Introduction: With the projected increase of 60% ,in the demand for healthcare in Ireland expected by 2020, treatment of patients in the community needs to be a critical focus of an Irish Integrated Health System and Healthcare Reform, to relieve the burden of over reliance on acute hospital care (HSE 2008). In the 2015 HSE Service plan ,one of the Primary Care priorities, was to expansion of the CIT service (HSE,2015 ).The Community Intervention Team (CIT) is a specialist, nurse led health professional team which provides a rapid and integrated response, to patients with acute episodes of illness ,who requires enhanced services/acute interventions for a defined short period of time. This may be provided at home, in a residential setting or in a clinic as deemed appropriate, thereby avoiding acute hospital attendance or admission, or facilitating early discharge.
Background: The CIT North Dublin Service identified a need to develop a CIT clinic, to assist in freeing up available patient slots in acute hospital based day units, and also to increase the capacity on the service by seeing patients both in the clinic, as well as on home visits . The service indentified two groups of patients from 2 different acute daycare hospitals’ acute daycare units , that were identified as been suitable for the first phase of this patient quality improvement project. The first group were Oncology patients requiring compounded chemotherapy pump disconnections and central line care.The second group were patients with Inflammatory Bowel Disease(IBD), who were medically stablised on ongoing Infliximab I.V Infusion treatment.
Aims: To facilitate a safe effective community nurse led infusion clinic, to patients with chronic illnesses, that can allocate appointments around their working and family commitments.
To provide a timely and efficient Oncology chemotherapy pump disconnection and central line care service in community , thus facilitating minimal wait time for patients, reducing exposure to hospital acquired infections with options of out of hours clinic times.
To work collaboratively with acute hospital based medical teams and staff to ensure patients receive care in an appropriate community setting and reduce the necessary time spent in hospital
The CIT clinic one year later: The service opened in November 2015 operating 1.5 days per week. The service was managed and staffed by the existing CIT nursing team .During the next 12 months period the clinic provided 298 clinic patient visits, for administration of Infliximab Infusions ,and 797 clinic visits for chemotherapy pump disconnection and central line care. In May 2016 a business case was submitted to open the clinic 5 days per week .Funding has been approved and the service is in the policy planning and development stage to provide additional services in the clinic.There is potential to replicate this model of care in other CIT services nationally
1- Health Service Executive (2008) Towards an Integrated Health Service or More of the Same? Available from: http://www.hse.ie/eng/services/publications/hospitals/An_Integrated_Health_System_ for_Ireland.htmlAccessed on the 26th November 2016.
2- Health Service Executive. Health Service Executive National Service Plan 2015.Health service executive (HSE). 2015.