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Help me understand the 24/7 Heart Attack care report

  • 08-09-2016 5:10pm
    #1
    Closed Accounts Posts: 215 ✭✭ 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.


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Comments

  • Closed Accounts Posts: 215 ✭✭ 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!


  • Registered Users Posts: 2,223 ✭✭✭ 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.


  • Closed Accounts Posts: 215 ✭✭ 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!


  • Registered Users Posts: 2,223 ✭✭✭ 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


  • Closed Accounts Posts: 824 ✭✭✭ 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.


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  • Closed Accounts Posts: 1,107 O Riain


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


  • Registered Users Posts: 36,084 ✭✭✭✭ 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?


  • Closed Accounts Posts: 824 ✭✭✭ 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.


  • Closed Accounts Posts: 215 ✭✭ 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!


  • Registered Users Posts: 2,223 ✭✭✭ 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.


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  • Registered Users Posts: 3,511 ✭✭✭ 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.


  • Registered Users Posts: 2,223 ✭✭✭ Chiparus


    He who pays the piper calls the tune.


  • Closed Accounts Posts: 215 ✭✭ 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!


  • Registered Users Posts: 2,223 ✭✭✭ 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.


  • Closed Accounts Posts: 215 ✭✭ 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!!


  • Registered Users Posts: 2,223 ✭✭✭ 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.


  • Closed Accounts Posts: 215 ✭✭ 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!


  • Users Awaiting Email Confirmation Posts: 950 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


  • Closed Accounts Posts: 215 ✭✭ JMT2016


    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?


  • Users Awaiting Email Confirmation Posts: 950 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


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  • Registered Users Posts: 578 ✭✭✭ Dunmoreroader


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


  • Registered Users Posts: 36,084 ✭✭✭✭ 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.


  • Closed Accounts Posts: 1,107 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.


  • Registered Users Posts: 2,223 ✭✭✭ 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 .


  • Closed Accounts Posts: 1,107 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


  • Registered Users Posts: 65 ✭✭ 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.


  • Closed Accounts Posts: 1,107 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


  • Closed Accounts Posts: 1,107 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?


  • Closed Accounts Posts: 215 ✭✭ 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.


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  • Closed Accounts Posts: 215 ✭✭ 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/


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