Lack of patient checks puts lives at risk

Patients not fit for day surgery could end up going under the knife because a significant number of hospitals do not routinely conduct pre-operative assessments to identify potential risks, a report has found.

The report also found that half the State’s hospitals have no protocols in place when determining which patients are suitable for day surgery across a range of procedures, including tonsillectomy, removal of breast lumps, and stripping of varicose veins.

The authors of the report noted that, in one hospital, the decision to list a patient for day surgery “appeared to come down to the overall ‘gut feeling’ of the clinician in the outpatients department”.

Health Minister Leo Varadkar yesterday described the findings of the report by the Comptroller and Auditor General & as “serious”.

“The fact that a significant number of hospitals do not routinely conduct pre-operative assessments is particularly serious,” said Mr Varadkar.

“I know that hospitals are stretched, but there is no excuse for not following best practice.”

While the HSE was addressing the shortcoming through clinical programmes “to some extent”, Mr Varadkar said “much more needs to be done”.

“It will be on the agenda for my next monthly meeting with the HSE directorate,” Mr Varadkar said.

Managing Elective Day Surgery, a special report by the C&AG presented to the Oireachtas yesterday, also found that:

* In two thirds of cases, day patients were not being provided with essential, procedure-specific information about their planned surgery. The C&AG said this may help explain “why many patients do not attend” for scheduled day surgery;

* Only half of day surgery patients are given emergency contact details at discharge and just one third are provided with information regarding pain relief;

* Some clinicians expressed the view that a number of the 24 procedures for which the HSE has set day surgery target rates are not suitable for day surgery, including keyhole surgery for gallbladder removal and tonsillectomy;

* While 69% of procedures are carried out through day surgery, just 10% of operating theatres are dedicated to it. This is despite the fact that the HSE estimates that day cases are on average almost 60% less costly to perform than inpatient cases.

In its defence, the HSE told the C&AG that if cases switch from being inpatient to day cases, the difference in costs “would not automatically translate into cash savings due to the fixed nature of a high proportion of the costs”.

The report said full savings could be realised “only if certain other measures are put in place such as ward closures or elimination of agency staff”.

The HSE’s Accounting Officer said that the current method of funding of hospitals “does not provide an economic incentive to perform procedures in their most appropriate setting”. Many minor procedures were being catered for in day surgery instead of in outpatients or a GP surgery. He said that this situation will be addressed when outpatients are included in the new ‘money follows the patient’ funding model.