Whole hospital system blamed for A&E problems

THERE is no evidence of an accident and emergency crisis and the number of people waiting on trolleys is due to failures throughout the hospital system, a new report has found.

The report, by British consultants Tribal Secta, which examined the patient’s journey through 10 of the State’s major hospitals, blames a variety of factors for the A&E bottlenecks including:

* Bed shortages and extremely high occupancy levels “manageable in the short term” but “not sustainable in the medium to long term”.

* Delayed patient discharges because of a shortage of nursing home places and home care packages. “It was not unusual within the review, to find lengths of stay well over a year in an acute hospital because of lack of appropriate alternative settings,” the report said.

* Ad-hoc development of A&Es leaving some “unequipped to deliver a modern emergency service”.

* Limited access to hospital diagnostic services because of restricted opening hours and shortages of specialist staff such as radiologists and pathologists.

* Poor flexibility to match clinical staff shift patterns with busy periods.

* Need to put greater focus on providing care in the community. “If solutions are only sought at emergency department and/or hospital level, it is almost guaranteed that these will fail,” the report says.

Entitled A&E Mapping and Efficiency Review, it is strongly critical of the lack of support, until recently, for community-based primary care teams. The Government has promised to provide 100 new enlarged primary care teams this year.

It says without proper resourcing of primary and continuing care, the “aim of the National Primary Care Strategy will remain unfulfilled and the emergency medical admissions will likely continue to rise”.

GPs — without the back-up of other health care workers to offer extended services and with limited access to diagnostic services and without adequate out-of-hours arrangements — are adding to A&E bottlenecks. Also, a lack of GPs was “consistently identified as a factor in the increasing number of patients presenting to the emergency department”.

‘GP with a letter’ was always in the top three referral routes to the emergency department, self-referral being the highest category. Another factor in referrals was a fear of being sued, particularly among junior hospital doctors.

Irish College of General Practitioners chairman Dr Richard Brennan said the report “certainly covers the complexity of causes for the so-called A&E crisis”.

He said the Government had unfairly scapegoated GPs for contributing to the A&E crisis but the report showed “health care is a complex ecosystem in which we need all parts working together in an integrated way to provide efficient, effective and appropriate healthcare”.

* The 10 hospitals to take part in the review were: Adelaide Hospital; St Vincent’s University Hospital; Beaumont; the Mater; St James, all in Dublin; Our Lady of Lourdes, Drogheda; Cork University Hospital; University College Hospital, Galway; Letterkenny General Hospital and Wexford General Hospital.

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