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 Developing safe, sustainable high quality acute and community services in the Mid-West The current catchment population of 360,000 justifies one regional ‘centre of excellence’ for acute care in the Mid-West, to be developed by reconfiguring the Dooradoyle site. We set out how the regional ‘centre of excellence’ needs to deliver an integrated service with a network of local ‘centres of excellence’. We propose three such local centres, one in each of the counties of Clare, Limerick City, and North Tipperary. These local centres will provide Urgent Care & Assessment, day surgery, enhanced diagnostics, endoscopy, outpatient services, and rehabilitation, all integrated with PCCC teams and services. Significant improvements in admissions avoidance, day case rates, and hospital length of stay are needed to bring current operational performance in line with international best practice. In addition to current PCCC investment plans, there needs to be further targeted investment to ensure that all patients have access to admissions avoidance and safe earlier discharge from the acute centre of excellence. The development of the local and regional ‘centres of excellence’ and the clinical networks need to be supported by a new clinical and corporate governance infrastructure and reporting system, specifically designed for the purposes of delivering clinically and cost-effective seamless, integrated care across a range of provider services. It is clear from the previous section that the current configuration of acute hospital services is not sustainable in its present form and does not conform to the emerging future clinical model of acute and community care. We now use the model to define what the optimal configuration for acute and community services needs to look like across the Mid-West in order to deliver an assured quality of care in line with international standards. 41
Integrating PCCC services with the acute services Review of acute hospital services in HSE Mid-West An action plan for acute and community services To complement the regional and local ‘centres of excellence’, there needs to be a comprehensive range of primary and community services, which can support the changes in acute hospital care. Most importantly will be health promotion and the prevention of ill health, the avoidance of hospital admissions and supporting earlier discharge from the acute care setting. Most of this support will be provided by the development of: • Self care, promoted through education of patients and carers and telemedicine; • Home care packages, PCTs and PSCNs to support patient management in the home; • Community chronic disease management programmes; • More PCCC services to cover out-of-hours and week-end requirements; • An Advanced Paramedic service; and • Community facilities to provide an Urgent Care Centre, nurse and therapy managed beds for rehabilitation, access to enhanced diagnostics and a base for staff. The recent national Acute Hospital Bed Review 32 identified a significant proportion of inpatients who could have been cared for in more appropriate care settings, both at admission and during their stay in hospital. At a national level the review found that 13% of patients were unnecessarily admitted to hospital and that 39% of patients in hospital could have been treated in an alternative setting on the day of care, if appropriate alternatives were available. The national review also identifies the appropriate alternatives to acute hospital care that would be required, and the proportion of patients occupying an inpatient bed that would satisfy these alternatives. For the Mid-West, these alternatives and their proportions are shown in Table 7. Table 7: Proportion of patients for alternative care settings in the Mid-West Alternative Care Setting Proportion of inappropriate admissions 42 Proportion of patients whose length of stay could have been reduced 32 HSE: Acute Hospital Bed Review: A review of acute hospital bed use in hospitals in the Republic of Ireland with Emergency Departments, PA Consulting and Balance of Care, 4 May 2007 (available from the HSE website at www.hse.ie).
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Appendix 3 - Documents provided Rev
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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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Table 43: A comparison of specialis
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Critical care network Review of acu
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Tele-medicine Review of acute hospi
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• Picture archiving and communica
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Review of acute hospital services in the Mid - Health Service Executive

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