The establishment of a minor injuries clinic and a GP referral system are options being considered by the Mid-Western Health Board to reduce the number of people attending Limerick Regional Hospital's accident and emergency (A&E) department.
The pioneering project is being led by Mr John O'Brien, a health board deputy chief executive with responsibility for acute hospital services.
He said the aim was to reduce the 55,000 people attending the department annually by up to a third. "It would free up staff to treat the people who really need to be there." Limerick Regional's A&E admissions are the fifth highest in the State after Tallaght, the Mater, Cork University and Beaumont, according to 1998 figures supplied by the Irish Hospital Consultants Association. Sligo, with 25,306 attendances, is at the bottom of the list of the 13 hospitals with A&E departments staffed by consultants. In Limerick, following the introduction of an IT system, the hospital reviewed its internal processes and found that 52 per cent of the 4,000 patients at the department between September 12th and October 12th had low risk complaints or should have been directly attending the X-ray unit or paediatric services.
"It is entirely inappropriate that they are waiting for treatment with people who are there after the Friday night on the town or whatever," Mr O'Brien said.
The hospital has been examining the problem for the past six months and has introduced a system of triage where nursing staff sort patients for treatment according to their priority.
"People fitting into those non-urgent categories can very easily be treated by GPs. If they require an X-ray, it is usually not critical to the treatment process and does not have to be done straight away," Mr O'Brien said.
The health board proposes to set up a separate minor-injuries clinic to which people would be referred if they have less serious complaints or which they would naturally attend rather than going to the hospital A&E department.
"We have been reviewing the A&E department for the last number of months. The GPs have been part of that process with us," Mr O'Brien added.
The project has not been costed but he said such a clinic would have to be in a separate location to the hospital at Dooradoyle. "Once you bring people on to the campus, it means that they clog up the A&E department because that is where they will gravitate towards."
A separate option is to link in with a GP network service which would have a doctor on call, but Mr O'Brien said the two options could merge into one. "We would either put health board doctors into it to staff the unit or GPs would staff it. The medical cover in this unit needs to be resolved."
The IHCA secretary general, Mr Finbarr Fitzpatrick, said that, nationally, about 20 per cent of the annual 650,000 attendances in casualty departments were "inappropriate" and where GPs should have been contacted. He said it resulted in longer waiting periods and aggravation for people who did not have life-threatening conditions.
"It is very much an urban phenomenon rather than a rural one. Because of the convenience of an urban hospital and because it is open around the clock, people tend to call there," he said.
He added that the advent of large GP practices, with doctors available on a rota basis, could take the load off casualty units.