Healthcare report: Providing advance nurse practitioners and diagnostic tools in the community, in addition to providing telephone assessments and strict A&E patient pathways, will help resolve the current crisis, according to a new report.
The first necessary measure is to undertake an audit of patients attending the departments and draw up consistent pathways as to where each patient should go, according to Marie Kehoe, president of the Irish Society for Quality and Safety in Healthcare.
This follows the recent publication of the Tribal Secta report which singled out A&E "logjams", poor management of patients with chronic diseases and lengthy stays by the elderly as key areas of concern.
"Say, for example, a child comes in with a fractured leg. Normally they would come in, sit, wait, see a doctor, have an X-ray, queue again in A&E and wait for a doctor to view the X-ray and then get a cast," said Ms Kehoe.
"What we are proposing is a system where you walk in and are immediately put in a queue for an X-ray and are immediately on a particular patient pathway.
"It's the same with cardiac. You come in, you get sent for blood tests because you need these in order to get diagnosed," she said.
These so called "pathways" must be formulated and recorded so that an advanced nurse practitioner in A&E can immediately check protocol on the arrival of a patient and refer them to a particular queue and pathway.
"We must work on the patient journey through the system and design our systems to make the patient experience an effective and efficient one, doing the right thing at the right time in the right place," said Ms Kehoe.
However, other measures can be implemented which would allow patients to avoid attending A&E in the first instance.
One of these measures is providing for telephone assessments whereby a member of the public can contact a nurse on duty and relay the symptoms of the person of concern. The nurse would have a checklist and set of protocols on which to advise the patient.
Community-based care is crucial in the effort to address the problems of A&E, according to the Irish Society for Quality and Safety in Healthcare.
The simple provision of diagnostic tools such as X-ray machines and the employment of an advance nurse practitioner in the buildings normally occupied by GPs would alleviate the need for persons with minor injury and illness to attend A&E.
"Often, for reasons I'm not too sure of, A&E can be so busy that patient notes and records aren't read and that's leading to a breakdown between the standard of community care and A&E," said Ms Kehoe.
Unlike the surroundings of a hospital where a patient is anonymous, the community setting allows for a doctor/nurse-patient relationship to evolve where the patient's medical history will be known and understood.
One final measure which reduces the need to attend A&E is the process of "empowering the patient population".
Ms Kehoe believes that working with patients and educating them to manage their health in a more proactive and responsible way would reduce the need for unplanned emergency visits.
"This [A&E crisis] is not about poorly performing people, this is about patients not getting the right kind of care in conditions that are simply unacceptable due to poor systems of work," said Ms Kehoe. "We all seem to agree on this. It is now time to agree on the mechanisms to put it right in all our interests."