Help me understand the 24/7 Heart Attack care report

JMT2016

So here is the report that is being mentioned in the news:

health.gov.ie/wp-content/uploads/2016/09/Dr.-Herity-Clinical-Review.pdf

There seems to be a big difference between the Waterford Consultants and the Dr. Herity over the catchment area. One says 560k and the other <300k and this seems to be making all the difference.

But it seems to me that most of kilkenny is not being counted as part of the catchment area for 24/7 south east heart attack care because St. Lukes sends a lot of referrals to St. James Hospital in Dublin instead of Waterford.

There is a diagram on page 19 showing a big arrow from Kilkenny heading towards Dublin while the rest of the south east points towards waterford.

If the arrow from Kilkenny to Dublin was pointing towards waterford would there be a totally different conclusion to the report? Could that be considered since Dublin already has a massive catchment area?

Then, on page 38 there is a picture showing that waterford city, south kilkenny and half of wexford has no 24/7 cover within 1.5 hours but the conclusion is that emergency care should be centralised in Cork even more than it is?

I'm genuinely baffled? Please help me out here.

JMT2016

Just something else I am now wondering about.

On page 18 it says:
"For most counties the admission profile at UHW is very similar to that of the total admission profile with the following notable differences: lower percentage admission rates for residents of Carlow and Kilkenny and higher percentage admission rates for residents of Wexford and Tipperary South These patterns are readily explained by the professional linkages (and cath lab sessions) of the consultant cardiologists in the relevant local hospitals."

What are these "professional linkages"? Is the region as a whole losing out as a result?

Also, there's something of a circular argument here when they mention the cath lab sessions - the lab is already restricted and overcrowded, causing referrals to go elsewhere, and because people go elsewhere, the catchment area is lower and therefore additional resources can't be provided! Nice!

Chiparus

The cath lab is open 8 hours a day and only does 72 heart attack cases a year, it is recommended to do 100 a year, so rather than opening it more hours a day and therefore do over 100 cases, he has said it should not be doing heart attack cases at all.

Bizarre report.

JMT2016

Chiparus wrote: »

The cath lab is open 8 hours a day and only does 72 heart attack cases a year, it is recommended to do 100 a year, so rather than opening it more hours a day and therefore do over 100 cases, he has said it should not be doing heart attack cases at all.

Bizarre report.

And those 8 hours are Monday to Friday 9-5 and that's already with massive overcrowding and delays and stoppages for emergencies?!

It only operates 24% of the hours in a year and manages to hit 72% of the target! That sounds like they are playing a blinder - imagine what % they would hit with more resources not less!

Chiparus

JMT2016 wrote: »

And those 8 hours are Monday to Friday 9-5 and that's already with massive overcrowding and delays and stoppages for emergencies?!

It only operates 24% of the hours in a year and manages to hit 72% of the target! That sounds like they are playing a blinder - imagine what % they would hit with more resources not less!

Only open 1/4 of the hours ( 40/168) yet doing 72 cases , if it was open 24/7 it would be the busiest in the country

debok

Its a bit of a strange report and the whole moving more services to cork doesn't make sense.it seems the catchment areas numbers are being downsized on the report to me and that looks like the governments only way out of there promises to halligan and it seems to have git them off the hook. But it seems Waterford is getting shafted again. We must be too quiet down here cos its happening more and more.

O Riain

We are too quiet, there should be absolute uproar over this but I'm barely hearing a whimper

ED E

debok wrote: »

Its a bit of a strange report and the whole moving more services to cork doesn't make sense.it seems the catchment areas numbers are being downsized on the report to me and that looks like the governments only way out of there promises to halligan and it seems to have git them off the hook. But it seems Waterford is getting shafted again. We must be too quiet down here cos its happening more and more.

If Im reading it correctly Herity is recommending keeping routine procedures at UHW and divert the PCI work (urgent/emergency) to CUH. Totally fits the centres of excellence policy and keeps the travel times down for repeat patients. Whats the issue?

debok

ED E wrote: »

If Im reading it correctly Herity is recommending keeping routine procedures at UHW and divert the PCI work (urgent/emergency) to CUH. Totally fits the centres of excellence policy and keeps the travel times down for repeat patients. Whats the issue?

. At the moment the cat lab takes the heart attack emergencies during the day (9-5) going by the report the cat lab will stop taking these emergency's. So if I'm in south Kilkenny and drop with a heart attack during the day I will have to bypass Waterford and head to cork instead. It just seems strange to drop this pci work during the day altogether. its a nice trip to cork while having heart attack.

JMT2016

ED E wrote: »

If Im reading it correctly Herity is recommending keeping routine procedures at UHW and divert the PCI work (urgent/emergency) to CUH. Totally fits the centres of excellence policy and keeps the travel times down for repeat patients. Whats the issue?

It increases the travel times for the emergency cases? The ones where time is of the essence?

I know traffic must be bad in Dublin 14 where you are - but are you facing a 2 hour + journey to get emergency care?

Dead on time!

Chiparus

ED E wrote: »

If Im reading it correctly Herity is recommending keeping routine procedures at UHW and divert the PCI work (urgent/emergency) to CUH. Totally fits the centres of excellence policy and keeps the travel times down for repeat patients. Whats the issue?

The longer the delay in getting PCI, the worse the outcome. so for people in the south east, the report says that they should get clot busting drug not PCI, but the outcomes are worse.

Max Powers

Didn't see prime time but from reading on aertel, this briefing note issued to chap doing review looks initially like exactly what has been previously spoken of here i.e.this is what what we think you should write in your report.

Chiparus

He who pays the piper calls the tune.

JMT2016

Max Powers wrote: »

Didn't see prime time but from reading on aertel, this briefing note issued to chap doing review looks initially like exactly what has been previously spoken of here i.e.this is what what we think you should write in your report.

Not sure what exactly you're referring to but it seems the whole report turns on the catchment area.

The man himself says: The catchment population served by the cardiology service at UHW (or any other hospital service) is a matter for interpretation. (page 13) and then he uses his interpretation to justify reducing emergency services!

Why is the catchment a matter for interpretation? - people live in the geographic area or they don't.

On page 20 he allows 26% of the population of Kilkenny to be part of the catchment area - I mean in all fairness that's ridiculous.

If "professional linkages" is the reason that 74% of the population of one of the main counties in the South East is being excluded then maybe we need a South Eastern Health Board NUA to be set up to fix those linkages and start saving lives!

Chiparus

JMT2016 wrote: »

Not sure what exactly you're referring to but it seems the whole report turns on the catchment area.

The man himself says: The catchment population served by the cardiology service at UHW (or any other hospital service) is a matter for interpretation. (page 13) and then he uses his interpretation to justify reducing emergency services!

Why is the catchment a matter for interpretation? - people live in the geographic area and or they don't.

On page 20 he allows 26% of the population of Kilkenny to be part of the catchment area - I mean in all fairness that's ridiculous.

If "professional linkages" is the reason that 74% of the population of one of the main counties in the South East is being excluded then maybe we need a South Eastern Health Board NUA to be set up to fix those linkages and start saving lives!

Ok, to have a viable unit you need to have a catchment area of 500k, the hospital groups were based about this except Limerick with a catchment are of 380k,
Originally Kerry fed into Cork cardiology services, however, Kerry suddenly became linked to Limerick.

Cork now had a problem as their unit did not have the volume of cases.
So they need Waterford patients to feed into Cork.

JMT2016

Chiparus wrote: »

Ok, to have a viable unit you need to have a catchment area of 500k, the hospital groups were based about this except Limerick with a catchment are of 380k,
Originally Kerry fed into Cork cardiology services, however, Kerry suddenly became linked to Limerick.

Cork now had a problem as their unit did not have the volume of cases.
So they need Waterford patients to feed into Cork.

Why is Kerry linked to Limerick even though they are in different hospital groups? Hmm...

I just cannot get the mindset - for once can we stop skimping on what is emergency care in one of the few medical areas where every minute counts!

We need life equality for the people of the south east!!

Chiparus

JMT2016 wrote: »

Why is Kerry linked to Limerick even though they are in different hospital groups? Hmm...

I just cannot get the mindset - for once can we stop skimping on what is emergency care in one of the few medical areas where every minute counts!

We need life equality for the people of the south east!!

For cardiology, like Wexford is linked to Waterford even though they are in different groups.

JMT2016

Chiparus wrote: »

For cardiology, like Wexford is linked to Waterford even though they are in different groups.

Because that makes good sense!

Interestingly the report page 20 only allows 53% of South Tipp population to Waterford catchment- surely cork aren't using that other 47% to boost their numbers as well!

mickmackmcgoo

This is a regional issue but media keep it focused on Waterford and Halligan. Katie Hannons FOI for prime time showed that Halligan was screwed over on the terms of reference. The guy doing the report was given the outcome that was wanted. Kenny and Harris saying they have to abide by the report . There was a few independent reports over the years that recommended immediate university status for WIT but of course they were always ignored due to vested interests in other universities and politics and it's the same here . It's all about numbers for Dublin and Cork and keeping their budgets. Mr Herritty actually consulted with consultants in Cork hospitals about the need for second lab in Waterford. They were hardly going to recommend it were they

JMT2016

mickmackmcgoo wrote: »

Mr Herritty actually consulted with consultants in Cork hospitals about the need for second lab in Waterford. They were hardly going to recommend it were they

Why is there no mention in the report of consultation with any of the other hospitals that actually are in the catchment area?

mickmackmcgoo

JMT2016 wrote:

Why is there no mention in the report of consultation with any of the other hospitals that actually are in the catchment area?

As far as I know the consultants in KK aligned the hospital there with Dublin a few years back but I don't know what areas were consulted about this. The population of the south east justifies the 24 hour service but it's all been divided up and aligned to Cork or Dublin already

Dunmoreroader

It's the same politics that served the British Empire fir a couple of centuries; divide and conquer.

ED E

JMT2016 wrote: »

It increases the travel times for the emergency cases? The ones where time is of the essence?

I know traffic must be bad in Dublin 14 where you are - but are you facing a 2 hour + journey to get emergency care?

Dead on time!

Well I'm served by DFB so we're already light years ahead for cardiac survival.

The city in the world with the best "out of hospital, cardiac arrest" survival rate is Seattle. Second best is Dublin. This means if your heart was to stop beating for whatever reason, and you weren't in a hospital, the only city with a better survival rate than Dublin, is Seattle. This is a combination of reduced response times, and all the firefighters being paramedics. It's a huge influence on survival percentages!

Not familiar with UHW but the point of centres of excellence is you have multidisciplinary care teams. If they cant keep all on a 24/7 there then its better to concentrate on Cork so you arent saved of your heart attack but die of your head injury.

O Riain

ED E wrote: »

JMT2016 wrote: »

It increases the travel times for the emergency cases? The ones where time is of the essence?

I know traffic must be bad in Dublin 14 where you are - but are you facing a 2 hour + journey to get emergency care?

Dead on time!

Well I'm served by DFB so we're already light years ahead for cardiac survival.

The city in the world with the best "out of hospital, cardiac arrest" survival rate is Seattle. Second best is Dublin. This means if your heart was to stop beating for whatever reason, and you weren't in a hospital, the only city with a better survival rate than Dublin, is Seattle. This is a combination of reduced response times, and all the firefighters being paramedics. It's a huge influence on survival percentages!

Not familiar with UHW but the point of centres of excellence is you have multidisciplinary care teams. If they cant keep all on a 24/7 there then its better to concentrate on Cork so you arent saved of your heart attack but die of your head injury.

Oh how lovely it is to live in the south east and have the choice of whether we want to die from a head injury or a heart attack. Who would want to live in Cork? Where you can have both and happily live.

Chiparus

ED E wrote: »

Well I'm served by DFB so we're already light years ahead for cardiac survival.




Not familiar with UHW but the point of centres of excellence is you have multidisciplinary care teams. If they cant keep all on a 24/7 there then its better to concentrate on Cork so you arent saved of your heart attack but die of your head injury.

There is a difference in the outcomes if you have to wait/ be transferred for catheterisation as opposed to getting it immediately .

O Riain

Has he managed to get another review carried out or am I getting lost in the timeline of events?


Link: http://www.irishexaminer.com/ireland/second-review-of-hospital-services-in-waterford-to-appease-john-halligan-420166.html

evani1976

If PCI cannot be provided within 120 minutes of first patient contact, the patient should be assessed for thrombolysis as soon as possible

Above statement from report means between 5.00pm on a Friday and 9.00 am Monday, people in SE have no access to PCI Intervention during this period.

So if you go in a with a cardiac arrest at during above period, you are given a clot busting drug and will hopefully stabilize and hang on until monday. Also patients who have suffered a major cardiac arrest cannot be transfered easilly.

People in Cork, Galway and Dublin have full 24/7 access. Disgrace.

O Riain

evani1976 wrote: »

If PCI cannot be provided within 120 minutes of first patient contact, the patient should be assessed for thrombolysis as soon as possible

Above statement from report means between 5.00pm on a Friday and 9.00 am Monday, people in SE have no access to PCI Intervention during this period.

So if you go in a with a cardiac arrest at during above period, you are given a clot busting drug and will hopefully stabilize and hang on until monday. Also patients who have suffered a major cardiac arrest cannot be transfered easilly.

People in Cork, Galway and Dublin have full 24/7 access. Disgrace.

And Limerick

O Riain

Could anyone document a patients journey after having a heart attack out of hours in the South East?

I know it would be difficult as somebody would have to give their consent but surely if this was videoed, giving an account of just how long they have to wait while in that life threatening situation then it might give people an idea why this is such an important issue.

At the moment I haven't heard anything being put in the difficult situation. Also has anyone gone on the Kilkenny, Tipperary, Wexford or Carlow boards?

JMT2016

Dr. Herity was interviewed this morning by Cathal MacCoille on Radio 1.

Was disappointed by it. Cathal was using the wrong figures in the report - he should have been using the table on page 20 and this wasted valuable time to discuss the key issues.

Cathal did mention the catchment area but didn't probe Dr. Herity's answer.

No mention of why 74% of the population of Kilkenny is left out of Dr. Herity's catchment area for example.

Also no questioning of the downgrade of the emergency care suggested by Dr. Herity - surely this controversial finding merited at least one question?

To end on a positive note, he did put it to Dr. Herity to explain how the people of South Wexford who would be well over 2 hours from the treatment would be treated? This was the only time Dr. Herity struggled throughout the interview and his answer was left wanting especially his need to point out that there were some other parts of the country in a similar situation.

Of course he didn't highlight that these areas were sparsely populated and not a regional hub of several hundred thousand people.

The interview did get across that this is a regional issue which has been somewhat missed with several people and media outlets taking advantage of the opportunity to have potshots at John Halligan at the expense of the serious healthcare issues at play.

JMT2016

You can listen to a podcast of the interview here under the rather misleading headline "Substantial expansion of cardiac services was recommended - Herity" - funny how the reduction in emergency care never even made the interview - nevermind the headline!

http://www.rte.ie/radio1/morning-ireland/

JMT2016

There's an important post on the politics cafe which reminds us of one of the main hazards of the "ship em all to cork" approach being foisted on us and why this report is significantly flawed

http://www.boards.ie/vbulletin/showthread.php?t=2057641960&page=8

Faugheen wrote: »

I'm with Halligan on this one. I'm not from Waterford nor am I an IA supporter by any means, but I'm in the catchment area for UHW.

Last winter, Dungarvan was like an island. Imagine someone in my family needed cardiac treatment out of hours at that time? The ambulance wouldn't have had a chance of getting through Dungarvan (the main road to Cork) and
Now imagine 10/20 other families were in the same boat around the same time? Imagine someone died on the transfer to CUH? Is that what it's going to take for people to realise UHW needs 24/7 cardiac services? If it prevents the above scenario then it serves it's purpose.

People who aren't from this area calling Halligan this, that and everything else need not to comment on something they know nothing about. This is a far bigger issue for people than just John Halligan and people living in Waterford. Three other counties need to be considered here too. He's just the first person trying to get something done about it.

He went into Government on the assumption this would happen. If FG go back on it, why should he stay around? He doesn't go into government if this isn't promised so why should he stick around if it's recommended to be reduced?

Of course Faugheen might think he/she is in the catchment area but according to Dr. Herity's opinion on catchment areas (s)he's probably in that other half of the region that has vanished for the purposes of the report.

Annabella1

JMT2016 wrote: »

Because that makes good sense!

Interestingly the report page 20 only allows 53% of South Tipp population to Waterford catchment- surely cork aren't using that other 47% to boost their numbers as well!

Patients from South Tipp General Hospital go to CUH via motorway

JMT2016

Annabella1 wrote: »

Patients from South Tipp General Hospital go to CUH via motorway

Page 19 has a diagram which says the opposite:
"Figure 3.4 Established referral patterns for cath lab procedures into UHW with external referrals predominantly coming from Wexford General and South Tipperary General Hospitals (arrows)"

Now that might be in the pipeline, divide the region and let the emergency cases of Waterford, Wexford and South Kilkenny be left stuck with this

evani1976

JMT2016 wrote: »

Dr. Herity was interviewed this morning by Cathal MacCoille on Radio 1.

Was disappointed by it. Cathal was using the wrong figures in the report - he should have been using the table on page 20 and this wasted valuable time to discuss the key issues.

Cathal did mention the catchment area but didn't probe Dr. Herity's answer.

No mention of why 74% of the population of Kilkenny is left out of Dr. Herity's catchment area for example.

Also no questioning of the downgrade of the emergency care suggested by Dr. Herity - surely this controversial finding merited at least one question?

To end on a positive note, he did put it to Dr. Herity to explain how the people of South Wexford who would be well over 2 hours from the treatment would be treated? This was the only time Dr. Herity struggled throughout the interview and his answer was left wanting especially his need to point out that there were some other parts of the country in a similar situation.

Of course he didn't highlight that these areas were sparsely populated and not a regional hub of several hundred thousand people.

The interview did get across that this is a regional issue which has been somewhat missed with several people and media outlets taking advantage of the opportunity to have potshots at John Halligan at the expense of the serious healthcare issues at play.

Its depressing what people are throwing at Halligan, he seems to have genuine integrity. Agree 100% about South Wexford, if there was only 1 person outside 2 hour intervention period that should still be a reason for 24/7 care. Everyone in Ireland should have access to same level of care.

JMT2016

evani1976 wrote: »

Its depressing what people are throwing at Halligan, he seems to have genuine integrity. Agree 100% about South Wexford, if there was only 1 person outside 2 hour intervention period that should still be a reason for 24/7 care. Everyone in Ireland should have access to same level of care.

Yes, it is a perfect mess - there are no winners here -

1 Halligan - (and by extension all independents) taking a beating,
2 People in the south east - still with precarious emergency healthcare,
3 Dr. Herity - whose reputation for statistical analysis hasn't been done any favours - only 26% of the population of Kilkenny is included in the core catchment area, I mean really, how patently wrong is that?
4 Fine Gael - committed to standing by what is a now discredited report.

JMT2016

Actually I'm wrong - there is one winner out of all this - it is the cardiology team in the hospital.

They are actually AMAZING and the fact that they can DELIVER such a wonderful caseload with only 24% opening hours compared to the other 24/7 cardiology units is truly a miracle.

The fact that this has been brought to national attention via the report is actually a success story we shouldn't forget about!

evani1976

JMT2016 wrote: »

Actually I'm wrong - there is one winner out of all this - it is the cardiology team in the hospital.

They are actually AMAZING and the fact that they can DELIVER such a wonderful caseload with only 24% opening hours compared to the other 24/7 cardiology units is truly a miracle.

The fact that this has been brought to national attention via the report is actually a success story we shouldn't forget about!

Why does minister not put trust in UHW cardiology team?

Dr Owens has stated in clear terms the need for 24/7 care in UHW in radio interview previously posted. Whats in it for him but genuine concern?

Would 24/7 care not also create a more pro active enviroment with increased screening , early diagnosis and possibly save money long term.

Wanderer78

evani1976 wrote: »

Would 24/7 care not also create a more pro active enviroment with increased screening , early diagnosis and possibly save money long term.

unfortunately, our 'health care system' is largely based on short term thinking and planning

O Riain

It's actually laughable when the HSE's own website describes UHW as follows:

University Hospital Waterford provides general medical, surgical and maternity care to people living in South Kilkenny, Waterford City and County. The hospital provides specialty services to the population of the south east c. 500 000 in the following areas of clinical practice:
Cardiology (including Interventional Cardiac Procedures), Trauma Orthopaedics, Opthalmology, Neurology, Nephrology, Rheumatology, Urology, Vascular Surgery, ENT and Neonatology, Radiology, Pathology and Microbiology.

So it seems like the population is 500,000 in everything but this report.

O Riain

Here's the link if people want it:

http://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/waterford/Waterford.html

O Riain

I think the tide is starting to turn on the the news stories regarding the report. Here's the Irish time discussing the increase in wait lists since we became administrated by cork:

http://www.irishtimes.com/news/health/waterford-hospital-waiting-lists-rise-161-since-2013-1.2786162?mode=sample&amp;auth-failed=1&amp;pw-origin=http://www.irishtimes.com/news/health/waterford-hospital-waiting-lists-rise-161-since-2013-1.2786162

Fairly shocking figure

fits

I am in south carlow. My father who is now deceased had ongoing cardiac issues and was usually cared for in kilkenny or dublin. Father in law living in carlow also has heart problems and again is in kiljenny and sometimes referred to st james' in dublin.

For other services eg maternity, people here seem to go to kilkenny, waterford and sometimes wexford. Waterford is about 50 minutes away. Dublin is about 105 minutes.

JMT2016

The hospital is being discussed on the Marion Finucane programme with Harry mcGee on Radio 1 at the moment - it was acknowledged as ludicrous that the service runs from 9-5 and they also highlighted that this is a regional issue - specifically noting that the consultants in Waterford were saying that large parts of Tipperary/Kilkenny/West Waterford were left out of the catchment area.

JMT2016

Paraphrasing a comment from a listener to the programme:
"I am from South Wexford and had to get a stent in Waterford and I was very happy to have the service there. I don't think John Halligan should resign - why do the media always go for the jugular".

This again reinforces that this is a regional issue - I agree with O'Riain - the tide is starting to turn here now that people are actually seeing the reality of the situation and not the spin.

FA Hayek

The people I talk to know that this issue is nothing more the parish pump localism. How much money are we talking here to provide this service, per year?

O Riain

FA Hayek wrote: »

The people I talk to know that this issue is nothing more the parish pump localism. How much money are we talking here to provide this service, per year?

When you say Parish Pump localism, can you tell me how big an issue it has to be to not be localism? Because this involves over 10% of the population.

I suppose the bailout was localism as well?

Sleeper12

I believe the correct political term is "yis got shafted"

JMT2016

FA Hayek wrote: »

The people I talk to know that this issue is nothing more the parish pump localism. How much money are we talking here to provide this service, per year?

Here is my reply to your post:

http://www.boards.ie/vbulletin/showthread.php?p=101001397#post101001397

Max Powers

O Riain wrote: »

I think the tide is starting to turn on the the news stories regarding the report. Here's the Irish time discussing the increase in wait lists since we became administrated by cork:

http://www.irishtimes.com/news/health/waterford-hospital-waiting-lists-rise-161-since-2013-1.2786162?mode=sample&auth-failed=1&pw-origin=http%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fhealth%2Fwaterford-hospital-waiting-lists-rise-161-since-2013-1.2786162

Fairly shocking figure

Couldn't agree more, shocking.Got the times and will be posting article to minister et al asking how can they morally stand over this hospital group.

FA Hayek

JMT2016 wrote: »

Here is my reply to your post:

http://www.boards.ie/vbulletin/showthread.php?p=101001397#post101001397

Your reply did not include any figure to how much this will cost. Are people seriously asking for a service and they do not know how much this service will cost per year to provide. Shoddy stuff!