Letters

Hospital discharges

Logistical preparation

Sat Jun 03 2023 - 00:08

Sir, – Reports that hospital discharge is relatively rare at weekends will not surprise people who have spent much time in Irish healthcare (“HSE to look at seven-day working as hospital discharges fall at weekends”, News, June 2nd).

There are several reasons for this, including a curious superstition.

In general, patients like to get home before weekends as families can then be available to help their returning relative adjust. Thus, as one might anticipate, Fridays see the most discharge activity, and include anyone close to full readiness. Often by Monday the family members can return to work with the initial troubleshooting done, be it setting up beds downstairs or getting lengthy prescriptions filled.

Logistical preparation for home often involves links to general practitioners and getting new medications from local pharmacies. Sunday can be a difficult time to access such services, with only emergencies being catered for. Discharge on Saturday is rarely appropriate since most patients close to fitness for home would have gone on the Friday.

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Dramatic or rapid recovery happens, but isn’t the usual pattern.

A phrase still occasionally heard, mostly from elderly patients, is “a Saturday flit is a short sit”. It reflects a superstitious belief that patients discharged home on that day fare poorly and are likely to be readmitted. It’s described in Irish medical literature north and south of the Border and in maternity as well as general hospital care.

Persuading patients of the irrational nature of their beliefs can be tricky and, as the placebo effect shows, some can be self-fulfilling prophecies. – Yours, etc,

BRIAN O’BRIEN,

Kinsale,

Co Cork.

Sir, – When I was in school, a popular form of maths question went: If it takes a man and a half, a day and a half, to dig a hole and a half, how many men will it take to . . . ?

Clearly the HSE gurus who came up with “three times as many discharged on weekdays as on weekends”.

Assuming the figures given are correct, 606 discharges on weekdays is 121 per day, while 202 on weekends is 101 per day. That equates to a fall-off on weekends of only 16.5 per cent. There is a potential gain in “productivity” of 19.8 per cent, but only if one makes an investment in hospital staff and community staff.

Spreading the current staff more thinly by using their time at weekends can only be achieved by increasing staff, or decreasing their availability to work during weekdays.

Or perhaps HSE chief Bernard Gloster can actually dig himself a hole and a half? – Yours, etc,

PATRICK KEVIN PLUNKETT,

Retired Consultant

in Emergency Medicine,

Adjunct Professor,

School of Medicine,

Trinity College Dublin,

Dublin 2.