Dáil Éireann Debate, Wednesday - 20 March 2013
10. Deputy Billy Timmins asked the Minister for Health the measures that have been taken to tackle the number of patients on trolleys in St. Vincent's University Hospital, Dublin; the impact of these measures; and if he will make a statement on the matter. [14312/13]
Amharc ar fhreagraImmediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit, (SDU), as set out in the Programme for Government. The SDU is working to unblock access to acute services by improving the flow of patients through the system. Since its establishment there has been significant improvements in the waiting times for unscheduled care against a background of reduced funding for health, reconfiguration of services and a challenging socio-economic climate.
Hospitals across the country have experienced a surge in presentations to Emergency Departments, as would be expected in the winter months, resulting in high demand for admissions and a consequent rise in trolley waits. Recent outbreaks of influenza have created additional logistical difficulties in relation to the admission, movement and discharge of patients in some hospitals. Those hospitals have released media messages advising non-attendance and restrictions on visiting. The SDU continues to monitor Emergency Department activity closely, engaging with key hospitals via teleconference and on-site meetings, collaborating in putting in place a range of measures to assist with patient flow and reviewing the available data for trends in relation to the reported levels of high activity.
Despite these pressures the year on year improvements continue nationally. Numbers recorded on trolleys at the end of 2012 showed a marked improvement of 23.6% less than 2011 which equates to 20,386 less people. From 1st January to 15th March, there has been a total of 15,220 patients on trolleys: this is a reduction of 2,258 patients or 12.9% on the equivalent period last year. Priority now is to reduce long waiters (over 9 hours) as we move to a six hour patient journey target. The SDU and the Patient Safety & Quality Directorate in HSE are in communication to agree a mechanism of capturing and responding in instances where a hospital reports one or more patients breaching the targets.
In relation to St. Vincent’s University Hospital, it is the largest hospital in Dublin South East region dealing with all trauma and serious cases and providing support for such patients presenting to St. Michael’s Hospital, Dun Laoghaire and St. Columcille’s Hospital. The hospital has advised that over the past few weeks the number of patients requiring admission has averaged between a low of 10 to a high of 30. The hospital is working closely with the SDU and the Acute Medicine Programme in order to enhance patient care pathways and patient flow.
The hospitals discharge process has been reviewed in detail and additional emphasis has been placed on the early identification of potential discharges. All members of the multi-disciplinary team have been engaged in this process. All consultants and their teams are required to identify potential “weekend discharges” for review by the consultant on call. Consultants and their teams are also required to prepare a list of “next day discharges” on a daily basis with a view to effecting discharges by 11.00 am the following day. The hospital has also introduced the following initiatives in relation to dealing with Emergency Department pressures:
- Introduction of an Acute Medicine Unit (AMU)
- Acute Assessment Unit (AAU)
- Clinical Decision Unit (CDU)
- Chest Pain Evaluation Unit (CPEU)
- Rapid access triage (Doctor/Nurse triaging patients)
- Specialty Specific targets for Length of Stay
The hospital is also in daily consultation with their community based colleagues to ensure that all necessary supports are in place to facilitate discharge from the acute setting, to facilities more appropriate to the patients needs.
It is envisaged that these developments will lead to shorter lengths of stay in acute hospital care which will in turn improve waiting times and patient experience in the Emergency Department.
