OUTPATIENT WAITING lists will temporarily get longer in several hospitals over the next six to 12 months while the Health Service Executive attempts to fix a separate problem which leads to logjams in emergency departments.
The HSE will this year focus on improving the way medical patients with acute conditions such as heart failure and strokes are treated when they arrive in emergency departments. Those with GP letters will be prioritised and sent to a medical assessment unit rather than having to languish in a queue with those who have other conditions such as broken bones.
Prof Gary Courtney, joint national clinical lead of the HSE’s acute medicine programme and a doctor at St Luke’s Hospital in Kilkenny, said that fixing the delays currently encountered by acute medical patients attending emergency departments would in the short term result in delays by clinicians getting to see those on outpatient waiting lists and those awaiting elective endoscopies.
“We don’t want that. But which is more important: to treat the emergencies coming in such as heart attacks and strokes or leaving people that can wait?” he asked.
The changes planned for how doctors deal with medical patients coming into hospital would ultimately result in more outpatients being seen and waiting lists being reduced in the long run, he said.
“There is a little bit of a leap of faith here but it’s been done in other parts of the world . . . and it actually worked,” he said.
This year 12 hospitals will be targeted for improvements in the way they deal with acute medical patients. Site visits have already been made to five of the hospitals including Tallaght and Beaumont in Dublin, Our Lady of Lourdes in Drogheda, Limerick Regional Hospital and Galway University Hospital. The other seven sites are currently being agreed and will be visited by June.
Some €8.5 million is being spent on the programme this year, part of which will go towards development of stroke services and the appointment of an additional 34 hospital consultants.
Over three years improvements are expected at all hospitals.
The aim is to take 20 per cent of medically ill patients out of the workload of emergency departments and have them seen by a senior medical doctor within one hour of arriving in hospital.
Prof Shane O’Neill, also joint national clinical lead of the programme and a clinician at Beaumont Hospital, said the initiative would remove trolleys from emergency departments and also free up blocked surgical beds. Up to 40 per cent of acute medical patients when seen will be sent home, reducing numbers of unnecessary admissions and freeing up beds.
“If we don’t deal with this problem [trolleys] we are slowly strangling the hospital system.”
He said the hospitals visited so far had been overwhelmingly positive about what was proposed, which requires a cultural shift in how patients are dealt with. Teams would devote all their time to acute medical referrals rather than other work like outpatients and they would have to rejuggle other commitments.