How would you sort out Hospital A&E Crisis - Long waiting times- trolleys in corridor's etc

Andy From Sligo

Does 'after Hours' do 'serious' or is it just for fun? - should I have posted this in another category like 'Health' ? - oh well never mind I will post it here anyways.

You are given a magic wand and made yourself boss of your local HSE General Hospital A&E department and you have been given tasks to get waiting times down , reduce the number of trolleys in the corridors (maybe even eliminate them from the corridors totally) and just get the department running efficiently with the same amount of staff - how are you going to do it? - or how would you achieve it?

You are also tasked with sorting out abusive patients (like drunks etc) what are you going to do with them? (they are being a nuisance to the staff and to other patients in the waiting room) are you going to treat them or are you going to chuck them out of the department.

You are going to have to organise patients as part of your efficiency situation. Are you going to see to patients in the order they come into the department or are you going to prioritise older and vulnerable patients over other patients and get them out of the department first and home (or find them a bed on the ward if possible) - or are you going to treat them on the basis of severity of what they have come into the department for?

You have some patients that are in the department. You have already assessed them (triage etc , checked their blood pressure and bloods and their affliction / wound whatever) and you deem that they really do not need to be in the department and that their own local GP can see to their needs. are you going to treat them or send them home?

You have ambulances building up outside your department with patients in the back of them - are you going to offload / free up the ambulances first over everone else thats waiting or just treat everyone in order of when they come in or severity?

Wanderer78

virtually unresolvable, extremely deep and highly complex systemic issues, may never be resolved, but thats not to say we shouldnt try, wouldnt like to be responsible for doing so either....

Apiarist

I would wave my magic wand around and build more local hospitals, staffed with magically trained nurses and doctors. I would leave the minutia of actually running these hospitals to (magically) trained admin professionals, of which I am not.

Leg End Reject

Dispatch all annoying and drunk people to the mortuary ASAP.

There's no magic wand, more frontline staff, consultants working on weekends, more medical professionals and homecare workers in the community to allow patients home earlier, more care homes for patients who can't live independently but don't need acute medical care and a drunk tank built away from A & E. More primary care facilities and GPs would help too, many people are presenting at A & E because it can be impossible to get an appointment in time with a GP.

Wanderer78

https://www.boards.ie/discussion/comment/121588243#Comment_121588243

...maybe we actually have a serious addiction and mental health crisis!

I.R.Y.E.D

https://www.boards.ie/discussion/comment/121588328#Comment_121588328

We do, but in both cases unless the person wants and is ready to accept any help offered to them they are wasting time and resources.

banie01

https://www.boards.ie/discussion/comment/121588243#Comment_121588243

+1 on this, a move to a 7 day working model for OPDs + electives as part and parcel of a shift to a full 24/7/365 work roster.

The best way to ensure best use of resources is to ensure that clinical decision makers are part of that system and not splitting their time and hospital resources between public & private patients.

It is improving, particularly with MAU & SAU adjacent to A+Es but the same model needs to be extended to all wards.

Wanderer78

https://www.boards.ie/discussion/comment/121588353#Comment_121588353

not how addictions and mental issues work unfortunately, this approach would more than likely keep escalating issues, increasing likelihood of criminal outcomes etc, as early intervention as possible is key, in order to try prevent even bigger problems down the road, sit and wait, and best of luck with trying to resolving those issue's...

standardg60

https://www.breakingnews.ie/ireland/hospitals-dealing-with-overcrowding-should-copy-waterford-hospital-says-hiqa-1565463.html

No need for a magic wand, just put whoever runs Waterford in charge of the HSE, there's been minimal numbers on trolleys for years now.

Tom Mann Centuria

Sort out social care, reopen community hospitals.

Wanderer78

https://www.boards.ie/discussion/comment/121588401#Comment_121588401

hahaha, me bollcoks, tis terrible out there at times, jesus we re really getting to the bottom of the barrel with this, the least worst hospital, hahaha, holy fcuk!

standardg60

https://www.boards.ie/discussion/comment/121588411#Comment_121588411

Great contribution there, it's not the 'least worst', there's very rarely anyone waiting, it's perfectly run, seemingly by someone who doesn't take any sh1t from anyone.

HildaOgdenx

Mod - Moved to CA.

Local charter now applies.

SuperBowserWorld

...

Wanderer78

https://www.boards.ie/discussion/comment/121588432#Comment_121588432

not really, talk to many that pass through there, and especially those working there, yes its not too bad at times, but at other times its not great, it maybe preforming well compared to the rest of the country, but be under no illusion, its under severe pressure, just like the rest of the country, with all the same issues...

...what are you talking about not taking sh1t, what the hell are you talking about?

Until people start making better decision’s for their own health & government make policy that help to achieve clean water, air & healthy food there’s no solving it.

But a big one for me would be getting rid of unlimited medical card access to everything.

If people aren’t afraid of being hit in the pocket regarding their health, they’ll continue to do nothing about it.

Big Bag of Chips

https://www.boards.ie/discussion/comment/121588401#Comment_121588401

But, at what cost? Elective surgeries are regularly cancelled due to bed capacity. So yes, there are no patients on trollies in ED, they are in beds on wards. But there are thousands of patients sitting at home not being treated because there are no available beds for them.

A patient on a trolley in ED is being treated. A patient sitting on their couch waiting to be called for surgery isn't.

The health system in general is overloaded. If one area is working well, it's because resources are being taken from another area. ED is working well because elective admissions are being cancelled.

standardg60

https://www.boards.ie/discussion/comment/121588452#Comment_121588452

Seems that even when presented with facts some will still run it down to push their agenda that the country is in sh1te.

You've talked to 'many' to form your opinion?

Yeah right.

AndrewJRenko

While we're at it, getting people's opinions on stuff they know nothing about, can we get the views of Boards posters on techniques for Transsphenoidal Surgery please.

I.R.Y.E.D

https://www.boards.ie/discussion/comment/121588388#Comment_121588388

Bring any addict or alcoholic into treatment when they don't want the treatment because they do not think they have a problem and they will be back where they were after the treatment is completed, which is a waste of time and resources.

70% of individuals who actually want the treatment will have a relapse.

Same as people with mental health issues who believe that they are fine and don't have a mental health issue. They can be admitted into places like the Pine ward in Blanch for a couple of weeks on medication, come out and go to community treatment sessions for a few weeks maintaining that they have no issues. Unless they have family who are willing to take them back they aren't going to continue to take their prescribed medication.

standardg60

https://www.boards.ie/discussion/comment/121588495#Comment_121588495

Are you suggesting that Waterford ED is robbing Peter to pay Paul to make themselves look good?

I would have no truck with that, people are welcome to believe that the entire issue with the health service here is a matter of lack of 'resources' ie. money, yet it has been shown over and over again that no matter how much is invested the issue continues. Lack of efficiency is the real problem, and that essentially resolves around personnel, in all aspects of it's running.

I think it's interesting that Waterford has filled it's vacancies and has a good working relationship between staff and consultants, with special mention for 'strong leadership'. It sounds like it's a good place to work for all involved. If you build it, they will come.

Big Bag of Chips

It sounds like it's a good place to work for all involved.

I work there. I enjoy my job. I have a good relationship with my colleagues. But yes, admissions for surgery are being cancelled, daily, due to bed capacity issues. Today 2 of my consultants were discussing whether they'd even bother listing anybody for the month of January as they know these people will be given a date, will make arrangements to prepare themselves for theatre, make arrangements for post-op recovery times, arrange time off work, organise family etc, will attend clinic for a pre-op appointment and on the morning of their surgery they will get a call telling them not to come in as their surgery is cancelled because no bed is available.

But there's nobody on a trolley in ED.

Also people on chairs in ED aren't counted as being on a trolley, because they're not on a trolley. My 76 year old father sat for 8 hours on a chair (in the ED area, not the waiting area) recently waiting to be given blood results. Results that I know were available 6 hours earlier. My mother asked a number of times for the results only to be told they'd have to wait until the doctor was available to see him. They eventually left at 2am so he could go home to sleep - without being given the blood results.

standardg60

https://www.boards.ie/discussion/comment/121588930#Comment_121588930

Not sure what point you're trying to make, should he have been on a trolley and was put on a chair to deliberately make the numbers less?

He went home so i gather he was fine to do so, was it a disgrace to have him sit in a chair waiting for blood results while the staff probably had more important things to attend to?

csirl

Performamce manage the hospitals, tender for services and pay per patient/,treatment ala health insurance companies.

Stop throwing obscene amounts of money at religious groups for "running" hospitals

Feets

I would add one idea. The shortfall in the health budget is largely due to sick leave. If there isnt enough at work, there will always be delays. Tackle sick leave vs faux sick leave.

Big Bag of Chips

I'm making the point that maybe everything isn't as fabulous as the PR spin would have you believe.

My father was holding up a space in the ED dept for 8 hours which meant another person was sitting in the waiting area for 8 hours waiting for the space to open up. Yes, he was ok to go home. But he could have been sent home at 6pm rather than 2am.

You mentioned earlier that they should put whoever is in charge in Waterford running the HSE. I'd ask, what have the management in UHW figured out that no other management team in any other hospital in Ireland has thought of? There's a finite number of physical beds. There's an increased population. There's more demand for the finite number of beds. If people are not on trolleys in ED they are in beds in the hospital. If they are in beds then those beds are not available to other people for elective admission and therefore those other people have their admissions cancelled.

I'll repeat, the health service in general is overloaded. Like it is in very many other countries around the world. If something is working well in one area, it's because something else is being sacrificed.

Andy From Sligo

https://www.boards.ie/discussion/comment/121588930#Comment_121588930

June last year my local GP sent me into (well strongly urged me to) A&E (sligo) I got in there before 5pm I got out 11am the next day - to me now I was feeling that all my bloods and x-ray (well which was at 8am in the morning) was waiting for when a consultant was available to give me results/medication - I felt they 'strung out' the tests throughout the night because what was the point in getting me out/home quickly because a consultant wouldnt be available until the next morning anyway ... well thats how I feel, maybe I am just beeing paranoid.

Funny about people going on about it seems a 9-5 job instead of a 24hr operation because overninght in ED things were going very slow, with a few nurses walking up and down the corridors and just popping their head in the waiting room to see how many people were left , but as soon as morning came around 8am things , a lot of things, seemed to kick in - new rota's of nurses more urgency, more nurses walking up and down and around and a plethora of suits (Doctors/consultants)!

standardg60

https://www.boards.ie/discussion/comment/121589163#Comment_121589163

No you were implying that because your father was on a chair he wasn't 'officially' being classed as waiting on a trolley. He wasn't on a trolley because he didn't need to be, and he wasn't holding anyone up because he was on a chair, unless there was a shortage of chairs?

It's not a question of thinking of something new, it's just having the wherewithall, brains, skill and leadership to run a department efficiently, that is what's lacking in the other hospitals.

You work there, did you work there before and see a change or work elsewhere and see a change in the work practices?

stringed theory

As something regularly discussed on media, something that strikes me is the lack of international comparison, especially with well funded EU countries, Australia, or anywhere with comparable social provisions.

It seems to me, for example, there is a great absence of specialist doctors in Ireland, in comparison with most of Europe. There are general hospitals here without even a paediatrician, or opthalmologist (etc. etc.) on staff, and, I suspect that what specialists that are available go home at night. So patients who could be instantly discharged are kept waiting around until the specialist arrives. I have seen this myself.

Then there are experienced nurses who can't just examine minor cases and send them home without chasing down an often very junior doctor to sign them off. How many nurses in Ireland who can prescribe?

Then there are GP surgeries which could do more, including simple radiology in some cases (which I've seen in Australia, but unheard of in Ireland AFAIK).

Just saying, in other sectors people actively look for best practice around the world.

RobbieV

Privatisation.

Efficiency and productivity matters

Big Bag of Chips

https://www.boards.ie/discussion/comment/121589292#Comment_121589292

I originally posted to you regarding elective procedures being cancelled and admissions from ED being prioritised over theatre lists. You said you didn't believe that. So I told you again, adding some extra detail to let you know that I know what I'm talking about. I'm a "frontline worker" dealing with upset and angry patients whose procedures (day case and overnight admissions) are cancelled multiple times. There used to be a dedicated "day ward" that was always kept available for day case admissions. This ward has now become mostly a general ward with a big reduction in the number of beds available for day case admissions.

I then added an anecdote about my father being in the ED treatment area. On a chair. Not a trolley. Yes, there are a certain number of chairs in the ED area. He was in ED. In the treatment area. In a treatment cubicle. On a chair for over 8 hours just waiting on blood results. He had bloods done and cardiac workup pretty much immediately on presentation to ED (cardiac history). He was very well looked after. These are my colleagues. I am proud of the work we all do with the resources available. But he then waited for 8 hours for someone to look at his bloods and tell him he was ok to go home. He could have been discharged 6 hours earlier and freed up that treatment cubicle for someone else sitting in the waiting area.

You work there, did you work there before and see a change or work elsewhere and see a change in the work practices?

Yes, I see a lot more elective admissions being cancelled than previously.

I work in the hospital. I am very proud of the work I do, and I am very proud of the service provided across the whole hospital. But it is not without it's faults. People tend to come up with very simplistic solutions to very complex problems. Waterford have "solved" the issue of patients on trollies in ED. That's true. But as I said - at what cost?

Cluedo Monopoly

More beds and more frontline staff. Pay them more.

FFG have let the capacity and staff levels fester so long that many of our best healthcare workers have left.

I have MS, symptoms got abruptly worse, MS society advises contacting nurse team. This is the response…

*GP is not in a position of expertise to handle sudden immobility that confines you mostly to bed

* A&E put you in a chair 15 hours plus and tell you to go back to GP and contact MS nurse team

Rinse and repeat.

We are waaaaaay under-resourced in ALL areas of health service.

Andy From Sligo

@Big Bag of Chips - I like your posts here and it makes sense , but your very brave arent you discussing things to do with your place of work on a public discussion group - just wouldnt like you to loose your job or anything over it, or are they cool with things being discussed like that out of work and inside issues shared?

cosanostra

The A&E system is completely abused, there needs to be a societal change in how people view it, that includes GP's who are very trigger happy when it comes to referring people to A&E, like people with minor injuries that could be treated in the surgery or medical complaints that can be done through the gp referral system or indeed diagnosed and treated by themselves. A&E's across the country are full of people who don't need to be there, it should be treated as a place to go as a last resort when every other option has been exhausted. People are now actually phoning 999 as presenting to A&E via ambulance gets you seen quicker that's the kind of attitude that needs to be sorted. So basically a societal change of view to what A&E is and GP's Rolling their sleaves up it might be an idea to remove blood tests and vaccine's from the Gp's and have standalone clinics for that sort of stuff

Sheep breeder

A couple of things about hospitals, firstly the security are not fit for purpose to handle trouble and are mostly older and unfit and spend most of the time on their phones, secondly to try ring a section in a hospital is crazy nobody answering phones and all on voice mail, today at 11 o’clock rang crumlin for a secretary who’s voicemail played out of the office till the 4th of January and ring back next week when she would be back in the office. Letter from another hospital with the number for outpatient department on it, is in a office for storage where nobody works in, too many getting away with swinging the lead, consultants get away with murder and in 6 visits over two years to Vincent’s hospital have never seen the consultant only his junior and still on a waiting list for surgery because won’t go private where the consultant will see you straight away. It’s a three tier system of medical card, private or the working queue.

Andy From Sligo

https://www.boards.ie/discussion/comment/121589967#Comment_121589967

yeah , your post resonates a lot .

Just before christmas I was told to phone a number "You need appointments you can phone them on xxxxxx" - I phoned and got a message "this number is not available, please dial again carefully" - so I phone back original person and said "Can I just check that number you give me again please because it says this number is not available please hang up and dial again "Oh she says you get that message when they are on another call !!"

An awful lot of money might get wasted on admin, over the years I have got 2 duplicate letters in the post for the same appointment and thats happened a few times.

and yes I have heard that before where people have been on medical card and only seeing the consultants junior/associate and not the consultant themselves and then going private and actually seeing the consultant then... and fast

Geuze

https://www.boards.ie/discussion/comment/121589748#Comment_121589748

HSE headcount has risen and risen.

https://www.hse.ie/eng/staff/resources/our-workforce/workforce-reporting/

In four years, the HSE headcount has grown by 25,000.

We are pouring money into healthcare.

ottolwinner

(Maybe off topic slightly)

I often think if someone wrote a computer game of the current health system like those where you build your castle and grow your crops and build a city. Would. Any players be able to produce a model that would be efficient and see a fall in waiting times.

kind of like a flight simulator programme.

JP Liz V1

We need more staff working in healthcare, perhaps cut the big salaries and pensions of government ministers and HSE top brass and put into getting more on the ground healthcare staff

GPs and Southdoc (out of hours service) have to start seeing more patients instead of sending to A&E with minor issues

A competent government minister holding the portfolio of health also is needed

Big Bag of Chips

https://www.boards.ie/discussion/comment/121589947#Comment_121589947

Thanks for your concern Andy, but I'm anonymous here. I'm also not giving away any state secrets. The hospital is run as well as it can be in the current situation. There is a national bed crisis. UHW isn't unique in that regard. They are doing somethings very well. But there are challenges in every area.

They have improved ED through various means. The staff do excellent work with the tools given to them. Every year there would have been an element of cancellations and bed capacity around flu season etc. COVID has also contributed to this. I'm not saying my explanations are the only reasons ED in UHW is working, as per that article other processes have also been put in place. But the fact is there is a national bed crisis. UHW isn't exempt from that. And patients are having surgeries cancelled. The consultants are frustrated, but not much they can do. An ED admission is generally given priority ahead of an elective admission.

Big Bag of Chips

today at 11 o’clock rang crumlin for a secretary who’s voicemail played out of the office till the 4th of January and ring back next week when she would be back in the office.

She may be out sick! Secretaries tend not to get cover when they are on leave. She may have had some leave to take over Christmas, and has been sick since. There's a lot of illness around at the moment.

Tom Mann Centuria

The knock on effect of bigger hospitals like UHW being full, is patients waiting for transfer in smaller hospitals wait longer.

Nothing much UHW or Vincents or wherever can do, but it means beds are blocked in the smaller hospitals, sometimes for over a week, waiting for more specialist care and the best management in the world in the smaller hosptial can't shift those patients, adding to ED backlogs and patients sleeping on corridors.

Geuze

https://www.boards.ie/discussion/comment/121590186#Comment_121590186

The HSE have grown by 25,000 staff over four years 2019 to 2023, that seems like plenty to me.

Cutting the pensions of 15 people is a drop in the ocean compared to the 20bn+ spent on the HSE.

https://www.boards.ie/discussion/comment/121590452#Comment_121590452

Has the population of Ireland grown in the last few years? do we have an ageing population?

A massive increase in CTs and diagnostic equipment in all hospitals, every A&E to have an urgent care center and an enhanced GP type of service in the A&E much more enhanced and more targeted tirage led by a nurse practitioner with the right to admit patients or discharge to a nursing home or initiate a home care plan, treatment at home with a specialist team that go to the person's home, or falling that treatment from a nursing home with a specialist team consultants leads but the consultants will use online zoom type consultation once the person is home or in the nursing home.

Better GPs, better community service, and procedure-only hospitals.

Sheep breeder

https://www.boards.ie/discussion/comment/121590358#Comment_121590358

The message is for the 4th yesterday was the 8th, rang the other secretary who was also out of the office till the 8th and this is the norm.previously we had a letter for a X-ray appointment and when we arrived at the department were told no X-ray was booked and had the letter given at reception and would have to go home, had to go look for the surgeon to get the X-ray sorted, before Christmas went up for appointment as per surgeon on previous visit and the letter came two days after attending the clinic, Crumlin do not do emails for appointments, anybody dealing with admin will tell you it’s a disaster they are stealing a living on the backs of sick people.

csirl

The restrictions on the number of people who can study medicine in the first place and the limits on the number of consultants - so as to ensure that existing consultants are always in demand and can charge large fees cannot be underestimated.

Why are people waiting 14hrs in A&E? To see a doctor/consultant often only for a few minutes.

Why are people waiting months/years for an appointment with a consultant?

We"ve a dire shortage of GPs, but 1,000s of dissappointed school leavers who dont get into medical courses.

I have a fear that the only impact of the new childrens hospital will be a more comfortable environment for people to wait rather than shorter waiting times.

The throughput of the health system i.e. rate at which people get treatment is entirely dependent on the number of doctors/consultants. Increase the numbers being trained/hired and waiting times will drop.

My anecdotal story. I once had to bring a family member to A&E in downtown New York while on holidays. The hospital didnt have a large waiting room ala Irish hospitals. Was seen to immediately by a consultant who had New Scientist articles about his discoveries framed on his walls. Paid in cash - the cost was less than my local GP costs per visit. When I remarked to the secretary that the cost was very cheap, less than a GP in Ireland, she actually took offence saying that there's no way a doctor in Ireland is charging more than an world renowned consultant in Manhatten!

Diagnostic only centers as well, they would do bloods, CTs, Xrays and the results sent to the consultants. They would in every large town. A few of the larger ones would have a Pet scaner as well.

No need for outpatient appointments for xray ect to be in a hospital. There needs to be a major mover to the community for all sorts of medical related issues and a massive investment in what's known as tellyhealth.

Sheep breeder

https://www.boards.ie/discussion/comment/121590819#Comment_121590819

Just an example of what your thinking about, our daughter had an MRI done in cherrywood outside of hospital to speed things up and was sent back to Crumlin with urgent attention required asap marked due to a problem showing up and 3 months later at the appointment this was only looked at on the day for the first time and then panic station as this should have been done straight away and would have saved the child 3 months of pain and black outs, surgeon response this should have been highlighted straight away and someone f…. Up. Just look at the temple street surgeon who was doing his own thing the way it is brushed under the counter and move on. Nobody is accountable in the HSE.

Chris_5339762

Everyone is saying to move to a 24/7/365 roster, but don't forget the current staff will just simply not accept that. It is in peoples contracts, yet, for everyone younger than about 40, but that just won't happen.

Even if everyone said ok, you'd need need about 30% more staff across all disciplines to actually do it. Maybe more.