Rehabilitation Medicine.

In addition Dr Carroll, Catriona Moran, Edwina Walsh and Alison McCann presented a poster on a “Profile and Assessment of Visual Impairment in Patients with Acquired Brain Injury” at the European Federation for Research in Rehabilitation in May 2015.

Dr Daniela Stancila, along with K Roberts, C O’Neill, E Wallace, K Lennon, O Crean, L Croxon, B Lee, Á Carroll, É Smith, S McNicholas. Presented a poster on: ‘Introduction of a Urinary Catheter Care Bundle in a Specialist Spinal Cord Injury Centre – Expected and Unexpected Benefits’ at the MASCIP annual scientific meeting, UK.

Dr Cara McDonagh presented her research at the European League against Rheumatism (EULAR) conference in Rome in June.

Dr McElligott, Dr Morgan and Dr Áine Carroll continues to participate in the RCPI Stroke Diploma and Dr Smith presented an ‘Update on Spinal Cord Injury Rehabilitation’ at the Annual Neurological Surgery Symposium, RCSI in Ireland.

Higher Specialist Training

Dr Eimaear Smith served as National Specialty Director for Rehabilitation Medicine. The Medical Board congratulated Dr Raymond Carson on his successful completion of highest specialist training in Rehabilitation Medicine in 2015. We welcomed new SPR Trainee Dr Sabrina McAllister who joins Dr Aaisha Khan and Dr Kinley Roberts currently enrolled in the HST in Rehabilitation Medicine at NRH.

Basic Specialty Training

The NRH continues to provide the primary teaching for NCHDs in the Basic Specialty and RCSI General Physician training programme, in the principles and practices of Rehabilitation Medicine with BST trainees rotating through NRH from Beaumont, SVUH and the Mater Teaching Hospitals.

Drs McElligott, Morgan, and Wallace continue to participate in the membership examinations.

Undergraduate Medical Education

The NRH had 390 medical students from TCD, UCD and RCSI rotating through our under-graduate educational programmes. Feedback from students is very positive especially in relation to the opportunity to interact with patients, gaining a better understanding of disability and the importance of interdisciplinary rehabilitation. They particularly appreciate the opportunity to work within the interdisciplinary teams, learn from other allied health professionals and interact with students from other disciplines.

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Research

Dr Smith who was awarded a HRB grant award for a study ‘Traumatic Spinal Cord Injury in Ireland: service planning for changing epidemiology’ to be conducted during 2016.

Dr McDonagh was awarded Young Investigator Award 2015 by Irish Society of Rheumatology for her research for her work on ‘Ultrasound Assessment of the Median Nerve in Carpal Tunnel Syndrome before and after Corticosteroid Injection”.

Dr Wallace continues to be involved in research with a paper recently submitted on the subject of Blood Brain Barrier dysfunction in the presence of Chronic Traumatic Encephalopathy.

Dr Ryall and Dr Stow are the lead NRH clinicians on a multidisciplinary multisite research PhD project with UCD school of Medicine, UCD School of Mechanical and Materials Engineering, UCD School of Public Health, Physiotherapy, and Sports Science, MMUH and Santry Sports Clinic on ‘Design and Validation of Patient-specific, 3D-printed, Unilateral Below-Knee Prostheses with Integrated Bio-mimetic, Artificial Muscles and Bones’.

Publications in 2016

Smith É, Comiskey C, Carroll Á. Prevalence of and risk factors for osteoporosis in adults with acquired brain injury. Ir J Med Sci. 2016 Jan 19.

Smith É, Proximal tibia fracture in patients with incomplete spinal cord injury associated with robotic treadmill testing. Correspondence. Spinal Cord Series, article no 16010, July 2016.

Carroll Á, McGlone B. Botulin Toxin in the Management of Sialorrhoea in Acquired Brain Injury Ir Med J. 2016; 109: (6) Carroll Á, Carty A. Treatment advances in the management of Traumatic Brain Injury. Hospital Doctor of Ireland. April 2016 Vol 22; 3

Cooney M.T., Carroll Á. Cost effectiveness of Inpatient rehabilitation in patients with brain injury. Clin Med (Lond). 2016 Apr; 16(2):109-13.

New PW, Reeves RK, Smith É, Eriks-Hooglando I, Gupta A, Scivoletto G, Townson A, Belci M, Post MW. International retrospective comparison of in-patient spinal cord injury difference according to etiology. Arch Phys Med Rehabil 2016; 97 (3): 380-5

Publications in 2015

PW New, RK Reeves, É Smith, I Eriks-Hoogland, A Gupta, G Scivoletto, A Townson, M Belci, MW Post. International retrospective comparison of in-patient rehabilitation for patients with spinal cord dysfunction: differences according to aetiology. Arch Phys Med Rehabil 2015 Nov 22: epub ahead of print

S Wong, M Saif, J O’Driscoll, N Kumar, É Smith, E Roels, I Vas Nes, W Faber, E McKeown, S Hirani, A Jamous. Use of probiotics in preventing antibiotic associated diarrhoea and clostridium difficile associated diarrhoea in spinal injury centres: an international survey of 4 western European countries. International Journal of Probiotics & Prebiotics 2015; 10(2/3):85-90

PW New, RK Reeves, É Smith, a Townson, I Eriks-Hoogland, a Gupta, M Belci, G Scivoletto, MW Post. International retrospective comparison of in-patient rehabilitation outcomes for patients with spinal cord dysfunction: epidemiology and clinical outcomes. Arch Phys Med Rehabil 2015; 96(6):1080- 7.

É Smith, A O’Reilly, S Morris, K Synnott, M Timlin. Review of time to surgical decompression in traumatic spinal cord injured patients in Ireland. Ir Med J 2015; 108(9):265-7 S Wong, J van Middendorp, M Belci, I van Nes, E Roels, É Smith, SP Hirani, A Forbes. Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an international survey of four western European countries.

M Cuesta, MJ Hannon, RK Crowley, LA Behan, W Tormey, D Rawluk, M Delargy, A Agha, CJ Thompson: Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury, Clinical Endocrinology 84 (1), 92-98

Publications in 2014

Éimear Smith, Michael Brosnan, Catherine Comiskey, Keith Synnott. Road Collisions as a cause of traumatic spinal cord injury in Ireland, 2001 – 2010.

Top Spinal Cord Inj Rehabil 2014; 20(2): 158-165  – Stanley E, Broderick J, Synnott K, McCarthy J, Smith É, Reid V, Colreavy F, Carton E. Successful weaning from mechanical ventilation using phrenic nerve stimulation. Ir J Med Sci. 2014;183(1):149-50