Blueprint outlines major ED revamp

Current facilities in our hospital emergency departments (EDs) are not fit for purpose, according to a major new report.

It says ED facilities around the country are in the main, unfit for purpose. it also calls for a major reorganisation of ED care that would involve the 'downgrading' of some hospitals currently providing major emergency services.

The HSE report says even where EDs have been redeveloped in recent years, they have been upgraded to designs that have generally resulted in departments that are suboptimal by international standards.

The findings are contained in a a major blueprint for improving how hospital emergency departments (EDs) should deliver care to patients.

The report is highly critical of current ED facilities. It says some general EDs do not have proper facilites to ensure that child and adult patients are kept apart.

The report calls for major improvements in ED infrastructure to ensure that EDs provide safe clinical environments for patients and staff.

A key recommendation of the Emergency Medicine Programme (EMP) report is that hospital ED services be reorganised and delivered through collaborative emergency care networks around the country.

These networks will include hospitals with 24/7 major EDs (Type A), local emergency units (Type B) as well as local injury units (Type C) for less serious cases, all of which will be linked in the provision of local services. Type B and C units would not be open overnight.

These networks would be backed up by an effective pre-hospital care system including ambulance and helicopter emergency services, and would also include community level emergency care and a role for GPs as immediate care doctors.

The report says that in centralising some ED services, the overall approach in any reorganisation should be to centralise only those services for which a benefit can be demonstrated, while providing as much care as can be provided safely as conveniently as possible to patients, close to where they live.

The report says there should be more than one emergency care network each of the four HSE administrative regions - Dublin North-East, Dublin Mid-Leinster, South and West.

However, while the type A units would be located in major teaching hospitals, the report does not specifically name smaller hospitals which would be likely to lose their current major ED services under the planned reorganisation.

This is expected to be outlined in more detail in the forthcoming Framework Document on the organisation of hospital services being prepared by the Department of Health and the HSE.

Among the recommendations of the ED report aimed at improving services are:

*Increasing consultant numbers to improve access to consultant-provided care.

*Expand the roles of nurses, therapy professionals and other staff in ED services.

*Better liaison between ED services and other hospital specialties.

*Implement a 'six-hour standard' so that 95% of patients are admitted or discharged within six hours of attending at an ED.

*Give a greater role for GPs in ED services and improve links with general practice and primary care.

*Generally improving and standardising quality of care thorugh performance indicators and monitoring.

The HSE says implementing the EMP will mean patients will be assessed and either discharged or admitted within six hours of arrival in an ED.

However, latest HSE statistics show that hard-pressed hospitals are currently way off reaching this target. Only 67% of all ED attendees are processed within this timeframe at the moment.

The EMP report says emergency networks will work closely with pre-hospital care, hospital-based services and primary care to ensure patients can access the care they need in the most appropriate setting.

New clinical governance structures are set out in the report, aimed at driving improvements in the quality, efficiency and cost-effectiveness of emergency patient care. The HSE says emergency care network services will be continuously measured and improved to protect patient safety and the quality of care they receive.

EDs - welcome to my (third) world

[Posted: Tue 19/06/2012]