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 The ‘gap’ between today’s acute services and the emerging future model KEY ACHIEVEMENTS The Mid-West has already made good progress towards best practice through the development of regional services for obstetrics, paediatrics, cancer/oncology, haematology, nephrology and orthopaedics. KEY ‘GAPS’ Standard 1: Acute emergency and complex planned care is provided in a single regional ‘centre of excellence’, serving a minimum population of 350,000 to 500,000. Not met - the present system has 3 HSE hospitals and 1 voluntary hospital providing acute general care for the Mid-West population of 360,000. Standard 2: Acute care in core medical and surgical services is delivered in teams of at least 8 consultants in order to provide patients with access to safe, high quality ‘round the clock’ care. Not met – the present system of running 4 acute hospitals means that each team in each hospital lacks the critical mass of workforce and workload needed to meet international quality standards. CONCLUSION The core specialties of general medicine, general surgery, A&E and critical care are too fragmented, carry increased risks for patients and staff, and are not sustainable in their present form. In the previous section, we described the argument for the acute regional ‘centre of excellence’ and the importance of critical mass and size of population in determining how best to deliver an assured, high quality service. We now use these strategic criteria to understand the patient benefits and risks in the current acute hospital services in the Mid- West. The evidence from international practice on how best to systematically achieve the delivery of high quality clinical outcomes includes to: 21
Review of acute hospital services in HSE Mid-West An action plan for acute and community services • Concentrate the expert skills and competencies required into regional ‘centres of excellence’; • Manage patients according to integrated care pathways that reflect international standards; • Use automatic peer review to continually assess the quality of patient care; • Ensure that service quality is monitored and reported through a system of clinical risk management and clinical governance; • Ensure that staff stay fresh and patients stay safe, using working patterns that comply with the European Working Time Directive; • Provide close clinical supervision of junior medical staff; and • Avoid the damaging effects of professional isolation. All these elements of best practice mean that current acute services, being delivered with low numbers of consultant staff per specialty, are no longer viable or sustainable. Patient benefits in the current acute service configuration In the Mid-West, patients are already benefiting from the move towards centralisation and previous regionalisation of some specialties, an important step in the provision of better, safer and more sustainable services. For example: • Obstetrics & midwifery services are centralised in the Mid-Western Regional Maternity Hospital (St. Munchin’s). However, there are well recognised residual risks to mothers as the hospital is not co-located with adult critical care support services. Furthermore, there is no on-site paediatric cover for babies which poses further risks. Plans are now agreed for a final move of the service to the Regional Hospital Dooradoyle; • Orthopaedics operates a regional trauma centre at Dooradoyle and a regional elective centre at St. Nessan’s Orthopaedic Hospital, Croom; and • The regional hospital, Dooradoyle, is also recognised as providing regional services for paediatrics, urology and a range of tertiary services, including nephrology, haematology and cancer / oncology, as one of eight major specialist cancer centres. 22
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Current service delivery Regional s
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Consultant Medical Workforce Review
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Future clinical model of care Revie
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The patient at the local ‘centre
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Centralising specialist acute servi
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Specialty British Columbia 100 New
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Critical care network Review of acu
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Tele-medicine Review of acute hospi
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