Private "A&E"s misnamed?

JuliusCaesar

I've been hearing ads on the radio for a certain private hospitals' Accident & Emergency Dept. which apparently provides a 'full service'. It's been riling me because aren't they more like a Minor Injuries Clinic?

You wouldn't be taken there by ambulance after a nasty car crash or after any serious accident of any sort.

I remember seeing a documentary about an A&E in Chicago, where people were brought in by ambulance with serious injuries, and a clerk running beside the trolley trying to get their insurance details. Is this what we're heading towards?

Anyway, I wonder if they could be prosecuted for misnaming themselves. :mad:

JuliusCaesar

JuliusCaesar wrote: »

I've been hearing ads on the radio for a certain private hospitals' Accident & Emergency Dept. which apparently provides a 'full service'. It's been riling me because aren't they more like a Minor Injuries Clinic?

You wouldn't be taken there by ambulance after a nasty car crash or after any serious accident of any sort.

I remember seeing a documentary about an A&E in Chicago, where people were brought in by ambulance with serious injuries, and a clerk running beside the trolley trying to get their insurance details. Is this what we're heading towards?

Anyway, I wonder if they could be prosecuted for misnaming themselves. :mad:

Whats the problem? They deal with accident and emergencies.

resus

The abbreviation A&E or name Accident and Emergency Department strictly hasn't existed for years !!!

It's just Emergency Department and Emergency Medicine. Privates are NOT the devils work. They take a massive appropriate strain off the government departments, and NOT for the wrong reasons. >75% of people coming to Emergency Departments are NOT in the appropriate place, but are there because they have nowhere else to go or GPs can't be bothered modernising AND the hospital systems they need services from can't be bothered modernising (although this is changing).

1) MOST medical, Surgical or Paediatric patients referred in by a GP ought to be in a Medical, Surgical or Paediatric assessment unit. Like in Limerick (or at least what should happen!). It is just bloody laziness and poor system design that people are triaged (or in reality properly treated) by ED staff to wait on trolleys for hours to see a junior medical, surgical or paediatric doctor.

2) Walking WOUNDED ought to be treated by their GPs if they where modernised (ie. access to x-ray), or in PRIVATE if patients preferred (they have radiology) or in properly set up MINOR INJURIES clinics (like exists in Cork 8-8).

3) Walking SICK aught to see their GPs. ED is NOT the place. If their GPs aren't up to it (many aren't) Go get another, because the majority are. And then if needs be, be referred as in point 1) above. Alternative, go to PRIVATE walk in department.

4) That leaves serious ambulance cases to be dealt with by Emergency Medical Physicians in an Emergency Department. Although the fact that the ambulance service are not yet set up to triage the abuse they get to a local GP (ie. treat and discharge) like in many other countries, the general public (particularly in the cities) will continue to abuse.

dredre

resus wrote: »

They take a massive appropriate strain off the government departments, and NOT for the wrong reasons.

Not true. Having worked in several EDs in Dublin in areas also served by the private facilities, there has been no let up in attendances. The reverse if anything!

>75% of people coming to Emergency Departments are NOT in the appropriate place,

Evidence for this? A proportion of attendances are certainly inappropriate, but more like 10% than 75%!

to wait on trolleys for hours to see a junior medical, surgical or paediatric doctor.

The wait on trollies for hours is generally for a hospital bed rather than to see another doctor. The process of admission and treatment generally does take place within 6 hours, but the lack of availability of hospital beds results in prolonged stays in the ED. This has knock on effects on other ED patients due to lack of space.

Walking WOUNDED ought to be treated by their GPs if they where modernised (ie. access to x-ray), or in PRIVATE if patients preferred (they have radiology) or in properly set up MINOR INJURIES clinics (like exists in Cork 8-8).

This can also be provided in EDs, many EDs stream 'minor' injuries to a separately staffed area (effectively an in house minor injuries unit).

3) Walking SICK aught to see their GPs. ED is NOT the place. If their GPs aren't up to it (many aren't) Go get another, because the majority are. And then if needs be, be referred as in point 1) above. Alternative, go to PRIVATE walk in department.

Many patients with heart attacks, meningitis and other serious illnesses WALK into EDs, these patients should not be encouraged to go to their GP first! In fact, the public generally have a pretty good perception of what should be seen in EDs and what is appropriate for GP care.

A proportion of patients seen ad the private facilities are referred on to public EDs because they are not staffed or set up to care for them (e.g. dislocated shoulders, testicular torsion, amputated fingers). I think it is a misnomer to refer to them as 'full service' emergency departments in this context.

4) That leaves serious ambulance cases to be dealt with by Emergency Medical Physicians in an Emergency Department

Which represents about 2% of total cases... I don't think you could seriously expect an ED to solely provide care for heart attacks and major trauma? EDs are a versatile resource which can fulfill many of the roles mentioned above, as opposed to MIUs, MAUs etc, which can only undertake a narrower role.

JuliusCaesar wrote: »

I remember seeing a documentary about an A&E in Chicago, where people were brought in by ambulance with serious injuries, and a clerk running beside the trolley trying to get their insurance details. Is this what we're heading towards?

Near enough - can't pay, get sent on elsewhere! Although they don't take emergency ambulance cases at present.

Bang Bang

My personal belief is that they advertise their services incorrectly. Yes they deal with a large number of cases that could/should be dealt with by a GP Practice, ie; minor suturing.
But speaking to members of the public, many think they have a full ED set up at the local private clinic, far from it, again in my experience.
I personally have dealt with a number of calls to these "A&E's" to transfer patients to an appropriate facility, as in the nearest Emergency Department, many of these would be fractures requiring surgery, also certain level cardiac and diabetic patients. Many of those I have treated couldn't believe that their treatment couldn't be carried further in the private clinic and felt it was unfair that they were now going to "another" A&E to sit it out, some having passed by their local ED enroute to the private clinic.

So do I feel they are misnamed? Yes I feel they are, I also feel somebody in advertised standards should have a quiet word in their ear and get them to advertise clearly what services they do and do not provide.

Paulzx

Yes they are misnamed.

They are minor injury clinics.

If they were "Emergency Departments" they wouldn't have to constantly call 999 to get their serious patients brought to full Emergency departments in our public hospitals.

The money is to be made in quick minor illness turnarounds. There is no money to be made in dealing with all the social ills i.e homelessness, drug abuse, psyciatric issues and illnesses associated with chronically ill elderly people. They are all resource heavy and left to the public health system to deal with.

To me it is targeted health care. We want you if you produce a profit for us

Bang Bang

^^ Well said Paulzx.

Delancey

I have heard these private clinics will not look at cases of head injury with loss of conciousness or indeed children under 2 years - true ?

UpstateEMS

Not to be overly academic or anything, but a study published in 1985 using data from 3 community hospitals in the States found that the inappropriate visit rate was 10.8%. Risk factors for inappropriate presentations included inability to name a GP, paediatric patients, unemployement, and failing to contact a known GP prior to presentation.

The strategy of using copays to keep people out of hospitals was debunked by RAND, especially for the paediatric population.

From working in Dublin area A&E's, my perspective is that until GP's have timely access to outpatient diagnostic services or specialist consultation, the A&E's will continue to be burdened with ridiculous, non-emergent presentations.

And finally, in regards to the Chicago area ED looking for insurance info.....
Absolute dramatic trash. A Federal mandate, the Emergency Medical Treatment and Active Labor Act (EMTALA), specifically forbids hospitals and physicians from inquiring about a patient's ability to pay or insurance status until receiving a "medical screening exam" finding that no acute emergency exists or the patient has been stabilized. EMTALA is not messed with as the penalties for violation are significant.

sickpuppy32

slightly off topic but what annoys me most about EDs is the medical card holders clogging up the dept, if they had to pay for the service out of their pocket like the hardworking PAYE worker, the place wouldn't be so full with minor complaints -

dredre

delancey42 wrote: »

I have heard these private clinics will not look at cases of head injury with loss of conciousness or indeed children under 2 years - true ?

Among other things... yes.

Elessar

I know of one private A&E in dublin which takes emergency cases by ambulance - only the ambulance is private and only takes calls from GPs surgeries.

Delancey

Elessar wrote: »

I know of one private A&E in dublin which takes emergency cases by ambulance - only the ambulance is private and only takes calls from GPs surgeries.

Jesus , and Mary Harney still swears we don't operate a 2 tier health service :pac:

Shield

delancey42 wrote: »

Jesus , and Mary Harney still swears we don't operate a 2 tier health service :pac:

As an aside, when she's on the news, it's embarrassing to tell people in my workplace that she is the Minister for Health in the ROI.

As they say a lot up here: "Only in Ireland".

wicklaman83

sickpuppy32 wrote: »

slightly off topic but what annoys me most about EDs is the medical card holders clogging up the dept, if they had to pay for the service out of their pocket like the hardworking PAYE worker, the place wouldn't be so full with minor complaints -

I'm not going to sit by and let a statment like that so unchallenged.off topic or not.
that statment might have looked alright 5/6 years ago but in this day and age it doesn't.Are you saying anyone on a medical card are not hard working,you maybe think they are scrougers.
I am 27yrs old which i've worked 11 of them full time.thats since i was 16 and yes i now have a medical card as i was involuntary laid off but i'm not one to sit around and wallow.i now have a part time job just for something to do so dont go labelling people when you know nothing about it.

Spanish Eyes

Darren I think the poster was making reference to the ease with which Med Card holders can go to the A+E for minor complaints (free) outside of GP hours (also free). I am sure you are not one of them.

This is a problem. The non med card holders have to pay a hefty fee for A+E either through a primary visit to GP or an immediate visit to A+E.

Triaging is supposed to weed out the non critical cases and leave them to wait.

I have often dreamt in my eerie dreams that why can we not have emergency hospitals only! Yes think about it, a hospital that will treat emergencies only for a period of time without the elective cohort looking for the same beds.

Yes, that is pie in the sky I know....

Shield

Fair challenge darren254, but I want to leave that there please. We have to get this back on topic.

Thanks.

UpstateEMS

Spanish Eyes wrote: »

I have often dreamt in my eerie dreams that why can we not have emergency hospitals only! Yes think about it, a hospital that will treat emergencies only for a period of time without the elective cohort looking for the same beds.

Yes, that is pie in the sky I know....

Never will happen. ED's are normally loss making operations in hospitals. To build a facility entirely around an ED would certainly lead to operations consistently in the red.

Spanish Eyes

UpstateEMS wrote: »

Never will happen. ED's are normally loss making operations in hospitals. To build a facility entirely around an ED would certainly lead to operations consistently in the red.

Yes, it was a pipe dream, otherwise it would have been adopted elsewhere I guess.

Anyway, your point about operations in the red under this pipe dream made me smile. Are not ALL the HSE's operations in the red at the moment? Is there any efficient operation at all in this country's health service. I see ST. James' got a good rating for something like that recently so something is working, but I wonder what the terms of reference were? I'd guess A+E referrals to beds within 12 hours was not great.

Incidentally, when Tallaght hospital was built it was expected that James' throughput would decrease significantly to only inner city population, but it would appear that with the increase in apartments etc. in that catchment, they are back or further from square one, and with an ageing population too. Their oncology suites have improved greatly though from the old days, will give them that.

And what the hell if a dedicated emergency hospital turns into the red.... what about the patients?

gbee

resus wrote: »

>75% of people coming to Emergency Departments are NOT in the appropriate place, but are there because they have nowhere else to go or GPs can't be bothered modernising .

As a boy, walking the streets of Cork, if I had an accident, the first port of call was the Chemist ~ he'd assess and dress wounds and prescribe medication or procedures, he'd splint and sow up to three stitches.

On his advice a doctor could be summoned or if deemed serious enough an or an ambulance called for emergency ~ at some time the Government took all these facilities away and turned chemists into pharmacists or beauty clinics.

Also the lengthy bureaucracy enforced on patient entry into hospital, has led to the abuse of the A&N as the ONLY way to get a patient into hospital at all; even if they may not be critical but still need attention in a timely manner.

Also the combination of hospitals into these super regional monstrosities, has caused incidents whereby consultants only work one day a week ~ instead of the perceived five days a week as the said consultant would have done one day in each hospital prior to amalgamation.

So in essence, we have reduced service outlets, reduced service technicians working times and forced EVERYONE to go through A&N.

This is called bureaucracy with blinkered agenda dogma administration.

JuliusCaesar

Spanish Eyes wrote: »

The non med card holders have to pay a hefty fee for A+E either through a primary visit to GP or an immediate visit to A+E.

Triaging is supposed to weed out the non critical cases and leave them to wait.

Indeed. Had to pay E90 for a child with suspected appendicitis on a Bank Holiday weekend, when I brought him into Crumlin Children's Hospital A&E. Could claim it on VHI, but the point remains. We were there for 8 hours and were finally released after midnight, when they decided it wasn't the appendix (I know it's a difficult diagnosis). Just as well I happened to have cash on me, which I don't every day! (Otherwise we would have starved and had to walk home). Mind you, a maybe surgical case like that would have been ideal for the Beacon, wouldn't it?