Children’s hospital ‘will not take all emergency cases’

The proposed new national children’s hospital will not have the capacity to meet demand for emergency treatment but many children will be encouraged to seek treatment in other hospitals, a planning hearing has been told.

Up to half of all sick children requiring urgent care after the hospital is built will be treated in satellite centres, an oral hearing into the project has heard.

The new hospital will not have the capacity to handle the projected daily emergency attendance of 350 children a day in 2021, according to Dr Emma Curtis, paediatrician and clinical director of the project.

“There is no children’s hospital in the developed world which has an annual emergency department attendance of this magnitude,” she said. The two planned satellite centres in Tallaght and Blanchardstown will therefore play a role in preventing an “unsustainable and unmanageable concentration” of emergency care admissions for the greater Dublin area.

Dr Curtis set out the proposed model of care that will apply to children’s health services after the hospital and satellite services open from 2020.

Local children with fever, rash, vomiting and diarrhoea, or sprains and fractures - should attend the urgent care units in the two satellite centres, she said. These centres will have observation beds but no inpatient beds. The hospital will also provide urgent care.

Children requiring emergency care involving life- or limb-saving treatment - for example, meningitis, pneumonia, multiple fractures or a collapsed child - will be treated 24/7 in the new hospital at St James’s.

Currently, one in seven children who attends an emergency department in one of the existing Dublin children’s hospitals is admitted. Dr Curtis said the vast majority of children are assessed, treated and discharged on the same day, and most children do not require the resources of a specialist paediatric hospital.

“Therefore, the satellite centres meet the requirement of delivering appropriate clinical care to the child as close to home as possible.”

Currently, 78 per cent of inpatients and 94 per cent of emergency department attendances at the three Dublin children’s hospital come from the surrounding area, she pointed out.

Dr Curtis said the project represented a unique opportunity to improve the delivery of paediatric care and the experience of children and their families. Co-locating the children’s hospital with the adult hospital at St James’s provided access to the greatest breadth and depth of subspecialties. The hospital was being designed in a sustainable manner so as to interface with a possible future maternity hospital on the same campus.

Hundreds of very sick newborns will still need to be transported by ambulance from a maternity hospital to the children’s hospital until such time as a new maternity hospital is built at St James’s.

Dr Curtis said it would be preferable if transport of these infants could be avoided but she pointed out that there hasn’t been a single fatality during transport during the 14 years of the neonatal transport programme. “The least risk in neonatal transfer in Ireland is associated with transfer within Dublin.”

The HSE supports the “compelling, coherent and pressing” case for developing the new hospital at St James’s, its chief architectural advisor, Paul de Freine, told the inquiry.

Most key stakeholders have agreed that deficiencies in the existing children’s hospitals are at a point where urgent action is required now, he said.