Emergency departments coping well with the ‘cold snap’
With the current cold snap our public hospital emergency departments have been inundated with large numbers of people injured from falls on snow and ice. So how are the emergency departments (EDs) coping?
In the very immediate sense, if you look at the fact that schools are closed today because teachers can’t get there, yet all our public hospitals’ EDs are still open, doctors and nurses and all other care staff are managing to get there. They are staying with friends, in hotels, people are opening up their houses to make sure staff can get there.
Plus in the last 3 weeks, EDs they are providing much more care to many more patients often with more severe injuries.
For example from the week before Christmas to today, EDs are consistently seeing 10 times more fractures than normal, many of which require complex surgery. So there are large numbers presenting and many waiting long times but the service is being provided.
Overall, there are some improvements in EDs. Although it is hard to tell. But perhaps reflected in some public commentary on good experiences of EDs in remarkable contrast to the entirely negative ED reporting up to now. HSE has a notorious record for manipulating the wait times and the figures that they produce, also the figures produced are not comparable.
EDs have a target of 6 hours between arriving in EDs and either being admitted as a patient or being discharged.
According to the HSE – 94% of people who are not admitted to hospital are seen and discharged within 6 hours – if this is true then this is real progress.
Of those from whom a decision to admit (those who need a hospital bed) has been made, 55% are admitted within 6 hours but 45% are not.
And this is where the real problem is – the long wait times for those needing admissions.
Are those HSE wait times REAL wait times?
Well if the figures they are telling me are true then yes. Up to last February wait times were measured from when a decision to admit was made where as now it is from when you actually present at ED. Target has changed from 24 hours, to 12 hours and now 6 and it reflects the actual wait times.
So while no one wants to have to wait at all, at least the lengths of time have come down and they are measuring real time instead of gaming the figures.
Also we can verify the wait times the Irish Nurses Organisation which has kept figures since 2004/5 in Trolley Watch – these are measured each morning – contested by HSE but at least they are consistent and not gamed. I have compared figures from November and December 2008 and 2009 and these show that fewer people are waiting.
There are still too many people waiting but it is going down and in the right direction. And there hospitals do better than others.
If we use the real wait times (according to the HSE) then hospitals who are seeing large numbers each day (over 150 people), Waterford and Limerick manage to see and discharge or admit ALL within the 6 hour target. Kilkenny also does well consistently.
And then there are the poor performers, consistently Beaumont and the Mater have large numbers of long waiters. Drogheda and the North East consistently do badly too.
There factors which influence but it is not straight forward – it is usually a combination of factors but central to it are
• the hospital processes – do they plan and set a discharge date on admission?
• are beds being managed and available for Emergency admissions?
• is there strong leadership on this issue? Clinical and administrative management
• But also there are wider health systems issues which influence how cases are dealt eg can emergency doctors get test results quickly and also are there beds to put the emergency patients needing admission into?
• And this may be about services in the community or the availability of out of hours GP services or long say beds eg North Dublin.
We know from HSE figures that approx 800 beds are closed due to refurbishment, cost cutting and another 800 are filled with people who should not be in hospital (bed blockers – delayed discharges). So that’s 1600 plus fewer beds which does have an impact.
HSE say these beds are irrelevant or certainly not central that it is about management and process and getting rid of inefficiencies in the system.
The HSE say that 35% of people who are in hospital should not be there – they should be in the community or in long stay beds and also 15% are admitted unnecessarily.
But in order to address these so-called “in-efficiencies” one needs to have those services in the community and while some progress was made on this during 2007 and 2008 eg increased provision of homecare packages, the more recent figures show these are levelling off or decreasing which will again increase pressure on public hospital care.
Many people are now using private emergency departments. However, these are more injury clinics and urgent care centres not EDs. There are open Mon to Friday/Sat 9-5 or 8-8, although you may wait a shorter time. But if you have an emergency and are in need of serious care then best to go to a ED. Also if you have a chronic illness or minor illness go to your GP.
But best of all stay warm and stay in. But if you need to, go to your nearest ED.