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

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General surgery Review of acute hospital services in HSE Mid-West An action plan for acute and community services The Mid-West has sufficient consultant surgeons and anaesthetists to deliver emergency general surgery in line with international standards of practice. However, this is not happening at present, as these consultant resources are excessively dispersed across 4 separate general surgery services, such that patients are exposed unnecessarily to increased clinical risks. We recommend, in the interests of patient safety, that emergency general surgery is delivered as one regional service, based in Dooradoyle, as soon as possible. Table 2: General surgery: consultants, non-elective activity and catchment population Component Dooradoyle St. John’s* Ennis Nenagh Total Baseline >>> Population 183,863 110,800 65,988 360,651 Beds 80 36 24 26 166 Consultant Surgeons >>> Full time 2 0 2 1 5 F/t split site (wte) 3.4 2.3 0.4 0.9 6.9 Total (wte) surgeons 5.4 2.3 2.4 1.9 11.9 No. of consultant sessions 59 25 26 21 131 Consultant Anaesthetists >> Full time 7 1 2 2 12 F/t split site (wte) 6.2 1.7 0.7 0.7 9.4 Total (wte) anaesthetists 13.2 2.7 2.7 2.7 21.4 No. of consultant sessions 145 30 30 30 235 Non-Elective Inpatient activity >>> Admissions 2,294 351 1,329 1,249 5,223 Average length of stay 6.7 6.6 5.2 4.8 5.8 Daily average admissions 6.3 1.4 3.6 3.4 14.8 Source: HIPE data, 2005 and individual hospital submissions for the number of consultants validated by the HSE NHO Mid-West. Note: The emergency service at St. John’s Hospital is a Mon-Fri, 8am to 8pm service only. 27
Review of acute hospital services in HSE Mid-West An action plan for acute and community services Analysing the information for 2005 (Table 2 above) against the criteria for the emerging clinical model of care shows the following. For Emergency Care • There are not enough consultant surgeons or anaesthetists to deliver sustainable 24/7 services in the present fragmented service arrangement: - Ennis has 2 full time consultant surgeons and 2 full time anaesthetists to run a 24/7 service; - Nenagh has 1 full time consultant surgeon and 2 full time anaesthetists to run a 24/7 service; - St. John’s has no full time surgeon and 1 full time anaesthetist to cover its weekday service; and • There are very low rates of daily average admissions: 6.3 at Dooradoyle, and only 3.6 at Ennis; 3.4 at Nenagh; and 1.4 at St John’s (weekday service only). Conclusions • Presently, the general surgery resources are dispersed, attempting to deliver 4 separate general surgery services across the Mid-West; • This fragmentation means that the 3 services at Ennis, Nenagh and St. John’s do not have enough consultants to maintain a safe service for patients; • The 3 services do not have enough workload to justify any more consultants; • The services at Ennis and Nenagh do not have enough workload to justify the HSE keeping these theatre services available on a 24/7 basis; and • If there had been a single regional general surgery service, there would have been enough surgeons and anaesthetists (11.9 surgeons + 21.4 anaesthetists), enough to manage a daily average of 14.8 emergency surgical admissions and to meet the critical mass criteria for the delivery of high quality care to international standards. Recommendations • We strongly recommend that the emergency surgery service is regionalised as soon as possible at Dooradoyle to reduce the risks to patients and raise the quality of care to international standards; and • We strongly recommend the initial rationalisation of the emergency out-of-hours arrangements for theatres between Dooradoyle, Ennis and Nenagh. 28
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Current service delivery Regional s
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Consultant Medical Workforce Review
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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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