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Bed review ‘key to solution’ of emergency department crowding

13 Feb 2017

There were 150 acute beds and 190 community beds closed in the public health system due to essential refurbishment, infection prevention and control and staffing deficits on January 24, the HSE has informed the Joint Oireachtas Committee on Health.

The hospital crowding seen at the start of January was “distressing for both patients and staff” and the HSE had apologised for them, according to the Executive’s National Director for Acute Services Liam Woods, who stressed that the recently announced acute bed review would be one important piece of the long-term solution.

“However, unless we shift our model of healthcare from its current hospital-centric focus and towards the community, with the associated investment required, we will continue to be challenged in delivering the service we would wish for our patients,” Woods told the Committee late last month (January 25).

Liam Woods, HSE

During the first week of 2017 an “unacceptable level” of overcrowding was evident in emergency departments (EDs), Woods accepted, citing several factors in December and January that led to increased pressure on the numbers of patients delayed for admission.

Overall, there was a 6 per cent increase in ED attendances in December 2016 compared to the same month in 2015, and a 7.2 per cent increase in ED admissions, a 7 per cent increase in GP out-of-hours services and an 18 per cent increase in ambulance calls. An increase in flu and respiratory-related illness commenced in mid-December, earlier than the previous year, with the virus influenza A (H3N2) primarily affecting those aged 65 years and older. Thus, the highest ever number of respiratory admissions was recorded in HSE hospitals.

Enhancement of primary and social care services, development of integrated patient-centred care for the management of chronic conditions, investment in hospital infrastructure and models for the delivery of acute services all needed to form part of strategic health policy initiatives, in order to address the causes of ED crowding in the longer-term, Woods advised.

However, a key Winter Initiative objective had been met: a targeted reduction of delayed discharges that freed up the equivalent of an additional 200 beds for the acute system, which was achieved through increased provision of Fair Deal and home care capacity.

The initiative contained a number of key measures in terms of hospital avoidance, timely access and discharge and was being implemented in all hospitals and Community Healthcare Organisations across the country, Woods added, with €40 million invested to alleviate winter pressures. While considerable planning was undertaken through the Winter Initiative, the system’s ability to expand to meet spikes in demand was currently limited by a number of factors that varied from hospital to hospital, the National Director accepted.

These included not having enough beds in the system to deal with a surge and difficulties in recruiting nursing staff, which in turn posed a challenge in opening some surge-capacity beds.

In early January, the HSE announced a series of additional measures as part of the existing Winter Initiative Plan, focused on augmenting the supports for primary and community care, targeting a small growth in acute capacity, and the further strengthening of existing actions such as the Executive’s information campaigns on flu vaccines.

Additional investment in the community would mean that many scans and tests could be carried out without people having to attend acute hospitals, more home supports could allow people to move out of hospital sooner and Community Intervention Teams could treat people in their own homes rather than in a hospital environment. However, Woods said this would involve a “decisive” shift away from the most expensive form of treating and caring for people: the acute hospital system.

In 2016, the HSE’s urgent and emergency care system dealt with 310,000 emergency ambulance calls, a 4 per cent rise on 2015. There were a total of 1.155 million ED attendances, a 4.9 per cent rise on 2015, and there were 286,701 ED admissions — up 5.3 per cent on 2015.

“Improving processes and achieving efficiencies in hospitals in order to alleviate ED overcrowding continues to be a priority,” said Woods.

“Additionally, in order to address the causes and challenges of ED overcrowding, and sustain the solution, a more strategic approach is needed, from both policy and operational perspectives, in the medium and longer term.”

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