Patients suffer in face of chaotic hospital practices

MANAGEMENT and consultants in hospitals have reported chaos in the way patients are assessed, admitted and discharged.

A Comhairle na nOspidéal review of the role of Acute Medical Assessment and Admission Units (AMUs) found serious concerns about poor use of resources, the impact of delays on patient health and the public’s perceptions of the health service.

The report, published yesterday, recommended that all acute general hospitals receiving acutely ill medical patients have a medical assessment unit.

In the course of its review, one hospital said it was not uncommon for an acute medical patient to have to wait four or five days before treatment even began.

“These delays centred on waiting in the A&E department, waiting for an in-patient bed, waiting to be seen by the relevant consultant and his/her team, waiting for tests, their results and waiting for a diagnosis,” said the report, calling for urgent measures to tackle the delays. “Overall the acute hospital system in Ireland at present deals with unplanned acute medical assessments and admissions in a largely reactive manner. Pressure begins in the A&E department and then builds up and spreads throughout the hospital.

“There is now an urgent need within the hospital system in Ireland to ensure that acute medical patients, whose numbers are growing, are dealt with in a more centralised, planned and co-ordinated manner.”

One Dublin hospital informed the committee that, at any one time, the hospital would have in the region of 60-70 patients awaiting placement in long-term care. Delays in accessing long-stay beds for these patients can range from six months up to three years. Twenty per cent of these are in the younger/middle-age group.

Comhairle recommends that AMUs be located in all acute general hospitals with access by way of GPs, A&E or the hospital’s outpatient department. All AMUs should have dedicated staff to ensure the provision of a high quality service.

In AMUs in major hospitals, additional consultant physicians with appropriate training in acute medical care should be appointed to and based in the AMU. The AMU must have priority access to acute investigative facilities and in-patient beds within the hospital and consultant-led ward rounds should take place at least twice daily in an AMU.

Hospitals visited in the course of the review include Cork University Hospital, the Mater, Mayo General, Mid-Western Regional, Limerick, St James, Dublin, and St Luke’s, Kilkenny.

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