Hospital service: A consultants report for the Government and senior health service management on problems in accident and emergency (A&E) services has criticised inefficiencies in the way the system is operated in hospitals and proposed major reforms to operational and work practices.
It has also recommended greater access for GPs to diagnostic and other facilities to avoid patients having to go to A&E in the first place.
However, the report on A&E mapping and efficiency, by consultants Tribal Secta, also says the impact of public spending cuts in the 1980s and 1990s has played a significant part in the manifestation of lengthy waiting periods in A&E departments.
In its report, extracts of which have been seen by The Irish Times, Tribal Secta tracked how patients were dealt with from A&E to discharge in 10 hospitals. The report, to be published next month, is expected to form the blueprint for an initiative to tackle difficulties in this area.
It states that on any given day up to 300 patients can be waiting on trolleys. While Ireland is not alone in such figures, the "sometimes catastrophic consequences this situation has on patients, carers, staff and organisations across the State" should not be underestimated.
The report criticises operational and work practices in hospitals and in the wider health services which have led to problems in A&E departments. It says there is duplication of services in hospitals as well as unnecessary queuing for patients.
There is further room for improvement in staff arrangements in A&E, particularly at weekends, and these should reflect patient arrival times and the case mix. It states that, traditionally, patients considered to be in need of admission are seen by the most junior member of the team, and this leads to delays. Senior decision-makers need to be available at every step.
However, the report also maintains the Government cuts "undoubtedly had a number of operational consequences on the health services". It says that these reduced capacity within hospitals as hundreds of beds were removed. They also eroded the traditionally strong and straight-forward direct contact/referral relationship between GPs and consultants. As open access to in-patient care became more limited, A&E became the "available route to the acute system" .
It says that although greater efficiency can undoubtedly be applied to the emergency department, it is only by addressing challenges faced within the wider health and social care system that the problem of waiting will be satisfactorily addressed.
The report states there are insufficient numbers of GPs and primary care teams available, and an inability for these to access acute services such as tests and observational facilities. It also says there is a perception, if not reality, that presentation at A&E will be cheaper for the patient than attending the GP.
The report proposes there should be new "one-stop" facilities in the community where patients could receive tests, diagnosis and some treatments without entering the hospital sector. It also proposes acute medical units be developed in hospitals and that GPs should have access to the observation/short-stay facilities beds established in these units.
Within the A&E department, the report encourages consultant input into the triage or initial patient assessment system to allow for rapid discharge from the centre. It also suggests that advance nurse practitioners be involved in a "see-and-treat" service which would deal with patients with minor injuries.
It recommends that there should be a clear policy about the maximum length of time which a patient can stay on a trolley in any hospital.
