A & E charges

byrner88

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charlieroot

byrner88 wrote: »

.

Whats your point?

DundalkDuffman

100 yoyos from next year :eek:

PaddyofNine

I don't think it's that drastic, there's an awful lot of people who come through the ED every week who could do with going to their GP instead!

Maybe it should be combined with a publicity campaign, "Keep the Emergency Department for Emergencies" or the like - a similar idea is working very well in Austrailia at the moment.

kelle

Correct me if I'm wrong, but if you're subsequently admitted into hospital this charge will be waived. I know as a private patient in the past, this charge was paid by the VHI after admission.

Amnesiac_ie

I also think the charge is waived if you hold a GP referral. Given the inappropriate use of A&E by much of the public and the severe pressures on every A&E department around the country I think it is correct that there is a charge at the point of entry to deter "the worried well" from misusing A&E.

RobFowl

The 100 charge is still kept if you are admitted, the research sows it does ack as a barrier to attending AE but does not decrease the numbers who attend . there are alot of things like strokes and chest pain which should go direct to AE anyway. There is no proof the charge stops thing which should be there arriving. Do you think the drunks are going to put off on saturday nights !!

Vorsprung

RobFowl wrote: »

Do you think the drunks are going to put off on saturday nights !!

To be honest I doubt they all pay. I'd love to know what the figures are for successful collection of the A&E charges.

Frisbee

The charge is supposedly supposed to stop people abusing A+E.
Having worked in an A+E myself I can say it doesnt work at all. As the most common people to abuse A+E are junkies, wasters and scumbags. Who all seem to have medical cards, thus being able to waive the charge. Its ridiculous to be honest....
If you had to pay 100euro and then could claim it back, now there's a way to at least half the majority of A+E waiting times...

sam34

bigjimthefirst wrote: »

To be honest I doubt they all pay. I'd love to know what the figures are for successful collection of the A&E charges.

do they make much of an effort to follow it up and collect the payment at all, does anyone know?

tallaght01

I just don't think that, in a wealthy country, finance should be an issue at all when deciding if you wish to access emergency medical care.

There's gotta be another way of increasing capacity. Does the triage system not do anything to put off the time wasters?

If A+E is that stretched, the time wasters must be waiting days to be seen if triage is working well?

Frisbee

We used to send out invoices if they didn't have the money on them at the time. If they didn't pay within a month we'd just send another.

They never took my advice of hiring a guy called Lou who was very adept with using a wiffle bat to sort them out....

kelle

sam34 wrote: »

do they make much of an effort to follow it up and collect the payment at all, does anyone know?

No. Apparently they haven't the finance to chase up unpaid bills. A lot of patients tend to give false addresses anyway.
The A+E at the hospital where I work used to have somebody at the desk collect the money or credit card number off the patient at registration. I don't know when that stopped, but surely that system would mean more money is generated for the HSE?

sam34

kelle wrote: »

No. Apparently they haven't the finance to chase up unpaid bills. A lot of patients tend to give false addresses anyway.
The A+E at the hospital where I work used to have somebody at the desk collect the money or credit card number off the patient at registration. I don't know when that stopped, but surely that system would mean more money is generated for the HSE?

the whole thing is wide open to abuse so. once someone realises theyll get away without paying, theyll keep doing that. an attempt to collect the fee when the patient signs in might get more money, but you'll still ahve some genuine folk who wont ahve enough cash and really dont have a credit card, and the scroungers who'll claim not to.

DrIndy

i don't think it will make much of a difference.

People who think they are too sick to see "just a GP" will still wreck our heads. The real problem is with the drunks and drug users who all have medical cards.

It will sting middle income earners mostly and people who have minor trauma who have to go to us anyway. if the increase of 30% or so was used to hire 20% more staff then it would definitely work. We could then deliver.

I'm on tonight and popped over the the A&E to do some paperwork - the waiting room is standing room only already.

Fionnanc

Triage doesn't really work. It is great for identifying the conscious patient that will need llife-saving treatment in the next hour, but the vast majority of people attending get Triag category 3(recommended see within next 6 hours) or category 4. A category 1(almost dead) or a category 2( eg a sever asthma attack with the drowsy patient or O2 sats less than 94%) is a rare occurence in the A+e I used to work in. Lots of people who couldn't be arsed going to their GP because they come to A+E immediately when they feel unwell/sore. Most normal people if they went over on their ankle and it was reasonable straight, ice it up, elevate and go to their GP at his next session. The crowd that go to A+e call an ambulance. I've seen im call an ambulance for a strep throat.
The most annoying ones are the young adults with diarrhoea and vomiting. Most decent people stay at home and try tough it out(literally). THese ones come in potentially infecting the whole casualty.
And lastly the junies. They know exactly what to say to the triage nurse to get a triage category 3 and as soon as they see the doctor they ask for methadone. Should be an official no-methadone policy for emergency units. Nobody ever died from opiate withdrawal.

The standard of my writen english has really deteriorated. lol

tallaght01

A+E charges in themselves won't work.

People with crappy illness often think they're ill. That's why they're there.

In particular in kids A+E. People get really worried about their kids. A mum called an ambulance the other night for her kid coz he had a high temperature. But she was worried.

The triage system should be leaving people with minor illness waiting for a long long time. If it doesn't then, A+E aren't seeing enough accidents and emergencies presumably.

And why is everyone down on the drug addicts. These people are sick. they're very sick. They have a life threatening illness. Sure it's a scruffy, antisocial illness. But it's an illness. It's an illness where they don't have a lot of access to primary healthcare either. I think doctors should be the one group who can understand this. I remember them frustrating the hell outa me when I was an adult doc. They still frustrate me in neonates, as their kids have a higher rate of admission to NICU than non-addicts. But we don't do anyone any favours by treating them badly. Though I do appreciate that venting your spleen about them is therapeutic :P

Traumadoc

How does the person with the strep throat know if the have a strep throat or epiglottitis?
They dont.
One of the reasons people are willing to come to A&E and wait for many hours in cosiderable discomfort is that there is nowhere else to tell them they are OK.

The real reason for the problms in the A&E is that there is nowhere to put admitted patients as a result minors are waiting hours to be seen, many of whom are in severe discomfort but have nowhere else to go.

Swiftcare aims to treat these people as they are quick and easy to treat. The do not take ambulances, chest pain and the like because they want the cat 3 and 4 . puttng up the charges will mean more people will go to the Swiftcare, same price , no 6 hour wait.

Fionnanc

They don't know, but most people who have a sore throat either tough it out or go to the GP. In a child this woould e a different matter

Traumadoc

One of my neighbours had a sore throat, he toughed out as he could not get an appointment for the GP, stoical sort of guy, bumped into him on the road and he asked me to have a look - big ol quinsey he had been tolerating for at least 3 days.

Could have killed him but he did not want to go to the A&E and wait 6 hours to be told he only had a sore throat.

Ask yourself the next time you see someone presenting with a sore throat: Am I prepared to let this person go, tell them to go to their own gp, without having a look inside?

Fionnanc

If they show up to casualty I look, doesn't make it an appropriate place to go with just a sore throat.

Traumadoc

ask yourself why anyone would wait hours in the dumps we call waiting rooms , either they cannot get to their GPs or do not trust them.

Amnesiac_ie

I work as a medical SHO and recently I've moved to a regional hospital for a peripheral rotation. In the Dublin hospital I work in, the majority of patients I admit in A/E wait between 12 and 36 hours from the time I decide to admit them to leave the A/E department and go to a ward bed. In the hospital I'm working in for 3 months, the majority of patients go to the ward 1-6 hours after I've decided to admit them. The A/E department is tiny but the turnover of patients seems to tick over nicely; both for admitting docs and the A/E guys.

Why do patients in the Dublin hospital wait so long? The hospital is running at over 100% occupancy (I find that one hard to figure out too). Why is it so difficult to find beds?

1. No step down facilites
2. Poor access to long term care beds and sometimes up to 100 in-patients awaiting a long term care placement (nursing home bed)
3. No home IV service (Harney axed it) meaning people who could be safely treated in their own homes for cellulitis, endocarditis, osteomyelitis, COPD are taking up A/E trolleys/hospital beds
4. A poorly developed primary care service that is not resourced to look after a lot of conditions that in other countries are safely looked after in primary care.

So how would I solve the A/E crisis?
1. Invest hugely in primary care - empower patients, GPs, nurses and MDTs to look after patients in their own homes
2. Invest in home care packages to support the elderly and frail who want to stay in their own homes
3. Reestablish "Hospital In The Home" IV service
4. Double the public nursing home bed capacity in Dublin
5. Allow GPs and A/E docs rapid access to outpatient investigations such as ECHO, ultrasound, CT that would save many people being admitted by cautious junior docs who fear losing discharged patients to follow up

I really don't think the funds need to be directed into the A/E department itself but into the community, step-down/nursing home facilities and structural issues in the hospital.

Traumadoc

Access for GPs to radiology , would allow a lot of patients to bypass the Emergency room.