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Cappagh National Orthopaedic Hospital holds unique position in Irish health care
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Throughout its history, Cappagh National Orthopaedic Hospital has been a pioneer in health care, from being the first hospital in Ireland to treat children with tuberculosis in “open air” wards, to performing the first total hip replacement in the country.
Cappagh National Orthopaedic Hospital is unique in Ireland. It is the largest elective orthopaedic hospital in the country, said Prof. John O’Byrne, MD, Abraham Colles Professor of Orthopaedic and Trauma Surgery. The hospital has no emergency department.
“We can always plan the surgeries,” he said. “What that has meant is that over the years, everybody working in the hospital has developed this huge knowledge of how to look after the orthopaedic patient.”
Cappagh provides elective orthopaedic services for St. Vincent’s Hospital, Mater Misericordiae Hospital, Beaumont Hospital, James Connolly Memorial Hospital, The Children’s Hospital Temple Street and the Central Remedial Clinic.
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Images: Cappagh National Orthopaedic Hospital |
It is a busy facility. In 2010, the staff performed 2,960 orthopaedic procedures, according to O’Byrne. There were 581 primary total hip arthroplasties (THAs), 122 revision THAs, 432 primary total knee arthroplasties (TKAs) and 45 revision TKAs, among other procedures.
Cappagh hospital sits on a plot surrounded by trees. “It has a nice, restorative atmosphere, which blends very well with the musculoskeletal surgery postoperative rehabilitation,” O’Byrne said.
Today, the hospital boasts a staff of 21 orthopaedic surgeons, each with a major subspecialty. In addition, there are four rheumatologists, 10 consultant anesthetists, two consultant radiologists, a hematologist, a biochemist, a histopathologist and a microbiologist. The facility has 160 beds, 11 of which are semi-private. There are seven operating rooms, although not all are used at present due to the economy, O’Byrne said.
The hospital had humbler beginnings. Originally, Cappagh House was the residence of Lady Martin, who upon her death in 1908, bequeathed the property to the Irish Sisters of Charity. The sisters established a convalescent home for the Children’s Hospital, Temple Street. Children with poverty-related diseases such as rickets, tuberculosis and malnutrition came to the 60-bed Cappagh Hospital for continuing treatment.
Innovative TB treatment
In 1921, Cappagh became an “open air” hospital for the surgical treatment of tuberculosis. Based on the design of a Swiss hospital, patients were kept outside, exposed to fresh air and sunlight. Cappagh was only the third hospital in the world to employ this technique.
From 1921 until the mid-1950s, the number of beds increased to 260, partly due to the influx of patients with polio.
The hospital had its own farm, according to Frank McManus, MD, an orthopaedic surgeon at Cappagh for 29 years.
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“The farm was there for the single purpose of producing quality food for the patients because good food was considered to be important in managing the diseases of the day,” said McManus, a retired consultant orthopaedic surgeon. “The patients were extremely well fed.”
In the 1950s and 1960s, the hospital’s patient population began to change. New treatments and a general improvement in living standards led to a rapid decline in the diseases of poverty, so fewer children were admitted.
“Soon after, the joint replacement wave came in James Sheehan, FRCSI, PhD, established a joint replacement unit in Cappagh” said Joe Gallagher, MCh, FRCSI, who ushered in that wave by performing the first Charnley total hip replacement at Cappagh in September 1969. As surgeons performed more joint replacements at the hospital the population gradually changed to more adults, Gallagher said.
Education critical at Cappagh
Physician and nurse education has always been important at Cappagh, according to Brian J. Hurson, MCh, FRCSI, consultant orthopaedic surgeon at Cappagh and St. Vincent’s Hospital in Dublin and member of the Orthopaedics Today Europe editorial board. It is the main hospital for orthopaedic residency in Ireland. All of the residents rotate through Cappagh, he said.
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For many years, the hospital offered the only postgraduate orthopaedic training course for nurses. In 1991, the Royal College of Surgeons in Ireland approved the Diploma Course in Orthopaedic Nursing for Cappagh. Since 1999, nurses have been able to obtain a Higher Diploma in Nursing Studies (Orthopaedic Nursing).
The education program received a boost in 1991 when the Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland was opened. Timothy O’Brien was appointed the first Abraham Colles Professor of Orthopaedic Surgery. According to the hospital website, the new department established a Higher Surgical Training Programme in Trauma and Orthopaedic Surgery.
Creating this department advanced orthopaedic training at the hospital.
“There was a residency program up and running before the chair was created, but the creation of an academic chair enhanced it considerably,” McManus said.
After O’Byrne was appointed as professor in 2005, he established a musculoskeletal module, where medical students from the University College Dublin and the Royal College of Surgeons in Ireland, spend 2 weeks in Cappagh, learning about musculoskeletal and orthopaedic medicine.
The facility is also renowned for treating bone cancers. In the 1980s, Cappagh surgeons pioneered the surgical treatment of bone and soft sarcomas in Ireland, Hurson said. The hospital is now the national referral center for musculoskeletal tumors.
“Prior to the 1980s, 100% of patients would have amputations for bone cancer; now 90% have limb-sparing surgery,” Hurson said.
Joint register
The Cappagh Joint Register, established in 2004, is the only registry in Ireland and currently includes only primary and revision TKA and THA patients. In 2010, there were 1,759 patients enrolled, O’Byrne said. Researchers follow the patients at 6 months, 2 years and every 5 years.
The Cappagh staff always strives to improve outcomes. For example, the Preoperative Assessment Unit, which triages all patients at the hospital before surgery, has reduced the number of same-day surgery cancellations, O’Byrne said.
“More importantly, it has reduced dramatically the number of patients who were being transferred postoperatively to hospitals with more medical facilities.”
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The staff is trying to shorten hospital stays as well.
“We have brought the stay down to about 5 days following hip and knee replacement, which is by no means earth-shattering, but for Ireland it’s improving,” Hurson said.
In addition, “We are developing standardized protocols for DVT prophylaxis,” O’Byrne said. “We’ve got a lot of integrated care pathways in place.”
International accreditation
In 2005, an international accreditation agency assessed Cappagh, awarding the hospital an almost unheard of score of 94 out of 100, O’Byrne said.
“It was a huge endorsement of what is done at Cappagh and the way it is done.”
O’Byrne is optimistic about Cappagh’s future. Eventually, he would like to see all seven operating rooms running.
“We want all of the elective orthopaedic surgery in the eastern side of Ireland to be carried out in Cappagh,” he said.
He would like to expand the research currently being done at the facility. In addition, he would like to see an extended workday, which would really maximize efficiency and likely eliminate waiting lists for THA and TKA in Ireland. To achieve these goals, the staff is concentrating on high-end orthopaedic surgery, he said.
“We don’t just want to be an efficient primary hip replacement or a primary knee replacement hospital,” O’Byrne said. “We want to keep a whole profile in the range of high-end expertise that we have.” – by Colleen Owens
References:
- Cappagh National Orthopaedic Hospital — Celebrating 100 Years. Compiled by Hurson, Kelly M.
- Joe Gallagher, MCh, FRCSI,can be reached at +353 1 497 3784.
- Brian J. Hurson, MCh, FRCSI, can be reached at +353 8 624 6561; email: jbhurson@gmail.com.
- Frank McManus, MD, can be reached at +353 1 830 9367; email: mcmanusf@rcsi.ie.
- Prof. John O’Byrne, MD, can be reached at +353 1 8340230; email: jmobyrne@rcsi.ie.
- Disclosures: Gallagher, Hurson, McManus and O’Byrne have no relevant financial disclosures.