Thousands of patients are bypassing GPs and going directly to hospitals for medical help, adding to chronic overcrowding in A&E departments, unpublished reports reveal. Eithne Donnellan, Health Correspondent, reports.
The reports, commissioned by the Health Service Executive (HSE) and seen by The Irish Times, shows that in 2004 over half, or 54 per cent, of people who presented at University College Hospital Galway (UCHG) had not gone to a GP first.
At Cork University Hospital 44 per cent of attendances at A&E had bypassed a doctor while at Wexford General Hospital 41 per cent of people self referred.
Details of the reports emerged as the union representing 6,000 doctors, the IMO, last night began a three-day conference in Killarney, Co Kerry discussing a range of problems in the health service, including overcrowding.
Outgoing president of the IMO, Dr Asam Ishtiaq, said overcrowding in A&E units was resulting in patients having planned surgery cancelled on a daily basis.
The reports on 10 hospitals in the State, aimed at determining the causes of A&E overcrowding, were carried out last year by UK healthcare consultancy Tribal Secta.
As well as patients bypassing GPs and going directly to A&Es, the reports say delayed discharges due to consultants doing ward rounds late in the day, and patients not being seen by specialists for several days, were adding to hospital overcrowding.
A deficit of suitable care for elderly people in the community and a lack of rehabilitation beds for young people were also resulting in discharges being delayed.
The Irish Times requested copies of all ten reports under the Freedom of Information Act, but to date only three - relating to Cork, Galway and Wexford General hospitals have been released by the HSE.
The other seven hospitals studied were Beaumont, the Mater, St Vincent's, St James's, and Tallaght hospitals in Dublin, as well as Letterkenny General Hospital and Our Lady of Lourdes Hospital in Drogheda.
The report on the Cork hospital reveals that of the 46,175 A&E attendances in 2004, 44 per cent (18,481 patients) were self referrals and 39 per cent (16,371 patients) were referred by a GP.
About 33 per cent of patients who attended the A&E department at the hospital "could possibly have been treated in other settings had these been available, thus relieving pressure on the emergency department," it adds.
Of 57,249 attendances at UCHG in 2004, 54.5 per cent of the attendances (31,206 patients) were self referrals and 43.5 per cent (24,970 patients) were referred by a GP.
Approximately 3,170 patients "could possibly have been treated in other settings had these been available", the report says.
The Tribal Secta report into Wexford General Hospital showed that in 2004 out of a total 28,467 attendances at the A&E unit, 41 per cent (11,757 patients) self referred and 44.5 per cent ((12,690 patients) were referred by a GP.
The reports found that having X-ray and other diagnostics departments open from only 9am to 5pm Monday to Friday was another problem.
The reports recommend that hospitals consider replacing more inpatient surgery with day surgery and said the length of stay of some patients may be able to be reduced.
For example, it said the average length of stay for patients having some types of hip replacement at Merlin Park Hospital in Galway was 13.2 days when in the UK the average length of stay for a primary hip replacement was seven days.
The ongoing problem of A&E overcrowding was recently branded "a national emergency" by Minister for Health Mary Harney. A special A&E taskforce established by the HSE is now working with individual hospitals to try and find solutions to the problems identified in each Tribal Secta report.