A and E waiting times

xzanti

I think they need to get their priorities straight, I had my tonsils out last year and I went for a walk down the hospital... and I stumbled accross AnE.. and tbh some of the people were in a BAD way, I felt bad for having my bed, I could have waited to have my tonsils out, I think they should have a day clinic for small procedures like that.. It's ridiculous, fair enough I did need morphene for a few hours after the op but my bf could have administered that at home if he was told how to... Why should I have a bed while somebody who's been stabbed or something have to lie on a trolly all night...

Wertz

sam34 wrote:

Wertz wrote:

The problem with people not going to their doctor/GP is again down to the 9-5 Mon-Fri work regeime of the entire health service.

I've worked for many years as a doctor in the health service and i can assure you it is not a 9 to 5 mon-fri regime. nowim not looking for sympathy, all i want to do is correct the above misconception. the demands of various teams and services that ive been on mean that i have often routinely worked from 7am to 6pm as a "regular" day, and on top of that have worked on call, whereby you come in on monday morn and go home tuesday evening, or worse, come in saturday morning and go home monday evening, having been on duty for 57 hours or so, more than most people work in a regular week. you may get sleep, but you may not, or you may only get 30 mins here and there. so wertz, excuse me if i snigger with derision when u state that the entire health service works 9 to 5 mon to fri.

Okay, "entire health service" is generalisation overkill and I recant it, with my apology.
I have the utmost respect for anyone working within the health services for the long hours they put in....but do you not take my point about GP hours? I can recall as a very young child being housecalled by my GP a few times, often at night and possibly the weekend. I can also recall being brought to the home/surgery of a doctor well outside of hours. I lived rurally at the time and it was the only choice as hospital was too far to be taken (and was probably unnecessary).
But AFAIK that sort of GP service doesn't happen as much anymore, and where it does it's in high demand and would most likely be private practice.
My whole point is that more out of hours doctors working locally could stem the flow into a lot of the busier A&E depts in urban areas....I know that it's a tall order to find GPs willing to work at times like that and that it's by no means the only solution but if you want to keep non-emergency cases from blocking up front end services and endangering the lives of real emergency cases then something has to change (including public awareness).

BTW what Wisheress said back up the page is so spot on it hurts....on many occassions I've worked in hospitals that were expecting visits from HSE/HB officials and/or the minister for health...no expense spared by management to have the place looking regimental, clean and efficient when on any normal day it was apparent the place was anything but...amazing what a lick of paint, and the shuffling of beds/patients will do.
I love her "people with clipboards" image as well....another contention of mine with the HSE....too many chiefs and not enough indians...if there were half the money spent on actual medical staff that there is on non-medically trained managers and office staff, that might a more efficient step in the right direction

The Queen

My gran was in A and E there recently. She's 82, has Alzheimers and had a fall, where they thought her hip was broken. She was waiting for 12 hours sitting in a wheelchair in a a corridor. It's disgraceful. However, when my brother went in, he was seen straight away. He went in at 10.30pm and left before 2am. Why? Only because it happened at hurling, and one the other players was the son of the Triage nurse. It's all who you know...
Though the staff are really great. They are so kind, and majority of them apologetic that patients have to wait for so long.

sam34

agreed wertz, better round the clock primary care services would lessen the burden on a &e. but the old idea of a gp running a practice singlehandedly 24/7 (as my own gp did) is no longer feasible. people dont want to work those long hours,, people want quality of life now. gp co-ops seem the way to go, but unfortunately, once it comes to midnight these are often not staffed by the regular local gps, but by people doing locum jobs who are aften more interested in the cash than anything else, and the easy solution is to ship someone into a&e....

ntlbell

Never had a long wait myself.

Was in last weekend.

Seen a nurse after about 4 minutes.

Doctor after 10

was in a bed and tanked up on morphine within 15 mins.

Quality service:D

Saskia

Wisheress wrote:

Hi Trampas,

I'm a doctor who has just finished a 36 hour shift in A+E. Several people I saw waited 11 hours or more. I am sleep deprived now and had 2 digestive biscuits all day so excuse me if I rant now or am not as articulate as I should be.

I am ashamed of the system I work in. I work in one of the busiest A+ E departments in the country. The waiting times are ridiculous. We just do not have the staff not the facilities to cope (not just at weekends). Every week when I finish a long shift, I question my ability to continue to work in this field. It is heartbreaking to see unwell patients who have waited such a long time and then must spend time on a trolley or even a chair for the night. Most of us would find it impossible to spend a night on a hard trolley/chair even when entirely well. Imagine having to do so when you’ve an awful pneumonia or multiple seizures. The people in this country deserve better. I am gutted that this happens every day. I can only apologise to my patients that they should have to bear such an experience. I ask them to write to Harney, to ask her to funnel her money into basic A+E facilities instead of paying people who walk around with clipboards. I ask them to ask for more community services. We need more clinics and operating theatre time. There are always doctors and nurses working at the weekend, we just need more. It not just about not having certain staff members in at weekends, the backlogs are equally bad during the week. Mondays tend to be horrendously busy. The crisis is due to all the factors I've mentioned before and until the HSE start asking hospital staff how to address issues, we'll never get anywhere.

Please don’t tell me Minister ,that you have added hundreds more beds since your election. Hundreds of such beds lie empty because we do not have the staff to manage them. For the record, I have no issue with taking a big pay cut in the future as a consultant. I have no problem with coming in at weekends, as I do now, for the rest of my working life. I have no issue with working evenings and nights. That’s what I signed up to. I do however oppose the new consultants contract proposed by Harney which states that new consultants will not have team (i.e. no registrar/house officer/intern) and no guaranteed access for their patients to nurse specialists, physiotherapists etc. The new contract also states that non-medics (the people with clipboards) can overrule a doctor who feels that a patient really needs a medication. We will also not be allowed to criticise the hospital system ‘if it brings down the name of the hospital’. I would not allow my own parents to be treated by anyone with this new contract. But that’s another argument.

OP, to address your issue with the patients who are drunk/take drugs. The thing is that we cannot just leave them out in the waiting room. Unsurprisingly, some of them fall over whilst drunk, hit their heads and thus end up with brain haemorrhages and the like that need urgent neurosurgical input. Some go into life threatening fulminant liver failure. I have seen three people in their 20s who took cocaine and then developed strokes in the last 4 months. One of these female patients has been left with debilitating left sided paralysis and is now in a wheelchair. The point I’m trying to make is that until these patients are assessed by a doctor we don’t know if they are simply drunk/off their heads or else if they’ve developed life threatening complications of alcohol/substance misuse. I don’t know if that explanation makes it any easier to understand why we can’t neglect any subset of patients. I hope it does.

By the way, I don’t think private hospitals for in-patients are the answer. In general private hospitals don’t provide urgent care which makes up most of the cases treated in public hospitals. Private hospitals are limited in provision of intensive care and rehabilitation too. And why should we have a two-tier system? And why of why did I see and elderly patient in hospital last night who had spent 600 days in hospital even thought her initial pneumonia only lasted 10 days?!! Why has funding for care packages for these elderly patients rapidly declined recently…they have even been discontinued in some areas. We need more long term nursing home beds now.

Let me tell you a quick story. Last year the Minister for Health came to visit our department. The ‘people with clipboards’ were everywhere. I was ready to tell her (calmly!) about the shortcomings of the system. I acknowledge that by and large, the political parties may have the health interests of the nation at heart, but I wanted to highlight the real situation as it is on the ground, the resources we need, how we can save money and still achieve better patient care. Anyhow I started my shift that day and was shocked as soon as I walked into the department. The place was almost empty. All the trolleys normally taking up every inch of floor space had been moved. The cubicles were largely empty too. It turned out the administration of the hospital (who are non-medical) had opened up a ward that normally remains closed, moved A+E patients up to the empty beds, and low and behold when the Minister arrived, the place was stunningly empty. The visiting party were whisked through the department in seconds, they did not stop to speak to any doctors or nurses. We were not given a chance to even approach them. I tried. They left with the impression that the fuss about A+E was imagined. The next day things were back to normal.

I said earlier that I am ashamed of the system. I am however immensely proud of the doctors, nurses, physiotherapists, social workers, porters and all the other staff who work in our hospitals. It is my confidence in the ability of all these staff that keeps me going as a doctor. I know that when you do eventually get seen in A+E, we will do our very best to make you better. I know that some of you have had negative experiences too, it would be silly to deny that, but overall I feel that the staff in Irish hospitals are second to none. We are trained brilliantly in this country (just google your own consultant and see how well they’re known worldwide!) and for that I am grateful.

OP, I agree that medicine is “not a Monday-Friday company”. The sad thing is that even during the week, when ancillary services are in full swing, the waiting times are still ridiculous. The system needs to be overhauled.

I’m going to stop now. Sorry if I went on and on. There is so much I want to say and so much that we are trying to change.

I really hope that your girlfriend feels better now.

All the best

W

That is probably the best post ive ever seen on Boards. Thanks for an inside look. Oh and Mary Harney should be publically hung, drawn and quartered :mad:

WindSock

Saskia wrote:

That is probably the best post ive ever seen on Boards. Thanks for an inside look. Oh and Mary Harney should be publically hung, drawn and quartered :mad:

Wouldn't happen, the ropes would break.

Thank you Wisheress for taking the time out to write and Informed view of the situation, when you must have been knackered.

xzanti

#Elites wrote:

Im pritty sure if your stabbed you wont be waiting on a trolley..

i hope :eek:

LOL.. Spose

sam34

xzanti wrote:

I
It's ridiculous, fair enough I did need morphene for a few hours after the op but my bf could have administered that at home if he was told how to
..

thats not a viable solution tbh. after having had a general anaesthetic there are risks to the patient and you need to be observed for a decent amount of time afterwards. there are also post-op complications that need to be watched for. and as for administering morphine at home- ffs. morphine is a controlled drug that is kept under double and sometimes treble locks in hospital wards. the ward stock has to be counted and signed off by two senior staff daily. if its being administered to a patient, two senior staff have to sign the "controlled drug" book as well as the patients drug chart. its a drug with street value as well. its certainly not a drug that u'd give someone going home, either in tablet form, or worse, as u seem to be suggesting, in injection (either IM or IV) form.

This post has been deleted.

Savman

Shocking alright. Just hope the hospital staff know how thankful the public are for doing what they do.

I've been in A&E a few times, its only when you are there you realise the Celtic Tiger has missed something and how bad it is. Getting Doctors to work 50hr shifts is not the bloody solution :mad:

Fook sake maybe I will vote after all :rolleyes:

fly_agaric

ronbyrne2005 wrote:

The system is a mess despite the vast amount of money thrown at it(We spend more per capita than countries with world class health systems despite having a young population which is a lot less sicker as a whole).

I believe we spend just about the average for a rich country on it. To say nothing of all the decades where we spend sweet fa because the country had no money!

A quick google search later:

http://www.oecd.org/dataoecd/31/2/36958547.pdf

ronbyrne2005 wrote:

Do you think the government wants the health system to be the way it is? No, obviously not.

Sometimes the cynic in me thinks that the PeeDee/FF government have their hands tied by the knowledge that they can only expand opportunities for business to make money out of private heathcare if the public system is bad!

crazy_dude6662

kinda of topic, but i find the new ad about MRSA (thats the infection thing right?? i can never remember) insulting. they are blaming people coming into the hospital for spreading it, but when you visit a relative or freind in hospital you dont start poking around the wound/bandages do you? and i very much doubt the patient does either.
when my grandad was in hospital he was getting a wound dressing changed, the nurse opened the door with her gloves on. then went digging through the cabinets, walked out of the room for a few minuets to talk to someone outside the door then came back in, not once did did he see her change gloves.


but i agree that more funding is needed, maybe if they didnt p*ss it away like they did on the spire.

mike65

but i agree that more funding is needed, maybe if they didnt p*ss it away like they did on the spire.

Spire - 4 million
Heath Service - 14 billion.

Mike.

maxi-twist

timmywex wrote:

thats wrong, if you are serious and come in an ambualnce, you get priority

Thats what i meant by properly injured,none of this cut knee ****e.

Are there more than 11 state owned ambulances in dublin yet?

DeVore

zuutroy wrote:

I dislocated a finger last night and was seen, x-rayed and strapped up within 2.5 hours and they were apologetic about the wait. How can other countries manage it. Do Iirish people just hurt themselves more?

I've just written a blog that is exactly on this topic (it might be of interest to a lot of people on this thread, see my sig under Medical Tourism).

I've just come back from Thailand where they have had a tsunami AND a revolution and their healthcare system kicks the nads off ours.

Have a read and see if you concur with my opinion because there are a lot of people who are leaving this country for non-emergency elective stuff....

DeV.

RoundyMooney

That makes for interesting reading, and just goes to highlight the boom in medical tourism (as opposed to dental or cosmetic-which has been around for a while, whether you choose to go to Newry or Budapest).

I'll certainly be reading the site at a more opportune hour, but will our politicians?

tallaght01

Health tourism is all very well and good. It's a symptom of the failings within our own health service. Health tourism is in no way a solution to the problems though.
Presumably, private clinics in south east asia will be competing with private clinics in Ireland for business, rather than competing with the public sector.
I'm not sure why people who can afford it wouldn't use the private system in Ireland, which is wold class. Perhaps as more people are taking out private healthcare insurance, the waiting lists are getting longer in the private hospitals? I don't know.
I'm also not sure that Thailand's health system "kicks the nads off ours". Ive never been to a thai hospital, but I know from friends who've worked out there that rural healthcare is atrocious, and that healthcare provision in their refugee camps is non existant (Though that was a few years ago). Thailand also fares much worse than Ireland on the important health indices, such as life expectancy and infant mortality. They also spend a smaller % of their GDP on healthcare than we do. Healthcare is about more than hospitals.
There's an old argument within the public health community, regarding the healthcare system. It goes along the lines of arguing that the health service will never improve while it serves mainly the lower socio-economic classes. This is because they have no real voice in demanding change. When the middle classes and the politicians and their families are forced to use the public healthcare systme, then things will change. Or will they? I don't know, but it's an interesting question. Where does Mary Harney and her family go if they're in hospital? Does the Taoiseach sit in A+E with the rest of u? Answers on a postcard.

Siogfinsceal

its been like that for ages its a joke. I once sat for 6 hours in A & E with a suspected back injury and was then asked to walk up a stairs for an xray afterwards - if I could bloody walk up stairs would i have been there in the first place??? no!!
I also once had an A & E doctor who read my xray on a desk with a lamp as the xray board was full - not surprisingly the damaged neck vertebrae and scolisois were not diagnosed until a year later when a chiropractor took xrays!

timmywex

maxi-twist wrote:

Thats what i meant by properly injured,none of this cut knee ****e.

Are there more than 11 state owned ambulances in dublin yet?

the dublin fire brigade now have 12!! the swords station went full time and it got a new ambulance, theres still only 12 for most of the city!! the hse only do patient transport but cover a small amount of 999 work in some areas

thats why the dublin fire brigade respond to all calls with lights and sirens, even a toothache!!they just dont have time to go slower!!

tallaght01

Siogfinsceal wrote:

its been like that for ages its a joke. I once sat for 6 hours in A & E with a suspected back injury and was then asked to walk up a stairs for an xray afterwards - if I could bloody walk up stairs would i have been there in the first place??? no!!
I also once had an A & E doctor who read my xray on a desk with a lamp as the xray board was full - not surprisingly the damaged neck vertebrae and scolisois were not diagnosed until a year later when a chiropractor took xrays!

Or maybe you didn't actually have scoliosis or damaged vertebrae

See the chiropracter thread in biology/medicine for the full banter :P


http://www.boards.ie/vbulletin/showthread.php?t=2055061953

Nala

Feckin hell how do doctors work such long shifts??? I doubt its a very relaxing job either. fair play.

I agree that GPs should fix stuff themselves more. It seems over here if you have a broken leg you get sent to A+E?? Maybe you should only get sent to A+E if it's a complicated break or a fracture. This is how it is with animals. My cat was only sent to a specialist because her leg was shattered in 3 places and her hip was dislocated. Her leg bones were in pieces. The vet said had it been just a clean break he would have just cast her leg up himself. Why can't it be the same with people???

galah

only back from holidays, just ploughing through all the posts...

anyways, my two cents:

The "healthcare system" here is absolutely shocking. And it's not the people (the doctors, the nurses) who are at fault - they are doing the best they can - and I honestly believe that. However, the set-up of A&E is utter sh*te...

Let me compare to Germany, for example. Most GPs would have specialised equipment to deal with certain types of emergencies - for example, X-rays for broken bones etc. No need to go to A&E for that, unless it's absolutely necessary. And even then, you would wait 2 hours MAX to be seen. Absolute max.

There's a weekend GP service attached to the hospital, and if your case is serious, you will be referred to the right department by the doctor. Again, no sitting on a trolley in A&E for hours.

The bf had a back problem while we were home in Germany last year - we went to this pre-A&E service, he got referred to the back department in the hospital, and after waiting in a (nice) private waiting room for half an hour, a nurse appeared and apologised for the delay!!!!! We couldn't believe it!

Here, he was made to wait 18 hours on a trolley in the corridor of UCHG with acute appendicitis (the night before Paddy's Day - wohoooo). Unreal!

So many shocking stories about the inefficieny of the Irish system...It's sad, and again, it's not the people I blame (I can only imagine how hard it must be to work in an Irish hospital), but the system that needs a total overhaul, so that only real emergencies end up in A&E, and everything else is dealt with by GPs!

Capt'n Midnight

crazy_dude6662 wrote:

kinda of topic, but i find the new ad about MRSA (thats the infection thing right?? i can never remember) insulting. they are blaming people coming into the hospital for spreading it,

On the radio they were comparing us to Holland. There they isolated patients and had staff wash hands frequently.

They also pointed out that visitors usually only visit one patient and so aren't very likely to transmit the infection to other patients. Of course you'd want to keep the doors clean and visitors washing hands isn't a bad idea but you can't blame visitors for everything.

faceman

tallaght01 wrote:

There's an old argument within the public health community, regarding the healthcare system. It goes along the lines of arguing that the health service will never improve while it serves mainly the lower socio-economic classes. This is because they have no real voice in demanding change. When the middle classes and the politicians and their families are forced to use the public healthcare systme, then things will change. Or will they? I don't know, but it's an interesting question. Where does Mary Harney and her family go if they're in hospital? Does the Taoiseach sit in A+E with the rest of u? Answers on a postcard.

I know u work in the UK tallaght01 from your other posts. You forget about ireland that we're a nation of begrudgers who would rather moan than complain.

When nurses go on strike, a large percentage of the population give out about them. That same large percentage of the population also agree that the health system in ireland needs reform! eh hello? Lazarus alert!

Here's a Q - How many people on this thread have ever confronted their local TD about the healthcare crisis?

I havent pro actively. but when FF called to the door the other day, i did.

PoleStar

I see MRSA mentioned again.

Might be slightly relevant to this debate.

One major contributor to MRSA rates is overcrowding. It is recommended that a hospital runs at a bed occupancy rate of 75-80% at all times which will aid hygiene practices and reduce MRSA colonisation rates (along with improving patient care which has been shown in Australia!).

We here in Ireland have bed occupation rates at 95-100% at all times.

Thats why our MRSA rates are crap.

The minister for health likes to blame nurses and doctors and all other non-administrative staff in the service for the short comings but until the big lady makes more beds and improves ancillary services such as Xray, lab diagnostics etc, nothing will change.

Oh yeah and to re-iterate what has been said already. The minister is trying to show how great she is by advertising for 68 new consultant jobs, woohoo!

Oh what she forgot to say is that no funding is being provided for these jobs. Oh yeah and what about the team that will work with the consultant so that he might be actually able to do his job, i.e. secretary, and junior doctors? No, none of these will be provided. And yeah no beds for these doctors to put their patients in. And yeah no operating theatres to operate in. So when these new consultants arrive I guess they will have plenty of time to twiddle their thumbs. Maybe they can take up managerial roles? The dept of helath certainly loves to employ these!

faceman

Capt'n Midnight wrote:

....MRSA....On the radio they were comparing us to Holland. There they isolated patients and had staff wash hands frequently.

They also pointed out that visitors usually only visit one patient and so aren't very likely to transmit the infection to other patients. Of course you'd want to keep the doors clean and visitors washing hands isn't a bad idea but you can't blame visitors for everything.

...or hospital staff.

MRSA accounts for only a tiny percent of the issues in our hospitals. Solve the major issues (overcrowding etc) and you solve the MRSA issue.

tallaght01

Faceman tells it like it is. If we're talking about waiting times and the burden of healthcare, then let's look at societal issues regarding excessive drinking, smoking, drug abuse, obesity, violence etc.

MRSA has it's place in the worry books, but the above are the bigger issues facing the health service.

Dr Galen

tallaght01 wrote:

Faceman tells it like it is. If we're talking about waiting times and the burden of healthcare, then let's look at societal issues regarding excessive drinking, smoking, drug abuse, obesity, violence etc.

MRSA has it's place in the worry books, but the above are the bigger issues facing the health service.

most definitely. if we solve or even partially solve the above issues, overcrowding in hospitals will drop anyway, and diesases like MRSA will automatically become less prevalent