The current hospital / A&E crisis

mondeoman72

https://www.boards.ie/discussion/comment/120074147#Comment_120074147

Yesterday at 4pm, I walked into my GP after being unable to get them on the phone. Chest pains. They were closing but saw me anyway and wanted to ambulance me to Tallaght with a doctors letter. Got a car to transport me.

I was in about 4.30pm. Examined, checked, ECG'd, blood tested, x-rayed and out the door by 9.30pm

I was listening to people complaining they were there all day. Triage works.

I do believe the issue is people appearing in A&E without genuine reason, but with the GP's overwhelmed, they may not have a choice. Community healthcare needs a boost and then, maybe a sanction for people turning up at A&E.

Gusser09

The HSE and Dept. Of Education are an absolute disgrace for the memos they are sending to parents.

Child has cough - stay at home

Child has a runny nose - stay at home

I think it's hocking at this stage. That's just a normal part of being a child. Fair enough if they are actually unwell. But keeping them off for no reason? Crazy stuff.

mumo3

https://www.boards.ie/discussion/comment/120074343#Comment_120074343

Child misses 20 days - Call TUSLA

thomas 123

https://www.boards.ie/discussion/comment/120074334#Comment_120074334

I do believe the issue is people appearing in A&E without genuine reason, but with the GP's overwhelmed, they may not have a choice. Community healthcare needs a boost and then, maybe a sanction for people turning up at A&E.

1. Its not, nobody goes to A&E for **** and giggles.
2. People are already sanctioned 100 euro for turning up on top of their PRSI.

cython

https://www.boards.ie/discussion/comment/120074334#Comment_120074334

I do believe the issue is people appearing in A&E without genuine reason

That may be an issue/part of the overall issue, and definitely isn't apt to be helping matters in EDs around the country. However, as several people have pointed out, there are still hundreds of people who have been triaged and are awaiting a bed who do not fall into this category, and this is its own problem and burden.

For what it's worth, my own mother was admitted from James's ED Christmas week for emergency surgery having presented with abdominal pains, and while conditions in hospitals were not as bad then as they seem to be now they still weren't optimal by any means, and she was post-op in a bed in ICU approx 12 hours after the onset of symptoms. That was entirely a function of the severity of her condition (ischaemic bowel), of course, and plenty of patients had to wait longer than her. Indeed she recalls overhearing a comment prior to the surgery that there wasn't a bed at the time for her to go to post-op, but the surgery couldn't wait, so one was evidently found while she was under GA. Had she presented with something less severe, I imagine she'd likely have been in ED overnight given the timing of when things really kicked off.

Suffice to say the medical staff could not be faulted in this instance, though I would say some of the clerical staff left a bit to be desired, with attention to detail/listening not being a forte.

cython

https://www.boards.ie/discussion/comment/120074440#Comment_120074440

There are some exceptions to the 100 euro fee, medical card holders being prominent among them, and (rightfully so, IMO) patients admitted to the hospital as a result of presenting to A&E.

mondeoman72

The people who dealt with me yesterday were superb. I could not fault any of them - not one. They do need more capacity for onward referral, but there is an issue with people turning up where they could be assessed or treated elsewhere.

Deeec

https://www.boards.ie/discussion/comment/120074477#Comment_120074477

Thats the issue - for some areas of the country you cannot get to see a GP if you are seriously ill. So if you are very ill and cant see a GP what choice do you have.

I think a starting point would be to discourage people clogging up GP appointments with minor issues. I think this is a big problem. The message currently should be only visit your GP if it is urgent.

BattleCorp

https://www.boards.ie/discussion/comment/120074334#Comment_120074334

Anything cardiac related and you get looked after very fast.

Similar to you, my doctor sent me to the hospital to get checked out because he didn't like the results of an ECG he carried out on me. Only difference was that I was able to drive myself to hospital, I didn't need an ambulance. I wasn't having a heart attack/cardiac arrest etc.

Drove to hospital and went in to A&E in St. Luke's Kilkenny which was bedlam. It was so full and chaotic that my heart sank (pardon the pun). I knew I was going to be there for hours upon hours. Walked up to the admin window and handed in my letter from the doc. The admin person told me to take a seat and they'd be with me when they were ready. My ar5e had hardly touched the seat before they came and whipped me in for examination.

They couldn't have possibly been any quicker and I was well looked after.

joe40

https://www.boards.ie/discussion/comment/120073960#Comment_120073960

They pay the big fees, that may be a reason.

mondeoman72

https://www.boards.ie/discussion/comment/120074545#Comment_120074545

Absolutely, but they did not want me to drive myself. I called the wife to drive me. That caused another issue, had to tell her. But all is good. Tallaght hospital last night were great.

BattleCorp

https://www.boards.ie/discussion/comment/120074568#Comment_120074568

My missus got a bit panicky too until she remembered that I've a good life assurance policy. 😁

A major public education campaign needs to be done as to what and what does not need to be seen by a doctor, as typically the course of illness caused by influenza cannot be altered by any medical intervention in an otherwise healthy & fit person, no matter how much they may feel to be “dying”. The warning signs of where things are really in the danger zone needs to be highlighted, as when someone may be developing sepsis. Then there add different kinds of pain the chest, one totally harmless yet quite alarming one is costochondritis which can accompany a viral infection. The telltale here is if you press along a few points of your breastbone and it is acutely painful you can be pretty reassured you just have cartilage pain which can be treated with ibuprofen/paracetamol or ibuprofen gel (which I use for that purpose). It can be genuinely quite confusing.

https://www.boards.ie/discussion/comment/120074545#Comment_120074545

St Luke’s has a good name, a friend of mine works there as a doctor and says there is excellent & friendly management, with staff having a great rapport with each other. Very busy of course.

GreeBo

https://www.boards.ie/discussion/comment/120067927#Comment_120067927

I had the same experience myself just this week in private Blackrock Clinic A&E

All told I spent about 10 hours there, I had a blood test and a CT scan in that time.

Timeline:

1.5 hours after arrival I was called up to register

2 hours later I was called into triage to see nurse and had blood taken

45 mins later Dr arrived and said I needed a scan

2.5 hours later I asked Dr about the scan and was told we were waiting for blood results

10 mins later the bloods were back and a CT was booked

45 mins later I had the CT

2 hours later I was given all clear

so I was in a bed in A&E for 2.5 hours "waiting for bloods" when in reality they had just forgotten about me.

From what I overheard I wasn't the only one in the same situation.

They should just have a nurse taking blood during registration process.

oh and all this was after I went to the Laya clinic where they also took blood but decided to send me to A&E, to be sure to be sure.

GreeBo

https://www.boards.ie/discussion/comment/120074736#Comment_120074736

I would call what you just described triage tbh.

https://www.boards.ie/discussion/comment/120074790#Comment_120074790

There are two forms of triage. The one where a professional initially assesses us, but first cones to the self-triage where we make a judgement of whether we need to see a medical professional in the first place. That can be tricky. The doctor on the radio was pointing out that too many people are triaging themselves as in need to see a doctor for the simple reason that they have never previously felt as sick in their lives before with the worst of these bugs, eg classic influenza where it’s an almighty task to get from bed to bathroom. His message was that public health should be driving home just how unwell you can feel without needing a doctor. Older people have been through plenty of influenzas and other things and tend to be more discriminatory as to what is more genuinely serious in their experience. It doesn’t shift people off trolleys though, just stops the unnecessary pre-triage crowding. A GP, of course, needs to eventually write a medical cert to cover for work, which can be collected when patient is well enough.

airy fairy

Newly qualified doctors should have to remain in the state, working as what they've qualified as, for a minimum of 5 years. Eu and non EU students should be the same.

My son was friendly in school with a child from India. Both parents came to Ireland to study medicine. After a number of years both parents qualified as doctors and upped the family to return to their home in India. How is that allowed, where we provide the best of education and they can then feck off?

I believe by doctors having to stay here,it would definitely rasetheburden of overworked ones already here, and hopefully as a result make it more attractive when there's less pressure.

I do think GPs are somewhat at fault here too. Wait for an appointment here is about 2 weeks, at which time a visit to vhi is necessary, and that can be hit or miss. I do think that they really could extend their hours while we are under pressure on our EDs. They were well able to extend hours when the call the vaccinate was sent out.

None of the above changes the trolley bed crisis once people need a bed, again, we need to revisit the care system for the elderly and those discharged.

Larbre34

Calls to extend Community Healthcare ignores the fact that these facilities need the same GP qualified Doctors that private GP practices need. They just aren't there.

We have to look at enabling more senior nurse practicioners, who can prescribe for minor illnesses and ailments, in people whose underlying health is fine, but just need their tonsillitis or norovirus or back ache seen to.

Juran

Agree with comments regarding increase community & primary care centers which stay open for at least 12 or 14 hrs a day eg. 7am to 9pm. And change the system so that nurses, who are qualified can prescribe certain drugs for common ailments.

Primary care centres should be able to manage urine tests, UTI's, flu, chest infectiion, dehyradtion, treatments, and basic stiche, tetenus shots, etc. These make most of A&E patients. Anyone in a nursing home with UTI, which is very common with eldery men and women, or flu/chest infection are sent to A&E straight away. You'll often see them lined on trollys coming out of ambulances.

Yes, primary care centres would need a lot of staff. But it would be more attractive to doctors and nurses if it wasnt mayhem like current A&E models.

As someone said, we saw so many staff recruited for covid testing and vaccine tole out. Most had no medical qualification, got basic training and did a great job. Primary care centres still need lots of asistants to support nurses and doctors, allowing medical staff to fully focus on diagnosis and treatment.

The government annouched billions extra take from taxes and VAT. Put it to good use. Building infrastructure, invest in medical care, invest in training and retaining skilled staff. We dont need architectural fancy buildings, like a previous poster said about the oval shaped CH being built in Dublin. We need practical and efficient hospitals and primary care centres.

Someone posted the German model, where the german governement takes 7% (something like that, i cant recall) out of your wages. Ireland already has this tax .. its called USC !! As well as paye tax, self employed income taxes, duties and VAT.

The german model works, as well as france, sweden and most other EU countries. The UK NHS and Irish model has money thrown at it every years, but its not working. They need to rethink or redesign the whole healthcare process.

Goldengirl

https://www.boards.ie/discussion/comment/120073960#Comment_120073960

Have to agree this is an issue.

And these places are not available for Irish students who have to achieve massively higher entrance points than the international students as a result . Colleges make money from international students so would need more funding to increase Irish entrants.

However..

International doctors find it harder to get internships and NCHD posts except for the very top group qualifying so that is one reason why more of them leave after qualifying.

And in fairness they or their own country pay for them through the nose to attend and learn here so they don't owe us.

Goldengirl

https://www.boards.ie/discussion/comment/120074334#Comment_120074334

Glad for you.

Not necessarily true.

Mkre people, more to triage, more bloods and ecgs and queues for xrays.

Longer waits for results to return and be reviewed by a doctor..

You were lucky and got in at a good time I think.

I know someone who ended up having energency cardiac intervention who was left ditting sitting in a busy A&E waiting area for 8 hours, even after triage and with chest pain... And it was not even in the last few weeks.

Big Dublin hospital, very very busy.

Goldengirl

Agree that community hubs to relieve pressure on GP and A&E services need to be set up with nurse practitioners leading them, as I and others have said before.

And utilising those people trained to vaccinate and swab would be good.

Just a point.. When minister and HSE are talking about recruiting x amount of staff only a certain amount are actually trained nurses and doctors. Numbers went up in the last couple of years but these people were not all in possession of skills and training that would allow them to work in a hospital setting without further education.

Good news.. Ennis A&E being reopened even if temporarily to relieve UHL. Mallow also for Cork

Now maybe do the same for Nenagh and Bantry to name but two and review the mooted closure of Navan A&E.

For sure major surgical emergencies should go to the bigger hospitals but so many nonemergent medical cases could go to smaller hospitals and be well cared for.

Goldengirl

https://www.boards.ie/discussion/comment/120073389#Comment_120073389

In dayrooms, behind ward doors, someone in a store cupboard.. Safety how are you 😔

Stephen Donnelly busy reading this thread for ideas 😂 and we’ll hear him reflect these on the news next week!

joe40

https://www.boards.ie/discussion/comment/120074736#Comment_120074736

That would ease problems in waiting rooms, but people on trolleys have already been seen and according to the medics they need to be admitted. But there is no ward space.

I accept that some attend A&E uneccesarily but I don't think that is the major factor here.

It is genuinely sick people that should be admitted but there is no space.

odyssey06

https://www.boards.ie/discussion/comment/120075926#Comment_120075926

He could do worse!

Galwayguy35

https://www.boards.ie/discussion/comment/120074440#Comment_120074440

Thats assuming the people showing up are paying the €100

Quite a few of them probably aren't, as someone who has to pay to see a GP and fork out the €100 if I had to go to A&E i wouldn't be going unless i was on my last legs.

howiya

https://www.boards.ie/discussion/comment/120076480#Comment_120076480

It's been a good while since I've been thankfully but as far as I recall if you've been referred to A&E by your GP you don't pay the A&E fee and only pay your GP.

Galwayguy35

https://www.boards.ie/discussion/comment/120076554#Comment_120076554

I'm aware of that but I'd imagine those people would be the ones who need to attend A&E and not the people who just show up because they have a runny nose.

A lot of people arrived here over the last 12 months and they all have free healthcare and they will take full advantage of it and not care if they clog up the system.