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

More documents

Recommendations

Info

The regional elements of the network: Review of acute hospital services in HSE Mid-West An action plan for acute and community services • Site specific cancer procedures undertaken by appropriately trained sub-specialist surgeons. The concentration of sub-specialty teams and a critical mass of patient volumes will ensure better outcomes and quality of care for patients; • Sufficient numbers of trained oncologists, clinical nurse specialists, and radiologists and radiographers; • Integrated working between the regional and tertiary service and the local centre and community services; • Ensuring each site is visited, audited for compliance with standards and confirmed to be undertaking sufficient procedures each year to maintain and develop sub-specialty skills and competencies; • Preventing individual surgeons and hospitals undertaking ‘occasional’ surgery; • Ensuring that the surgeon works as a key member of a multi-disciplinary team; • Ensuring that all patients have their management regularly reviewed by case conferencing across the network; • Implementing standard integrated care pathways that set the standards of care; and • Ensuring the results of all clinical outcomes are formally audited. Understanding how the model works in practice for patients To understand how the new configuration of services will benefit patients in the future, we have included a number of patient scenarios. They describe patient journeys for a variety of common conditions. The sequence of events presented within the scenarios is different from today, and is based upon application of best practice. Care will be delivered in the most appropriate setting as close to the patient’s home as possible with the regional hospital focused on the acute and complex care delivery. The scenarios are based on the preconditions that the infrastructure, resources, workforce and, most of all, this new way of working is in place to make it all happen in a cohesive, seamless manner. Scenario 1: Eileen has a fall at home Eileen is 86, lives alone and is fiercely independent. She has managed to stay at home, in her ground floor flat, supported by the home care service to take care of her basic health and personal hygiene needs. She was not interested in being a patient in an old folks’ home. 65
Review of acute hospital services in HSE Mid-West An action plan for acute and community services It’s 08:35 am. Coming out of the loo, she trips over the cat, falls and breaks her left hip. She activates the alarm that she wears round her neck and the community services are alerted. The call to the emergency helpline number is triaged to the Primary Care Team. Half-an-hour later, the team member on-call, a physiotherapist, attends Eileen and quickly diagnoses a fractured neck of femur. Her left hip is very painful, her leg is rotated. The system swings into motion. The physiotherapist knows the best practice guidelines for Eileen’s management. She had helped draw them up with the regional trauma team. A call to the trauma coordinator at the regional centre confirms that Eileen, if she is fit enough, can have her hip operated tomorrow. The coordinator makes three bookings: (1) a bed in the urgent elderly assessment unit for a check up, to make sure she has no other problems requiring attention and to prepare her for the operation; (2) a slot in the trauma theatre for 12.00 pm next day, to be confirmed by the duty physician as going ahead or not; (3) a ‘step down’ rehabilitation bed in the local centre, starting two days postsurgery, to continue her intensive physiotherapy and reablement programme. In the meantime, the physiotherapist calls the ambulance to get Eileen safely to the regional centre, and, while she is waiting, checks her records on-line, to find out that Eileen is already known to the elderly assessment team, has had an OT assessment carried out and that there is nothing to stop Eileen coming home, on the assumption her operation and recovery go as planned. She suspends her home care service for one week, to be confirmed, depending upon Eileen’s progress. One week later, Eileen has proven that the fractured neck of femur pathway works well. She has had uneventful surgery, is fit for discharge from the rehabilitation unit and is completing her recovery and reablement at home. She is now on tablets to make her bones stronger. The primary care team visits her twice daily for a week, confirms satisfactory progress and hands over to the home care service. The only thing Eileen is worried about is the cat, not herself. The physiotherapist books her in as well, for a week’s holiday at the local cat’s home. All part of the service! Scenario 2: Fionnuala develops a fever Fionnuala, age 3, already has a reputation. She is stubborn and into everything. Nothing is safe within 5 metres, so says her mum. But not today. Fionnuala is not herself. Went to bed last night, didn’t want any supper and was a bit grumpy, saying her head was sore. This morning, she does not bounce out of bed as usual. She is hot, looks flushed and has just been sick. Mum is worried. She immediately rings her GP for advice. The GP refers her to the local Urgent Care Centre that recently opened, one of the new local ‘centre of excellence’ services. He knows that the UCC offers urgent paediatric assessment from ten in the morning to ten at night and that it’s an outreach facility of the acute regional paediatric service. Fionnuala’s GP had gone to the open night at the new local centre of excellence when that opened last month. He was impressed. It may not admit emergencies any more, but it certainly did just about everything else his patients needed. No need for them to travel unless they were really ill. Local clinic to see the consultant. Local CT and ultrasound. Endoscopy suite. Day surgery suite. Twelve hour urgent care service for adults and kids. Good rehab team. And all hot wired to the regional hospital. Not bad at all. And even a seven day phlebotomy clinic and specimen collection service. Nice! It might just become a real ‘centre of excellence’ after all. 66
Page 1 and 2:
Review of Acute Hospital Services i
Page 3 and 4:
Page 5 and 6:
Page 7 and 8:
Key messages Review of acute hospit
Page 9 and 10:
Review of acute hospital services i
Page 11 and 12:
educe the length of stay in hospita
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
What is ‘International Best Pract
Page 19 and 20: Review of acute hospital services i
Page 47 and 48: Integrating PCCC services with the
Page 49 and 50: Key findings from the analysis are:
Page 51 and 52: Resource type Proportion Patients A
Page 53 and 54: The Mid-West needs 3 local ‘centr
Page 67 and 68: The regional elements of the networ
Page 69: Organisational infrastructure: Revi
Page 75 and 76: Developing the implementation plan
Page 81 and 82: Within three years Review of acute
Page 97 and 98: Appendix 3 - Documents provided Rev
Page 103 and 104: Current service delivery Regional s
Page 105 and 106: Consultant Medical Workforce Review
Page 115 and 116: Future clinical model of care Revie
Page 117 and 118: The patient at the local ‘centre
Page 121 and 122:
Centralising specialist acute servi
Page 123 and 124:
Page 125 and 126:
Specialty British Columbia 100 New
Page 127 and 128:
Table 43: A comparison of specialis
Page 129 and 130:
Page 131 and 132:
Critical care network Review of acu
Page 133 and 134:
Tele-medicine Review of acute hospi
Page 135 and 136:
• Picture archiving and communica
Page 137:
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?