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
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.
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