ANALYSIS:Staff, GPs and patients worry that the investigation will eventually lead to the hospital's closure
THE NEWS that one of the State’s small acute hospitals – Mallow in north Cork – is to be subject of an urgent inquiry into the safety of patient care will be a source of concern for patients, GPs and hospital staff. An understandable reaction, as articulated by local TD David Stanton at the weekend, is that the investigation presages the hospital’s eventual closure.
Hospital supporters will argue the unit has been starved of funding by the Health Service Executive. In a chicken-and-egg situation, they say that inadequate funding sets a hospital up for failure when staffing levels and other facilities are insufficient to ensure quality standards are met.
According to the latest performance assessment by the HSE in May of this year, Mallow hospital was given an overall amber grade, meaning it achieved average performance, with room for improvement. And in the absence of specific concerns voiced by patients or doctors it is difficult to say with certainty what led the board of the Health Information and Quality Authority (Hiqa) to initiate an urgent inquiry into the 76-bed unit.
The May HSE Healthstat report has a number of pointers. It found excessive delays for patients requiring a CT scan and poor figures for elective admission rates on the day of a procedure. However it found that patients requiring an urgent colonoscopy were assessed in a timely manner and that waiting times at the hospital’s emergency department were good.
A previous report by Hiqa into patient safety at Ennis General Hospital, published last year, offers some clues as to possible concerns at the similar-sized Mallow facility. It found that at least one cancer patient had suffered an adverse outcome because of failures in the communication of test results to GPs. There was also evidence that test results were being filed in charts without being signed off as either normal or requiring further specific action. The report concluded Ennis was unsafe for patients through a combination of inadequate consultant staffing levels and low patient throughput.
Mallow appears vulnerable on the staffing issue: it has three consultant physicians, three consultant surgeons and a sessional consultant ENT surgeon. The hospital has a small intensive care unit. How the hospital is performing will depend to what extent care is given through defined “care pathways”. An integrated care pathway is a structured approach to patient care which details the essential steps to be provided by different professionals in the care of patients with a specific clinical problem. It ensures the right patients are cared for in the right way in the right setting.
If these pathways are patchy or non-existent, then Hiqa may have been alerted to situations where key decisions on information about patients fall into gaps between systems, teams and departments. The inquiry may focus on local and regional laboratory services. It may conclude that Mallow should no longer provide acute or elective inpatient surgical services, with these being transferred to Cork University Hospital. In return, Mallow may be asked to perform more day case surgeries.
There may also be restrictions on the level of intensive or critical care that Mallow can provide. This may require changes in the way road traffic incidents are responded to in the north Cork area as well as whether seriously ill medical patients will in future be transferred to larger Cork city units. And restrictions on the range of medical services provided at Mallow will inevitably be examined as part of the review, with a protocol-driven model of what conditions can be treated safely there likely to emerge.
The publication today of the inquiry terms of reference should shed further light on the services at the facility that are giving rise to concern.
It would be helpful if the nature of complaints made about Mallow were made public in a way that preserves patient confidentiality. As well as the inquiry, an open and honest debate about safety concerns will ensure the best decisions about the hospital’s future are reached.
