Consultants hopeful that ‘Acute Medical Programme’ will be ‘all good news’ for patients
EMERGENCY CONSULTANTS, who have warned that overcrowding in their departments is worse than ever, seem hopeful that draft proposals aimed at transforming the way acute medical cases are dealt with once they cross the threshold of the hospital will ease the problem.
But many cautioned that other factors, such as staff shortages and non-availability of beds for new inpatients, must be sorted out before the unacceptable conditions many patients endure as they wait to be admitted are properly addressed.
Mr James Binchy, emergency consultant at University College Hospital Galway, welcomed the move and said the planned “Acute Medicine Programme” was “all good news – if it happens”. Mr Binchy said he believed overcrowding in emergency departments was worse than ever. “It is much worse now than it was in 2006 when Mary Harney declared it a ‘national emergency’,” he said. On one day last week there had been 35 people on trolleys in his hospital and 50 in Beaumont Hospital.
Mr Binchy added his main concern about the draft report was that there had been “false dawns before”.
He welcomed the assurances that emergency departments would not be competing with acute medical assessment units.
“We are very supportive of this plan. If it happens it will be great.”
Letterkenny-based emergency consultant Dr Gerry Lane also welcomed the plan, but he warned that the acute medical units were “just one piece of a large jigsaw puzzle” and would have to be properly resourced and manned in order to be effective. All the other pieces of the jigsaw would also have to be put in place for it to be effective.
He added it would be “absolutely superb” if patients could be given a guarantee that they would see a senior doctor within one hour of arriving at the hospital.
Dr Lane is concerned the recent announcement that two local community hospitals are to close could worsen the situation. The shortage of emergency doctors was now at crisis proportions, he said, adding that Letterkenny Regional Hospital had vacancies for 13 doctors but six of these were in the emergency department, reflecting the disproportionate impact of the staff shortages on this sector.
“The number one crisis we have now is a manpower shortage,” said Dr Lane. “We are handling it now by using agencies, locums and so on, but one would have to be very anxious when we head towards January.”
Cork-based emergency consultant Dr Chris Luke said he was “decidedly hopeful” that the radical proposals contained in the “Acute Medicine Programme” would improve the lot of patients and staff. Referring to a “doctor famine”, he said the problem was getting scary.
The consultant said 40 junior doctors were needed in Cork where there are three emergency departments, but he anticipated that with just two applications in, there would be a shortfall of 30 after the next batch of intakes.
“The system expects everybody who crosses the threshold to be fully worked up, whether they have a limp or diabetes or chest pain,” said the consultant. He said that 20 years ago a family doctor could contact a consultant directly to say a patient was on the way who should be sent to a particular ward. “Now everybody pitches in to AE, not just in crisis situations but people with a huge range of long-standing problems.”
Mr Aidan Gleeson, consultant at Beaumont Hospital, described the programme as a welcome initiative, but said he viewed the proposals as just one part of a package needed to reduce overcrowding.
It would not work without more step-down facilities for elderly patients and a better discharge plan to reduce delays in discharging patients.
“Our biggest problem is that when patients in emergency departments need to be admitted we do not have the beds, so they stay in the emergency department, requiring care from the nurses there and taking up space needed by new patients who are coming in,” explained Dr Gleeson.
After 10 years working in emergency departments in Ireland, Dr Gleeson said the overcrowding issue had yet to be resolved. “Nothing effective has been done. This may help, but I am not holding my breath.”
Dr Eamonn Brazil, consultant at the Mater hospital, said the proposals were “absolutely a good idea”. He said that “a big chunk” of the patients coming through the Mater’s emergency department had been referred by their GPs. Under the new system it would be possible to cut out “the middle man” who in many cases repeats what the GP has already done.
“The situation at the Mater yesterday was absolutely horrendous,” he said. “We had 196 patients coming though in 24 hours – the norm would probably be 150-160.”
Dr Brazil believes the new regime would mean 15-20 fewer GP-referred cases each day in his department. “This is the equivalent of the work of one and a half doctors”.
While these cases would obviously have to be dealt with elsewhere, such chronic medical conditions would be seen in the new acute medical units.
“If I could move 20 patients a day, that would make the experience for the others coming in much better,” said Dr Brazil.
Dr Brazil also anticipated that those arriving by ambulance would get a bed more quickly. And he welcomed the “clinical justice” aspect of the programme, which he said would mean nobody would have to wait on trolleys longer than an agreed period of time.
The consultant added that the proposal for a four-tier system of hospitals would cause people to worry that their local hospital would be different “and it may be”, but he said a new mindset was needed which would mean thinking in regional terms about the hospital facilities available.
The Irish Association for Emergency Medicine (IAEM) welcomed the development of the Acute Medicine Programme but warned that successful implementation of the model would require “profound changes in how medical care is delivered across the entire health system”.
The association said that as in the case of emergency medicine, the effectiveness of acute medicine would be compromised “unless there is improved access to inpatient bed capacity through a reduction in delayed discharges and avoidance of bed closures”.
In a statement, the IAEM said it welcomed “the proposed provision of early and ongoing senior doctor input into the acute care of patients with medical problems and the alignment of diagnostic imaging and support services to expedite patient care”.
It said that the potential benefits of acute medicine should be available to GP-referred patients and emergency department patients referred for inpatient care.
The IAEM said it was accepted that acute medicine would be developed conjointly with emergency medicine “rather than by competition for resources, in close clinical collaboration between acute physicians and consultants in emergency medicine”.
