Sepsis deaths in hospitals.

There are about 3,000 deaths per year from sepsis in Ireland, population 5m. In Australia there are 5,000 deaths for a Population of 26.4m, not 15,000 which would be the case if it was a medical hell-hole like Ireland. Ireland is very far away from having a 'best' or remotely adequate hospital environment.

Stop trying to make out that the death rate is anything remotely normal just because the condition is deadly, when the death rate shows that the way the health system operates in this coauntry is appalling, like so many things.

Great unless it's time critical. Which is often the case in A&E

I'm not blaming the staff. I'm saying the process is broken, under resourced etc.

Surely something is seriously wrong if on one hand a doctor works 17 hrs without rest , is unable to take meals and juggles a full emergency Dept plus 2 wards while on the other hand seriously ill people referred to hospital by their GPS and deemed emergencies at triage are not even seen by a doctor for more than 12 hours.
Isn’t it obvious that something is very wrong with the paper trail/ computer system within which they are expected to work.
Something is very wrong when the most important piece of information - sepsis- doesn’t seem to get past the hallway much less onto a computer screen.

You're correct there is something wrong- staffing. No amount of IT streamlining or work process improvements is going to get around the fact we simply do not have enough staff. The result of this systemic failure is that individual clinicians are forced to bear excessive clinical risk and will be hung out to dry when error happens as a result of that inadequate staffing.

Without knowing the specifics from this case, my experience is that consultants are typically on a 1 in 3ish rota, which means they work a full 9-5 followed then by 16h off-site call into the next morning where they they continue their next 9-5 shift. On weekends they will typically be on-call for the entire weekend. During this time the expectation is they come in for an emergency/complex case and that they're available for telephone advice (which is frequent).

In this case the consultant was asked to come in due to the volume of patients in the ED and declined. There was subsequently an avoidable bad outcome. On the surface I think it's easy to blame the consultant but that ignores the systemic issues at play. If the consultant in UHL was expected to come in and work 36h on site every 3 days because the ED consistently has a high volume of patients they would make many more fatigue-induced errors, would be utterly useless in a critical emergency (like team-leading an arrest or major trauma) and quickly would be off on long-term sick or quit due to having no semblance of a life by working such hours. In this case the consultant has borne an unfair degree of clinical risk due to systemic short staffing and a system which will not provide enough staff to safely manage their ED 24/7 but will hang them out to dry when an inevitable bad outcome occurs.

I suppose I'm just coming at this from the opposite end because I read the excerpts from the staff accounts that night and see that it could very easily be me. I'm a good doctor but even the best doctor in the world is just one person and cannot work safely and prevent avoidable harm if you're one of 3 people staffing an ED overnight with 190 patients and 60 category 2 patients which are meant to be seen within 30 min.

My question is not that consultants refuse to come in. But what has happened before this to cause them to refuse. There are systemic issues here.

"18,000 Admissions". That's BS worthy of an HSE statistician.

The number of Australians who survive sepsis each year is unknown. Estimates suggest in Australia there are over 48,000 hospital admissions each year where sepsis is the main reason for admission and approximately 1,400 deaths each year where the underlying cause of death is sepsis.

https://www.safetyandquality.gov.au/sites/default/files/2021-02/report_-_sepsis_survivorship_-_a_review_of_impacts_of_surviving_sepsis_final.pdfThat's a mortality rate of 2.91% in Australian hospitals

This report shows that the associated in-hospital mortality rate for sepsis in 2020 has remained relatively stable at 19.0% when compared to the 2019 data (18.4%).

https://www.hse.ie/eng/about/who/cspd/ncps/sepsis/resources/national-sepsis-report-2020.pdf

The differenece in mortality rates for hospital admissions for sepsis is stark.

You are really struggling to keep up you Ireland is terrible at everything schtik.

Irish Hospital mortality rates

Australia by comparison from your own report

Again you are attempting to not compare like with like.

The figures you quoted are for Sepsis as underlying cause of death and does include all cases in which Sepsis was present which includes cancers and other comorbidities, which are counted in the Irish report.

How about an electronic system - armband or such which recorded the need level of each patient as they went thru triage. The tags on level 1 and 2 high risk patients would emit an alarm after the magic 15 minutes had elapsed.

These alarms should ring in the A&E and in the higher hospital management offices during office hours. Out of hours the bells would transfer to the homes of top HSE and Dept of Health management. Would we get action then?
Would reinforcements arrive?

Ok so maybe alerting the entire govt is a step too far but I very much doubt that the numbers on level 2 could have reached anything like 66 if some sort of alarm system was pinging all that night in University Hospital Limerick.

People are tired of saying we need better staffed A&Es - time to make managements hear the calls.
Somehow.
Anyhow

You could tell this story a million times over, though admittedly in most cases it will be stress/anxiety/panic.

But I don't know, I'm essentially approaching middle age myself and I have my own experience of harsh treatment in A&E. They seem to only want you in A&E when you're crawling or being carried into the place. I went with a doctor's note in 2022, didn't make any difference to them. The nurse who signed me in was basically spitting in rage that I had the temerity to be there, and this was just a normal Wednesday afternoon.

Long story short I don't think it matters whether you're making a "big fuss" or just quietly waiting to be seen, if you walk in on your own 2 feet they don't want you there.

Some years ago I was an inpatient in a private hospital, when one of the patients in my room developed sepsis during the night. It was so sudden, she was chatting away in the phone at 10pm to her young son, advising him to pack a proper lunch for school, she was lively, full of chat, didn’t seem a thing was wrong.

An hour later the picture was quickly changing. She got sudden torrential diarrhoea, followed by increasing breathlessness, & intense headache which got progressively worse. The house doctor on duty was clueless as to what was happening, but two very experienced ICU agency nurses who had reported on duty in another ward, were called to see the patient and knew immediately what was happening and advised vasopressors, antibiotics , etc and quick transfer to ICU.

The trouble back then in the private hospital was that protocol required the patient’s own consultant to sanction the transfer to ICU and he was asleep at home and uncontactable. It was 7am before he answered the phone and ordered the transfer. I will never forget the distress of the patient, the sound of her drowning in her own fluids. I believe e she was placed on a ventilator and survived, but she could so easily have run out of time simply because of the protocol then in place in the hospital.

"That's a mortality rate of 2.91% in Australian hospitals"

That statement in itself should raise a large red flag that you are not comparing like with like, or that you're interpreting the statistics incorrectly.

Is medical misadventure really enough for what happened to Aoife Johnston? Were manslaughter charges considered?

The HSE, the dept of health, the management at the hospital, the health minister

I hope the DPP looks at this in detail

I think it depends on the GP. You can see from this thread alone some people are very lucky in the care they have received. But a lot of people seem to be stuck in these mass clinics now where you're unlikely to see the same doctor twice in a row, where both are likely to give wildly differing opinions.

Maybe it's a postcode thing in Dublin, as I doubt there's many of these mass clinics in D4.