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

Our findings in relation to inefficiencies in service delivery:
Review of acute hospital services in HSE Mid-West
An action plan for acute and community services
1. Too many patients are being admitted unnecessarily to hospital.
We found a wide variation in non-elective hospitalisation rates by county even
after adjusting for age and sex, in medicine ranging from 571 to 1,203 per
10,000, in surgery from 347 to 688, suggesting different clinical practices and
criteria for admission. This is in keeping with the findings of the recent
national bed utilisation review that found that some 10% of acute admissions
were inappropriate.
2. Too many patients are staying too long in hospital.
If the acute services in the Mid-West were to make efficiency improvements,
benchmarked to national and international comparators, then this would mean
that the 50,000 or so patients admitted each year would reduce their use of inpatient
beds from some 938 to 642, a reduction of 296 (32%). Again, this is
supported by the national bed utilisation review which found that 40% of inpatients
in the Mid-West were considered to be inappropriate for acute
hospital services.
An illustration of our findings and our concern about quality of service and
patient safety
We have selected the Accident & Emergency service (A&E) to illustrate how
the present service configuration, and corresponding consultant deployment,
leads to the conclusion that the fragmentation of the current services
generate an increased clinical risk to patient safety, are unsustainable and
need to be reconfigured if they are to deliver to international standards. A&E
should be delivered as a ‘consultant-led’ emergency ‘round the clock service’,
with continuous consultant supervision and direct clinical input as necessary
to provide systematic, high quality care at all times.
There are presently four discrete A&E units (Dooradoyle, the main A&E and
regional trauma centre, and 3 others, at St. John’s, Nenagh and Ennis) serving
the Mid-West population. There are only 3 A&E consultants to cover these 4
units, providing a total of only 99 contracted hours of work per week (33
sessions, each of 3 hours).
The consultant sessions are distributed as 29 to Dooradoyle, 3 to Ennis, 1 to
3