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
b) All sick children and pregnant mothers being conveyed by ambulance must be
taken directly to the appropriate recognised service
Despite clear protocols in place, it is reported that the ambulance services are continuing
to take sick children and pregnant mothers to Ennis and Nenagh hospitals, again being
the nearest site.
This practice is inherently unsafe, as these units have no facilities for their emergency
management. Moreover, Ennis and Nenagh are specifically excluded from providing
acute paediatric care 45 .
The HSE needs to issue immediate instructions for the relevant protocols to be adhered
to.
c) Establish a formal retrieval service for the transfer of critically ill patients
between hospitals
The transfer of critically ill patients commonly has significant patient safety issues on two
counts:
• The base hospital, from which the patient is being transferred, often has to send the
duty doctor /anaesthetist with the patient on the transfer to make sure any problems
on the way are properly managed; this means the base hospital has to try and backfill
the absence of the doctor during transfer, not easy to do in a peripheral unit;
• Some patients have to be transferred with staff that are not sufficiently skilled in
looking after the problems that may arise during transfer, so increasing the risks to
the patient during that transfer.
The HSE needs to establish a formal retrieval system for critically ill adults and children to
overcome these patient safety issues.
d) Establish a regional Level 3 adult critical care service at Dooradoyle as soon as
possible
Our report has already highlighted the dispersed nature of critical care across the Mid-
West. We understand the critical care network already works well informally but this is
against the backdrop of having to cope with excessive fragmentation of critical care
staffing and skills.
45 Care of the critically ill child in Irish Hospitals, Recommendations of the Faculty of Paediatrics, RCPI and the Irish Standing
Committee, Association of Anaesthetists of Great Britain and Ireland, February 2005.
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