CUH chief says union trolley count is flawed and unfair

The head of one of the country’s largest hospitals has described the main nursing union’s 8am trolley count as flawed and unfair to Irish hospitals.

Tony McNamara, the chief executive of Cork University Hospital (CUH) Group, said the use of this singular count is overly simplistic, and that the abuse of this single measurement can damage the reputation of hospitals and the health service.

“It is clearly in the interest of some stakeholders to use this data opportunistically to criticise the minister, the HSE and individual hospitals in support of increased resource allocation,” he wrote on his hospital blog.

“It might be observed that indeed it is not in the interest of some stakeholders to see a resolution to the ‘ED crisis’ or to optimise patient flow since that will only serve to reduce the leverage that might otherwise be exerted to secure more staffing.

“Whatever the motivation for the use of the 8am trolley count as a proxy for performance, the abuse of this singular metric serves to damage the reputation of individual hospitals and by extension, of the health system generally.”

According to yesterday’s Irish Nurses and Midwives Organisation (INMO) trolley count, there were 31 patients on trolleys in CUH at 8am — the highest number in the country.

But in his blog, Mr McNamara said the count is taken when hospitals are at their most vulnerable, having had only emergency diagnostic services available in the previous 12 hours, and minimal access to the resources needed to transfer patients to beds.

He said as of July, there were an average of 19 people on trolleys at CUH at 8am every day. But he said good internal processes can rapidly reduce that figure by almost half within hours to just nine patients each day, by 2pm. He also said the use of one trolley count is not a measure of the patient experience time, or a measure of the efficiency of patient flow, and that a more nuanced approach is needed to create a more informed debate.

But he accepted that work remains to be done following the reconfiguration of services in the region which have reduced the number of EDs serving Cork City and county from five to two in recent years.

He said CUH management are focused on ensuring that no patient waits over 24 hours and no patient aged over 75 will wait over nine hours for a bed, and that they plan to reduce these targets further later this year.

However, INMO general secretary Liam Doran defended the union’s trolley count tool and said instead of shooting the messenger, HSE bosses should be solving the problem. “We have been using trolley watch for 12 years and have consistently said it’s a public sign or symptom of a service-wide inadequacy which leaves patients on trolleys every single day,” he said.

“We pick 8am when the day starts — the figure shows what the day is going to present to that hospital in terms of volume of demand.

“It is not in any way related to the performance of a single hospital. It is totally the result of a system-wide failure.”

As well as providing extra acute and community beds, he said the HSE needs to hire additional ED and nursing staff. There are around 155 ED vacancies, 20 more than the start of the year, despite a 6% rise in presentations and the public hospital system is down 3,600 general nursing positions since 2009.