Sir, – There is ambiguity as to who is responsible for the safety of critically ill patients who suffer a brain haemorrhage and are denied emergency neurosurgical or endovascular treatment. Beaumont and Cork University Hospitals are the only centres which provide emergency neurosurgical treatment.
Subarachnoid haemorrhage (SAH) is an immediate life-threatening emergency. An estimated 460 to 1,290 people suffer a brain haemorrhage each year. Ten to 15 percent of casualties die before reaching hospital and about half of all patients die within the first six months. In 2012, 238 SAH patients were diagnosed. 138 were treated but 100 were denied treatment.
The Health Information and Quality Authority (HIQA) claims that it is not responsible and that the Health Service Executive (HSE) is accountable as the statutory agency for managing and monitoring the performance of Beaumont Hospital.
The HSE claims that Beaumont is not responsible because the hospital did not take over the care of the unadmitted SAH patients and therefore would not have information on the outcome for those patients.
The Minister for Health, in response to written parliamentary questions, advised: “as this is a service matter it has been referred to the HSE for direct reply”.
So who is responsible?
When my wife, Nuala, suffered a subarachnoid haemorrhage she was denied access to emergency neurosurgical treatment which would have prevented the catastrophic rebleed which caused her death in 2005.
In response to my criticism in The Irish Times on September 29th, 2009, that there were no guidelines, protocols or standards in place to monitor the safety of SAH patients unable to access emergency treatment, Beaumont Hospital said it was "satisfied that appropriate protocols were in place . . . contrary to Mr Lawless's assertion, bed availability was not a relevant factor".
In the same article, HIQA said its priority was to “develop generic standards to drive improvement across the whole health system” but confirmed that “a specific standard covering the transfer of cranial haemorrhage patients is not in our immediate plans.”
Later in response to my request to HIQA for a copy of the “appropriate protocols” which Beaumont Hospital claimed were in place, HIQA wrote to the hospital in 2010 seeking assurances that guidelines and protocols were in place. HIQA confirmed: “When it was established that there was not a single consistent guideline in place, the Authority ensured that National guidelines for patients with head injuries and subarachnoid haemorrhages with attendant algorithms were developed and disseminated to every HSE hospital”. These guidelines have not improved access to treatment.
Beaumont has just 10 neurosurgical intensive treatment beds. My assessment of a significant shortage of neurosurgical intensive treatment beds was confirmed by an expert group which reviewed critical care services in Ireland. Towards Excellence in Critical Care assessed the need for 52 intensive treatment and 8 high-dependency beds in 2014.
In a parliamentary question to the Minister for Health, I wanted to know the outcome for SAH patients admitted to various acute hospitals but denied emergency treatment in Beaumont Hospital in 2011, 2012 and 2013.
The response through the HSE advised that the information is stored on the hospital’s hard drive system, but the neurosurgical research and development unit does not have the resources to retrospectively review.
The significant shortage of neurosurgical intensive treatment beds is obvious, corporate and clinical governance is poor, as is the assessment of patient safety risks. The lives of several hundred SAH patients in Ireland continue to be put at risk. The level of mortality is unknown because there is no measure of performance to monitor the outcome for untreated SAH patients. In contrast, the National Neurology and Neurosurgery Hospital, London, accepts poor grade SAH patients for treatment and 53 per cent can expect a good recovery.
We need to review the outcome for untreated SAH patients in 2011, 2012 and 2013 and address patient safety risks in the Neurosurgical Centre. HIQA needs to be more proactive by putting in place a robust system to identify potential risks, and not just to react after tragedies have occurred. – Yours, etc,
JIM LAWLESS, MBA
Cypress Downs,
Templeogue,
Dublin 6w.