Hospitals were 'struggling with swine flu' during review

A REVIEW of the three Dublin children’s hospitals which found they were significantly under-using operating theatres was carried out during an “extraordinary week” for the health system, the hospitals have said.

The review by Meridian Productivity found that capacity planning did “not seem to be an element of management” in any of the hospitals and planned surgeries were being put on hold because of a lack of dedicated emergency theatres.

The unpublished report was commissioned in 2009 by the Health Service Executive to compare the services, performance levels and efficiencies across the three hospitals and make recommendations in line with international best practice.

In a joint statement last night, Temple Street, Our Lady’s Children’s Hospital in Crumlin and the National Children’s Hospital Tallaght said the review took place in a week where hospitals were struggling to deal with a “peaking swine flu crisis” resulting in the cancellation of a range of elective admissions with “a knock-on effect to theatre utilisation”.

The hospitals said that since the review took place in late 2009, improvements had been implemented, including the appointment of Dr Colm Costigan as a clinical director of all three hospitals.

Minister for Health James Reilly yesterday said he had not seen the report but that it was “shameful” children would have to wait for operations. Most recent figures show there are more that 500 children on waiting lists for surgery at the hospitals.

“It underscores the belief that I’ve held for a long time that lack of organisation and poor management rather than money are at the heart of significant problems within our health service,” Dr Reilly told RTÉ news.

Temple Street and Our Lady’s Children’s Hospital were only using their theatres 57 per cent of the time and the National Children’s Hospital had a 68 per cent utilisation. Best practice recommended an 85 per cent utilisation, according to the report.

The report said it was not uncommon for theatre sessions to start late, start early, finish late or finish early and there was a significant shortfall in operations that could be performed.

None of the hospitals had a dedicated emergency theatre and emergency cases were put into slots for planned operations, which affected waiting lists. The report found none of the hospitals systematically operated a manual or computerised theatre management system. While all had computerised systems, there was a “sense of underutilisation” of these for planning and reviewing.

Hospitals used “block booking” theatre allocation to a fixed surgeon and speciality, so that if the operation did not happen on time, the operating slot was lost, never to be recouped. There also appeared to be no systems in place to record or monitor cancellations and unallocated theatre slots.

No departmental budgets or forecasts were being used to plan the use of resources. The report recommended the appointment of a single director of theatre services for all three sites who would be responsible for theatre sessions and paediatric surgery as “a matter of urgency”.

Day-to-day running of theatre departments should be delegated to theatre managers – through restructuring and not through the creation of new posts. New review mechanisms should be introduced and dedicated emergency theatre slots provided to diminish the level of disruption to planned surgeries.

The hospitals last night said they had an agreed target of 70 per cent theatre utilisation and consistently utilised theatres well in excess of this target.