Heart Beat: In my intern days one of the most annoying duties was being called during the night watches to examine a patient who had fallen out of bed. They were nearly always older patients, some with dementia, incipient or established, some just confused and frightened in strange surroundings.
Some were heading for the bathroom; some were bound for a destination in their own private little world; and some were obstreperous, even violent, possibly exhibiting withdrawal symptoms from alcohol or drugs.
No matter what the cause, they had to be examined to ensure no injury had befallen them and they had to be assessed in an endeavour to make them more secure. Night sedation was the easy way but it had its problems in that it might mask an underlying problem.
Such incidents and calls were fairly common and in my experience seldom caused much harm to the patient. Unfortunately, there were occasional fractures and head injuries.
It was not uncommon to receive several such calls during the night and you could spend hours dealing with the problems that arose.
This subject came to mind when I read that 1,000 adverse healthcare incidents per week occurred in Irish hospitals. Here we go again, I thought to myself. Guess who'll be blamed?
No marks for that one, it's the doctors again. In fact, no sooner was this report leaked than we were told that the real figure was possibly three times this number as not all hospitals were reporting to the incident-reporting system at that time. In reality, the true figure was slightly fewer than 850 a week, but 1,000 sounds better doesn't it? Such incidents ranged from the extremely serious to the trivial and, frankly, it is difficult to see how some of them became a part of such a report at all.
Some non-consultant hospital doctors I spoke to during the week were scathing about some of the incidents being reported and the amount of time, effort and paperwork involved in dealing with them. Some such are described as "near misses", an intriguing description indeed. Some careless doctor or nurse missed doing harm, not good enough really in today's world.
However, to return to my original point, almost 40 per cent of the adverse incidents referred to the same slips and falls that often disturbed my sleep all those years ago. How ever did we manage back then without the State Claims Agency to run to? I'll tell you how. We just got on with it and examined and treated the patients as best we could.
I do not for one moment seek to deny that bad things can happen in hospitals, that there can be negligence and sins of omission and commission. There always will be and it would be very foolish indeed to postulate some sort of Utopian health system where such things will not occur.
This report is useful in that it provides a statistical base for the prevalence of all adverse happenings and, apparently, our figures conform roughly to international experience. I would have been mightily surprised if it had proved otherwise.
A short time ago in a television interview, I remarked that we are a very litigious people. This is what this is all about. The State Claims Agency defends all those employed within the system against allegations of poor treatment or bad outcomes. These figures allow them separate the wheat from the chaff.
Why else would such incidents be reported to the agency other than to warn of possible impending litigation? Apparently, we are also to have a new patient safety authority to assure best practice in the archaic and underfunded hospitals that we have. Great idea this, but how about a few more doctors and nurses and carers rather than another expensive collection of bean counters?
If we point out that we need more nurses and doctors, we are told that there is a cap on numbers employed in the public service. We need doctors, and yet newly qualified doctors sometimes have to look overseas to get intern jobs. Places on general practice training schemes are at a premium and yet the importance of primary care is constantly preached.
Newly qualified physiotherapists cannot get employment although desperately needed and we have the farcical situation whereby up to 70 per cent of newly qualified nurses leave the service within two years of graduation and leave us importing nurses, sometimes from countries that can ill afford to lose them.
Those who preach about "patient safety", as if they had invented it, are not the two night nurses charged with the care of 40 even 50 patients on their ward. They are not the intensive care, or coronary care, or theatre and A&E nurses struggling to make the best of often appalling conditions. They hold to their vocations despite a pay scale that is derisory compared with many less qualified groups. It is little wonder that many choose to leave the service. They have been shamefully treated.
I wrote some weeks ago that many hospitals were unable to do much of their elective work due to the pressure of emergency work. Figures given in this newspaper from Beaumont, Ennis, Naas, St James's and Tallaght show emergency work ranging from 67 to over 90 per cent. It is a crisis.
Apparently in the wonder world of the Minister for Trolleys you have to become an emergency to have the best chance of treatment.
Maurice Neligan is a cardiac surgeon.