Review of acute hospital services in the Mid - Health Service Executive

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Review of acute hospital services in HSE Mid-West An action plan for acute and community services - ‘Hospital at Home’ 84 85 service to safely avoid admission to acute care or allow earlier discharge from acute care. Planned care • Out-patient clinics, with all major specialties providing an outreach service from the regional hospital 86 ; • Physiotherapy, occupational therapy and podiatry services; • Admissions avoidance services for chronic disease and long term conditions including mental health liaison and outreach; • Minor surgery under local anaesthetic. GP trained surgeons may undertake this range of procedures; • Day surgery/23 hour surgery led by visiting consultants from the regional hospital, for conditions suitable for local or regional anaesthesia 87 . Provision of a day surgery theatre needs to ensure that it can generate sufficient workload for appropriate and effective use. In rural localities serving larger populations, there is potential to develop General Practitioners with a specialist interest, particularly, for specialties such as ENT, ophthalmology, dermatology and musculoskeletal medicine, who can accept referrals and provide advice and support. The roles of nurses and allied health professionals can also be extended to provide and support rural service provision 88 ; and • Ambulatory services for a range of conditions, for example, chemotherapy and blood transfusion. Local non-acute bed base • A local bed base, providing short term care for: 83 The Future Hospital, The Progressive Case for Change, Joe Farrington-Douglas and Richard Brooks, Institute of Public Policy Research, January 2007. 84 Montalto M et al. Acceptability of early discharge, hospital at home schemes. Treatments that can be safely managed at home need to be defined. BMJ 1998:317:111652. 85 Richards SH et al. Randomised controlled trial comparing effectiveness and acceptability of an early discharge hospital at home scheme with acute hospital care. BMJ 1998:316:1796-1801. 86 The Future Hospital, The Progressive Case for Change, Joe Farrington-Douglas and Richard Brooks, Institute of Public Policy Research, January 2007. 87 Suitable procedures include superficial hernia, selected laparoscopic cholecystectomy, cataracts, and simple foot operations. 88 The National Framework for Service Change in NHS Scotland, Rural Access Action Team, Final Report, 2005. 113
Review of acute hospital services in HSE Mid-West An action plan for acute and community services - Specialist rehabilitation 89 , for example, stroke and trauma management after an episode of critical care in the regional hospital; - Step down, for the early transfer of patients nearer to home after receiving acute care at the regional hospital; - A selected range of conditions that, at present, are routinely admitted to acute hospitals. For rural and remote localities, senior accessible medical cover for these patients could be provided by local GPs with additional training and skills in acute medicine or by specialists in providing remote general hospital services 90 91 ; and • The issue is to provide rehabilitation capacity in the community wherever there is sufficient need for the service. Therefore, rehabilitation/step-down care beds can be provided from a number of locations, including local hospitals, community hospitals and nursing homes with enhanced nursing and therapy staff support. Diagnostics Local services will be supported by a wide range of diagnostics, including near patient testing, plain X-ray, ultrasound, basic physiological measurement tests, etc. • CT scanning, MRI (either fixed or mobile) and contrast X-ray service; and • Routine diagnostic endoscopy services for gastroenterology, urology, orthopaedics, gynaecology, chest medicine, including gastroscopy, flexible sigmoidoscopy, colonoscopy, flexible cystoscopy, flexible bronchoscopy, colposcopy, hysteroscopy, etc. This guide list covers today’s approach to invasive diagnosis. With the increasing trend to less invasive diagnostic modalities, it is predicted that best practice in diagnostics will change rapidly in the next 5 to 10 years. 89 The National Framework for Service Change in NHS Scotland, Rural Access Action Team, Final Report, 2005. 90 Comments on Academy of Medical Royal Colleges Centralisation and Specialisation of Hospital Services – Bigger is not Necessarily Better for Rural and Remote Communities; Working Group of Medical Royal Colleges and Rural Forum, March 2006. 91 The National Framework for Service Change in NHS Scotland, Rural Access Action Team, Final Report, 2005. 114
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Key messages Review of acute hospit
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educe the length of stay in hospita
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What is ‘International Best Pract
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Integrating PCCC services with the
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Key findings from the analysis are:
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Resource type Proportion Patients A
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The Mid-West needs 3 local ‘centr
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Page 67 and 68: The regional elements of the networ
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Page 105 and 106: Consultant Medical Workforce Review
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Review of acute hospital services in the Mid - Health Service Executive

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