Madam, - Hospital consultants are becoming immune to criticism such as those highlighted by your Health Correspondent (January 29th). Consultants are yet again blamed for delays in seeing patients and for obstructing the discharge process. Incredibly this is now thought to "facilitate admission of consultants' own, mostly private, patients on a Monday"!
The CAPITA report recommends establishment of bed management departments in each major hospital and the introduction of formal discharge planning practices. In the past three years, the Division of Surgery at the Mater Misericordiae Hospital has actively engaged in such processes.
An entire surgical ward has been redesignated for the acute care of elderly medical patients. There is a proactive bed management department and discharge planning begins at the point of first patient contact. Accelerated care pathways have been introduced. The result is a more efficient hospital process.
Patients are more quickly ready for discharge - but where do they go? In three years the number of patients fit for hospital discharge but awaiting care in the community has tripled, and is currently 115. The number of patients on trolleys, chairs or on the floor in A&E has also tripled, 19 patients last night. Planned non-emergency surgery has disappeared. This at a time when the hospital has not yet received its final budgetary allocation for 2002 (yes, not 2003) and 200 or more private nursing home beds remain vacant and unavailed of in the ERHA catchment area.
The price of consultant engagement is unfortunately disillusionment, not with local hospital management but with the Department of Health, its agencies and its numerous reports. Disillusionment is followed by disengagement and then silence. Good luck to the consultant who can find a bed, public or private, to admit a patient next Monday! - Yours, etc.,
P. RONAN O'CONNELL MD, F.R.C.S.I., F.R.C.S,. (Glasg), Chairman Division of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7.