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Trolley numbers down significantly on Paddys weekend - the fix was rostering...

13

Comments

  • Registered Users, Registered Users 2 Posts: 6,781 ✭✭✭Flaneur OBrien


    Balderdash... Where there were unions, we now have 2 days off a week, holiday pay, sick pay, overtime, maternity leave, etc. etc. None of these were handed to the ordinary worker by the company owner.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    I get you but I disagree a bit. You have consultants without the downstream staff then loads of stuff still gets pushed to Monday (and you now may have those same consultants off on Monday)



  • Administrators Posts: 55,807 Admin ✭✭✭✭✭awec


    Kind of. But even just having consultants work weekends still significantly reduces the number of patients who have to wait on trolleys as many patients who present at the weekend can be seen to and sent home (i.e. clearing out the low hanging fruit), and patients who were already in the hospital can also be discharged over the weekend rather than having to wait around.

    Yea, ideally a hospital will operate the same on a Sunday as it does on a Monday for anything non-elective, but as you say this will require massive changes to rostering across the board.

    But having people wait in beds is better than having them wait in trolleys and it seems like we can achieve this by moving to a 5/7 model for consultants.



  • Registered Users, Registered Users 2 Posts: 21,905 ✭✭✭✭kneemos


    Nurses work nights and weekends as is. Might be a whole lot easier if there wasn't corridors full of patients.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    Clinic nurses do not, theatre nurses do not, day ward nurses do not. ED and ward nurses do (and on-call theatre)

    Overcrowding and understaffing is a large issue in the wards and a lot of backlog in ED is trying to free up bed space in the wards.



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  • Registered Users, Registered Users 2 Posts: 21,905 ✭✭✭✭kneemos


    Because the consultants don't work weekends. Put then all in five seven.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    All?

    So you are unilaterally tearing up the contracts of nurses, radiographers, sonographers, phlebotomists, administration et al ?

    We don't have enough ward and theatre nurses, for Mon-Fri, and you want to open elective theatres and day wards on the weekend too?

    Do NOT blame the staff for governments not building new hospitals, abdicating housing to the private market (meaning nurses can't even get housing near the hospital), and allowing conditions become so bad that our young staff are leaving.

    Hell, the nurses we imported from India are going to Australia for better conditions and family visas.

    We do not have the support staff to operate a full service 7 day a week hospital



  • Administrators Posts: 55,807 Admin ✭✭✭✭✭awec


    There is no need for theatre nurses to work 5/7 though, even with 5/7 consultants.

    Anyone who presents at the weekend who requires theatre can still wait until Monday (non-emergency obviously), but with this model they'll be waiting in a bed rather than a trolley.

    Obviously there is no need for day ward nurses to move to 5/7.

    Not 100% sure what clinic nurses do to be honest.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    What bed?

    ED is full of people waiting for a bed. I had a PE 2 years back and it took until my 4th night to be admitted.

    There are not enough physical beds and, where there may be, the nurse:patient ratio is outside safe staffing levels

    Our hospitals were creaking, for space and staff, 20 years ago and no hospitals have been built. Where is the physical ward space coming from?

    Edit: As we saw during the pandemic, our hospitals are being propped up through the exploitation of students



  • Registered Users, Registered Users 2 Posts: 12,759 ✭✭✭✭LambshankRedemption


    According to Breezy there are loads of rooms available but they cant be opened because of guidelines. So you and I are stuck in the hallway.



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  • Posts: 1,167 ✭✭✭ [Deleted User]


    Guidelines like, say, safe staffing levels? I alluded to that. Where there are actual bed spaces (very limited) there are not enough staff to offer safe care



  • Posts: 1,167 ✭✭✭ [Deleted User]


    I'm sure that the government and Bernard will throw another several million to some business consultancy firm to say that there is not enough staff/beds and this can not be fixed overnight, to push it down the road.

    where do we get similar? Oh yeah, housing. How many times over the past 5-10 years have we been told that housing can not be fixed overnight.



  • Registered Users, Registered Users 2 Posts: 21,905 ✭✭✭✭kneemos




  • Posts: 1,167 ✭✭✭ [Deleted User]


    Indeed, the best time to start fixing it was 10 years ago, 2nd best was anytime between then and now. Yet here we are still saying "Housing can't be fixed overnight"



  • Registered Users, Registered Users 2, Paid Member Posts: 3,998 ✭✭✭Beta Ray Bill


    So, one week later and we're back to the norm:

    https://www.breakingnews.ie/ireland/trolley-watch-over-500-patients-wait-for-beds-in-irish-hospitals-1744161.html

    Either the rostering plan didn't work or it wasn't implemented last weekend, or possibly there was a stack of elective surgery procedures that were cancelled two weeks ago.

    Disappointing all the same, I actually had my hopes up.



  • Registered Users, Registered Users 2 Posts: 1,128 ✭✭✭harryharry25


    It was reported in the media the day after Jennifer told us she fixed everything, from numerous leading medial professionals the only way possible the numbers were so low Paddy's weekend was because they cancelled hundred surgerys for the 2 weeks before



  • Registered Users, Registered Users 2 Posts: 14,775 ✭✭✭✭Potential-Monke


    The same used to happen in the Guards. Extra members would be rostered on when some "important" government official was coming. Made it look like everything was under control. Sounds like it was the same here, but all they've done is point out they need a lot more staff to have that type of cover 24/7. Plus you're now going to be asking medical staff to change from a 5/5 to a 5/7 and you just know they'll want massive remuneration for it.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    I remember seeing them cleaning blood off the walls, in Tallaght ED, for a Mary Harney visit, several years ago. It's all about making the upper management and ministers look good

    You'll have thousands of workers (yes, primarily women) who will tell them to take a running jump. Healthcare isn't monolithic and there are multiple career paths.

    So many people will have chosen specific paths around family plans. You think that they will happily take to the government just coming along and 5/7ing them?

    Nurses, lab workers, IT staff, and all the others will all tell them to get fecked



  • Registered Users, Registered Users 2 Posts: 14,775 ✭✭✭✭Potential-Monke


    As would any of us! To all the people who currently work a 9-5 M-F, would ye just accept ye now have to work 5/7? Not a hope, there'd be war. But the nurses and doctors will be the bad guys for not wanting it. It's fairly straight forward issue tbh, hire more staff. But there's no will for it? I would say money, but the country is pishing money away so can't be that…



  • Registered Users, Registered Users 2 Posts: 12,759 ✭✭✭✭LambshankRedemption


    I remember seeing them cleaning blood off the walls, in Tallaght ED, for a Mary Harney visit, several years ago. It's all about making the upper management and ministers look good

    My mother used to say that the Queen must think the entire world smells of fresh paint, because anywhere she goes the place has been freshly painted.



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  • Registered Users, Registered Users 2 Posts: 33,195 ✭✭✭✭blanch152


    If you only have medical activity on 5 days out of 7 as at present, less when you include bank holidays, you are only working the beds 245 days out of 365. You still have all of the nursing staff rostered on for those 365 days, all of the caterers, porters etc. You still have some admin staff for admissions etc.

    Assume that there is 20% shortfall in the number of beds, by increasing activity from 245 days to 294 days, you have an instant solution. Increasing it to 365 days, means you have a productivity gain of over 40%, meaning that you need less beds. The new staff needed to cover everywhere - radiologists, consultants, etc. - would be less than the savings from needing less beds.



  • Registered Users, Registered Users 2 Posts: 32,425 ✭✭✭✭breezy1985


    Figures were also manipulated by moving trolleys to wards so that you were not "on a trolley in ED"

    It was all for show. Consultants should definitely be working weekends but the idea that it was a eureka fix was crazy.



  • Posts: 1,167 ✭✭✭ [Deleted User]




  • Registered Users, Registered Users 2 Posts: 33,195 ✭✭✭✭blanch152


    Well, it is actually. The wards are fully staffed 24/7, if we are treating patients over 7 days rather than 5 days, there is a saving in the number of beds, subject to there being no excess demand. If the excess demand is 20%, there is another 20% surplus beds then.



  • Registered Users, Registered Users 2 Posts: 277 ✭✭Will0483


    The whole culture of the HSE from top to bottom is that it is run for the benefit of the staff at all times. Anything that inconveniences anyone, won't get done. For example, Nurses mostly refuse to put in canulas even though this duty is explicitly laid out in their job description and contracts.

    It's not a lasck of training, the majority just simply don't want to do it and have been backed up by their union. The weak management just accepts this with the result that highly paid and very busy Registrars and junior doctors spend an inordinate amount of their time on this task.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    You have medical activity in wards on a 24/7/365 rotation, they are fully (under) staffed

    Theatre nurses are not (outside emergency on-call)

    Day ward nurses are not

    Sonographers, radiographers, and MRI are reduced

    Laboratories are reduced

    Physiotherapy are not

    HCAs are not

    These roles (and many many more) are already working a full working week.

    Hospitals are more than just ward staff.

    There is also the simple issue that, in many cases, the ward nurse to patient ratio is dangerously low, even where there (potentially) would be room for more beds.

    Top that off with the simple fact that people are not pawns to rip up contracts and be forced onto a 24h shift rotation at a whim.

    The government already stole the public sector pension from public sector workers and you want health care workers forced into 24 hour shifts?

    Is there anything to be said for another round of applause?



  • Registered Users, Registered Users 2 Posts: 7,879 ✭✭✭circadian


    In the case of Reilly, placing 15 primary care centres, including two in his own constituency where he practiced as a doctor without explanation. He did experience a dip in trolley usage, but was mired in controversy including medical card cuts.

    The other lads are spoofers who just rode the gravy train although I'd argue Covid was handled somewhat reasonably well.

    I never put these things down to the ministers but actually the civil servants doing the work. In my opinion the impact the ministers really have is whether they listen to those civil servants and provide them with the resources they need to resolve issues. I'd say there's a lot of ego and wanting to do things their way, in the case of MacNeill she could be simply clever enough to listen to those who know what they're doing and enable them.



  • Registered Users, Registered Users 2 Posts: 33,195 ✭✭✭✭blanch152


    Nope, I didn't say 24 hour shifts, I said 5 over 7.

    If the day ward nurses, theatre nurses, radiographers etc. work 5 over 7, we see a 40% increase in the number of those staff, but an overall 40% increase in productivity of all staff as the ward staff etc. don't need to increase, and the consultants are already on 5 over 7.

    Normal working practices for hospitals all over the world. And as I said, if excess demand is less than 40% there is potential for some savings.



  • Posts: 1,167 ✭✭✭ [Deleted User]


    And that's been discussed. How will you see an increase? There has been no talk of getting more staff, just pushing existing staff to a 7 day roster

    Current staffing levels are pushing out the maximum number of surgeries they can do. Adding 2 days, with split staff, will not increase the amount of surgeries that same level of people can do.

    Again, CUH is contemplating rolling theatre closures during their current week as they do NOT have enough staff to safely manage current workload.

    Ward staff are already completely overloaded because we have no step down facilities which causes a massive backlog in current bedding levels. Adding more facilities leaning on a limited number of beds/staff will not work

    There is so much more physical infrastructure needed (and staffed) with our current system before any major change to roster will have a lasting effect. Ignoring the fact that you are unilaterally deciding to completely rip up the contracts of thousands of people



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  • Registered Users, Registered Users 2 Posts: 33,195 ✭✭✭✭blanch152


    Infrastructure such as theatres and scanners lying unused for two days a week plus bank holidays does not mean more infrastructure is needed.



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