Bright Sparks: Healthcare professionals strive to innovate and improve patient care

The HSE Spark Innovation awards for 2023, which have recently been announced, include projects which manage a severe form of morning sickness in pregnancy known as hyperemesis gravidarum, improve diagnosis of headaches to avoid hospital admissions, and improve people’s awareness of the importance of clean air for good health.

The programme was set up in 2017 to encourage and support non-consultant hospital doctors to implement innovations in their areas. In 2020, it expanded to include nurses, midwives, and health and social care professionals, both within hospitals and in community and public health services.

Here, we talk to some of the winners of the Bright Sparks awards in 2023.

Dementia training for community gardaí

Knowing the previous addresses of a missing person with dementia can be the key to finding them. This is just one piece of information that could transform a very stressful situation for families into a solvable case for local gardaí.

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Garda Gemma Collins from the Ronanstown community policing team in Dublin cites it as an example of what she learned on a dementia training workshop for An Garda Síochána, led by the Integrated Care Programme for Older Persons (ICPOP) in Tallaght. “I’ve personally dealt with a case where one gentleman was located at a previous address. He was very confused and wondering who was living in his house,” explains Garda Collins.

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Learning about how someone can behave very out-of-character when suffering from delirium was another important learning. “We have powers under the Mental Health Act to detain a person for their own safety. This includes those suffering from a presumed neurological condition, and we can call out a doctor to assess them,” explains Garda Collins.

Deirdre McNally, senior social worker with the ICPOP team at Tallaght, says people with dementia have a greater risk of developing delirium. “Delirium is a short-term state which can be due to an infection, pain, constipation or confusion. It can result in the patient being very aggressive and requires a medical response,” explains McNally.

The dementia training for gardaí led by the ICPOP team in Tallaght won the best community project award at the 2023 HSE Spark Summit.

McNally explains that the initiative came about due to the already close relationship between services for older people and gardaí. “We deal with older people with complex health and social care issues and the community policing team wanted to learn more about dementia,” says McNally.

During the Covid-19 pandemic, community gardaí were among those interfacing with older people in their homes when day and respite services were closed.

We would put on another jacket over our uniform so as not to frighten or distress the person

—  Garda Gemma Collins on dealing with patient dementia

Occupational therapist in the ICPOP team at Tallaght, Caitriona McGuinn, developed a “safe and found” document with personal information about dementia patients, including previous addresses where they lived. Such information is often kept in a plastic bottle in the fridge should family members or emergency services need to access it.

At the dementia training, gardaí learned about these personal information documents as well as assistive technology such as pendant alarms and wrist bands that many older people use. The importance of checking whether a person needs to put on their glasses or put in hearing aids before engaging with gardaí was also emphasised.

“We also explained how important body language is when speaking to a person with dementia. It’s important to be aware of your facial expressions and repeat things so the person has time to understand what you are saying,” explains McNally.

Garda Collins says she also learned that some older people with dementia can have a fear of uniforms. “So, we would put on another jacket over our uniform so as not to frighten or distress the person,” explains Garda Collins, who suggests dementia training could be included in training for all new gardaí.

McNally says the ICPOP team at Tallaght has had very positive feedback from gardaí in Tallaght, Crumlin and Lucan/Ronanstown who completed the dementia training. “We believe this model is transferable to other integrated care teams and community policing teams throughout the country,” she adds.

Helping GPs identify common skin conditions

Consultant dermatologist Dr Patsy Lenane says dermatology is poorly taught at undergraduate and postgraduate medical schools, which results in high numbers of GP referrals for routine skin conditions to specialist dermatology services.

“At the Mater University Hospital in 2020, we had 4,000 patients on our waiting lists. The urgent cases could be waiting up to 89 days, the next group of patients could be waiting for six months, and those with routine skin conditions didn’t get seen,” she explains.

“We got more staff and managed to reduce urgent referrals to 40 days, the next group to three months and patients with routine conditions to six months – but we knew we still needed to make other changes,” explains Dr Lenane.

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With the realisation that dermatology is both a tactile and visual specialism, the team employed a graduate from the National College of Art and Design Master’s programme in medical device design, Sean Gallagher, to make 3D skin models as educational tools for GPs.

“The skin models are made of silicone tinted with pigments. It’s a long lasting, durable waterproof material on which the colour stays vibrant for a long time,” explains Gallagher, who worked with photographs and met patients with different skin conditions before completing the models.

The skin models are contained within booklets with labelled diagrams and diagnostic information for 25 different skin conditions, ready to be used in medical training programmes.

We hope to set up an encrypted app that GPs can send photos to be reviewed and responded to

—  Dr Patsy Lehane, consultant dermatologist

“Our long-term goal is to reduce routine referrals to hospital with increased education,” explains Dr Lenane, who won the CEO’s Choice Award for Best Hospital and Community Integration Project at the 2023 HSE Spark Summit. The team is now working with University College Dublin to validate and integrate these skin models for educational purposes with undergraduate medical students and GP trainees.

Another strand of the so-called Skinnovate programme is to provide GPs with better support so that they don’t refer routine skin complaints to specialists. So, the next step for the Mater University Hospital team is to set up a dedicated phone line for GPs to speak with a clinical nurse specialist in dermatology about patients.

“We hope to set up an encrypted app that GPs can send photos to be reviewed and responded to,” explains Dr Lenane. Finally, she hopes to establish a programme in which a GP with a special interest in dermatology would work one day a week at the hospital’s dermatology clinic to build up expertise to bring back into the community to support other GPs in the area.

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Dr Niall Hurley, a GP in Ballymun, Dublin, is working with the Mater University Hospital dermatology team to help them understand the GP perspective and find ways to enable more diagnosis and treatment of skin conditions in the community.

“Skin problems represent about 20 per cent of what we see, and we do not have a lot of experience treating them,” explains Dr Hurley, who believes the Skinnovate skin models will be an excellent teaching resource.

Dr Lenane adds: “We will always see patients if there is a suspected cancer, but we’d like to support GPs to treat patients with eczema, psoriasis, acne, warts and skin tags going forwards.”