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ED crisis - will Dr Reilly have to eat his words?
[ by Niall Hunter, Editor www.irishhealth.com]
September, to misquote TS Eliot, is the cruellest month when it comes to running, working in and using our health services.
Any false sense of security brought on by the summer 'lull' in activity is rudely shattered.
The realities of trolley waits, treatment waiting lists, cancelled operations, inefficiencies and the various other privations and crises which make the service a nightmare to use and to run even in relatively good economic times, are busily flying home.
Also on a return flight will be Health Minister James Reilly, when he returns next week after trying to drum up some healthcare business in China. He will be faced with a very full in-tray.
The HSE's financial crisis is expected to have worsened during the summer months and figures will shortly show just how bad things will get for the rest of the year. Hospitals are already cutting agency staff and more beds, and the HSE has frozen practically all staff hiring.
Dr Reilly is returning to a healthcare system that is not only in many respects broken, but is also broke. Unlike with the banks, there is no bail-out in the horizon for the HSE.
Take the ED trolley crisis, which in reality is a hospital capacity crisis. The summer fall-off in trolley waits for patients needing admission is really a thing of the past.
In fact, while there is usually an increase in ED activity in the winter months due to more respiratory illnesses and other factors, there is in fact, not a huge variation between summer and winter ED activity.
The crucial factor is whether hospitals have the resources to deal with this activity at any given time. With staff and bed cuts in hospitals, trolley numbers are now pretty high at most times of the year as it gets increasingly difficult to admit emergency patients.
Trolley numbers are now growing steadily as staff return from holidays, and as more operations are carried out following the summer break, surgical beds fill up.
Conversely, as part of the ongoing hospital bed lottery, if there is considerable ED pressure, emergency patients when admitted can take up beds earmarked for surgery, leading to cancellations of procedures.
Against a background of reduced bed capacity and staff shortages, trolley numbers did not see any significant decrease during the summer months. This week, as hospitals get back into gear after the summer, we are already seeing winter-type trolley figures.
Four-hundred-and-one patients were on trolleys on August 31. The same day last year the figure was 314.
The previous week, the average number of patients on trolleys every day in hospitals was around 27% higher than the same week in 2010.
The traditional 'clinical winter',whereby hospital activity peaks as demand increases, now seems to last all year around. As hospital resources are reduced, they will struggle more and more to cope with this permanent peak.
The numbers turning up for treatment at EDs has actually dropped slightly so far this year, while emergency admissions are up slightly. However, bed and staff shortages mean chaos continues in many EDs.
The situation is not helped by the fact that due to funding and administrative problems with the Fair Deal Scheme, a greater than expected number of patients whose acute care has ended but who cannot find continuing care places remain in hospital beds.
And when we talk about an ED trolley crisis, it is not just a case of health news junkies and commentators hand-wringing over the latest statistics. It can literally be a matter of life and death.
Pressurised and overcrowded EDs can mean that patients do not always get admitted in time to receive the treatment they need when they need it. Experts now agree that hundreds of unnecessary deaths may occur in Irish hospitals each year that can be attributed to excessive ED pressure.
The HSE has set a target maximum ED target of six hours from registration to admission for a reason, although this target is only met 50% of the time. The reason is it is simply not safe to have patients waiting 12, 24 hour 48 hours or more for the proper care they need.
When he returns from the Far East, Dr Reilly may well start to regret a statement he made in the heady days following his appointment in March.
He promised that we would never again see 569 patients nationally on trolleys, as happened one day back in January in the 'bad old days' of Mary Harney.
This statement may come back to haunt him. For unless some very radical action is taken, trolley numbers could well exceed 600 at some stage in the November to January period. This record may be broken even sooner than that.
Dr Reilly's newly-established Special Delivery Unit is primarily tasked to deal with treatment waiting lists. However, as a priority, it will first be taking on the ED trolley crisis.
Those using and working in hospitals will await with interest further details of Dr Reilly ED plan, which are expected to emerge later this month.
A key barrier to any solution to the ED crisis is the fact that at least 1,900 acute and long-stay beds are currently cloxed, and this figure is likely to increase.
In the absence of any realistic solution to the hospital capacity issue, it is difficult to see how ED overcrowding can be tackled effectively.
Some improvements may be made through greater efficiencies in hospitals, and indeed some EDs suffer less from ovdercrowding than others, despite having similar pressure on services.
However, even emergency departments which have traditionally had lower trolley numbers are now finding it difficult to cope with ED pressure.
One way to reduce trolley numbers is to take the trolleys out of the ED alogether. This can have patient safety implications, although so does keeping 20 to 40 patients in an emergency room.
Tallaght Hospital got into trouble with the safety body HIQA for putting trolleys in corrdidors off its ED.
There is also the practice used by some hospitals of placing trolley patients on inpatient wards. Admittedly this can can alleviate overcrowding, and consultant emergency doctors argue this is safer than keeping these patients in the emergency room.
However, this is obviously not a long-term solution to the ED issue, and the Irish Nurses and Midwives Organisation argues that boarding ED patients on wards is effectively sweeping the capacity problem under the carpet.
Dr Reilly is, however, quite an enthusiast for putting ED patients on wards, but it is essentially a short-term solution. Many will hope that this 'sticking plaster' does not form the cornerstone of Dr Reilly's new ED policy.
In the longer term, the HSE says it will eventually reduce trolley waits through its new clincial programmes, which will move a good deal of current hosopital workload, such as diagnostic testing and treating minor and long-term conditions, from hospitals to the community.
This is indeed a great plan-unfortunately, at this stage it only seems to exist on paper.
In the meantime Dr Reilly has to come up with solutions pretty fast or we're going to have the mother of all 'clinical winters'
Let's hope the doesn't have to eat his words when it comes to delivering on his trolley promises.
|Absyrd Posted: 09/09/2011 14:45|
Chinese Medicine and Conscious Medicine may provide aternatives to costly Western Medicine. Selling Irish Health Services is not a good move although higher education providers appear to think so.
Illness is a product of self and context. Sick Societies typically lack spirituality and social justice. Dr Reilly may make a name for himself by some lateral thinking and quantum physics.
|Anonymous Posted: 13/09/2011 16:24|
Given the state of our hospitals, what on EARTH was he doing Over in China - apart from wasting taxpayers' money. It would fit his role better to study healthcare provision in Sweden, which is reknowned as providing a world class health service.
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