The State's largest children's hospital has indicated that the Government's cap on employment in the health service could inhibit plans for the development of cardiac surgery services drawn up following the controversy over the death of two-year-old Róisín Ruddle.
Róisín, from Limerick, died in June 2003 two days after a scheduled operation at Our Lady's Hospital for Sick Children in Crumlin in Dublin was postponed due to a shortage of specialist intensive care nurses.
Last February a Government-appointed review group put forward 13 recommendations for the development of hospital services. However, in its formal response the hospital has indicated that it would not be possible to put in place some of its recommendations in full.
Separately the hospital has warned that the implementation of a major reorganisation of non-emergency cardiac care for children around the State, which it has proposed, would not be possible within the current Government employment restrictions.
In its recommendations, the review group urged that young patients with heart conditions should not have to make two journeys in quick succession to Crumlin for pre-operative procedures and subsequently for surgery.
"If it is necessary to carry out operations on a Monday, facilities should be available to carry out the necessary pre-operative procedures in the hospital over the weekend." However, the hospital said while it would continue to seek to reduce the necessity for such repeated journeys, it would not be possible to avoid these in all circumstances.
"The hospital currently schedules cardiac surgery on Monday, Wednesday and Friday. The need for some families to undertake two journeys arises because in the case of patients scheduled for cardiac surgery on Monday, the hospital does not undertake pre-operative assessment over the weekend."
Crumlin said that best clinical practice dictated that cardiac surgery sessions should not be scheduled for successive days in order to deal appropriately with emergencies and to ensure the best use of intensive care capacity.
"To provide full cardiac services at weekends would require a fundamental change in how hospital investigative services are currently organised, delivered and resourced. Under current staffing and resourcing arrangements, it would also not be considered good or safe practice to carry out the pre-operative procedures for cardiac surgery at weekends."
One of the essential pre-operative tasks to be carried out for young cardiac patients was in relation to blood cross-matching.
It said advice from both the Irish Blood Transfusion Service and its own haematology department, based on international evidence, was that "the safest way to guarantee availability of fresh blood for patients going for cardiac surgery is to carry out all processing work in the week prior to the Monday surgery".
However, Crumlin had sought to avoid children having to undertake repeated journeys through the development of additional family accommodation nearby. It had 70 rooms available and priority was given to the families of critically-ill children and to those who had to travel long distances.
It was also actively looking at reorganising its cardiac operation schedules to ensure, where appropriate, that patients who had to travel long distances would undergo surgery on Wednesday or Friday.
In its response document, which was released by the Department of Health last week, the hospital said it was examining the development of a "hub-and- spoke" model for non-emergency cardiac care for children around the State which would curtail families having to take long journeys to Dublin. Key elements would involve the development of regular paediatric cardiology clinics in hospitals in Limerick, Galway, Waterford, Sligo and Drogheda.
It proposed increasing the frequency of cardiology clinics carried out by its staff in Cork from monthly to weekly.
The document also proposed the development of a pre-admission clinic as a "one-stop shop" for pre-operative investigations at Crumlin, introducing a tele- medicine link with regional paediatric centres and the appointment of two additional cardiologists.
The hospital said the proposed service could allow for initial diagnosis and follow-up of children with heart disease to be carried out much closer to home. It would not remove the need for a pre-operative assessment at Crumlin because of blood transfusion and other medical requirements.
The hospital also maintained that the technology now existed to diagnose most congenital heart problems from about 18 weeks gestation. Access to such technology had been hampered by a lack of sufficient consultant paediatric cardiologists and, to a lesser extent, by a lack of appropriate ultrasound equipment.
