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

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.
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