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

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The implementation plan: details and timescales Review of acute hospital services in HSE Mid-West An action plan for acute and community services We estimate, once detailed project planning has been completed, that the majority of the programme should be completed within 3-4 years, excluding new builds. The key milestones and provisional estimates of timescales for each element to be fully implemented are presented in Table 18. Table 18: Implementation plan – Indicative milestones and timescales Key milestones Timescale to completion Delivery of best practice in acute services 6 to 12 months maximum Transfer of Acute General Surgery to Dooradoyle Within 6 months Establishment of single critical care service Within 6 months Interim transition programme Within 12 months Transfer of day surgery to local services Within 12 months Completion of PCCC service developments Within 3 years Transfer of Acute General Medicine to Dooradoyle Within 3 years Advanced Paramedic workforce in place Within 3 years (Programme needs to be accelerated) Advanced Nurse Practitioner workforce in place Within 3 years (Programme needs to be accelerated) Local ‘centres of excellence’ established Within 3 to 4 years (excluding new build) Regional ‘centre of excellence’ established Within 4 years (excluding new build) Transfer of Obstetrics Dependent on new build Transfer of Orthopaedics Dependent on new build Within 6 months We recommend prompt action within the first six months to: reduce the current levels of clinical risk and improve patient safety in emergency general surgery and critical care; commence improved efficiencies right across all the acute services; and complete the entire detailed project planning for transformation for the reshaping of the regional and local ‘centres of excellence’. Within the first year We recommend action within the first year to: provide temporary ongoing support to other essential services, particularly A&E; deliver the efficiency improvement programme; and complete the rescheduling of day surgery to local services. 75
Within three years Review of acute hospital services in HSE Mid-West An action plan for acute and community services In years 1 to 3, we envisage a period of: progressive refurbishment of facilities to enable most services to be reprovided in their appropriate local or regional setting; consolidation and completion of the PCCC development programme; acceleration of the workforce development programmes for APs and ANPs to lead the development of the local ambulance emergency response and Urgent Care Centres; and, strong infrastructure development to support the clinical networks. Within 4 years Years 3 to 4 should see the regional ‘centre of excellence’ able to deliver all the core acute services not associated with new builds with further development of the local ‘centres of excellence’. We now proceed to describe the implementation plan in more detail. Areas for urgent action and implementation The first priority has to be for the HSE to take immediate action to reduce the current level of clinical risk and improve patient safety in a number of service areas where the quality of care needs to be addressed. 1. Taking action to reduce clinical risk and improve patient safety. a) All major trauma patients must be taken directly to the regional trauma centre In the opinion of the trauma consultants, the current practice of the ambulance service taking major trauma patients to the nearest hospital, instead of directly to the regional trauma centre at Dooradoyle, exposes the patient to increased risks. It delays the patient’s access to prompt and definitive emergency management, management that is not available in the smaller hospitals. Therefore, the HSE needs to restate the instruction that all major trauma patients must be taken directly to the regional trauma centre, with no ambulance stopover at a peripheral unit. This will immediately improve patient safety with regard to the transfer of trauma patients to hospital. In addition, there needs to be an urgent review of why the Helicopter Emergency Medical Service (HEMS) is so infrequently used. There is a general impression that it should be getting used much more frequently. 76
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Key messages Review of acute hospit
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educe the length of stay in hospita
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Critical care network Review of acu
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Tele-medicine Review of acute hospi
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Review of acute hospital services in the Mid - Health Service Executive

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