Comhairle na nOspid

1
Comhairle na nOspidéal

• Report of the Committee on
• Accident Emergency Services
• Mr. Tommie Martin

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Membership

• Professor Gerald OSullivan, Consultant General
  Surgeon, Mercy Hospital, Cork. Chairman
• Mr. Joseph Cregan, Principal Officer, Department
  of Health Children
• Dr. Deirdre Lohan, Consultant Anaesthetist,
  Navan/Drogheda
• Mr. Colman OLeary, Consultant in Emergency
  Medicine, Limerick
• Dr. Donie Ormonde, Consultant Radiologist,
  Waterford
• Dr. Sheelah Ryan, C.E.O., Western Health Board
• Mr. Tommie Martin, Chief Officer, Comhairle na
  nOspidéal
• Mr. Andrew Condon, HEO, Comhairle na nOspidéal
  (Secretary)
• Ms. Mary-Jo Biggs, EO, Comhairle na nOspidéal
  (Assistant Secretary)

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Terms of Reference

• Arising from discussions with the Minister and
  Department of Health Children,
• Comhairle na nOspidéal established a committee to
  undertake a review of the
• structure, operation staffing of Accident
  Emergency Services and
• Departments.
• The review will aim to
• Facilitate the development of a better quality
  service, with greater continuity in patient care,
  delivered twenty-four hours a day by
  appropriately trained doctors
• Promote the development of regionalised AE
  trauma services in line with national and
  international best practice in patient care
• Provide for a substantial increase in on-site
  senior clinical decision making on a 24 hour
  basis
• Define the future role of AE consultants
• Simultaneous to the Comhairle review, it is
  envisaged that health
• authorities will consider how best to organise
  AE services in their areas in
• conjunction with the Comhairle committee.

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Methodology

• Committee met over thirty times
• Extensive consultation process met received
  submissions from
• Health boards voluntary hospitals
• Professional bodies
• Training bodies
• Other interested parties
• Collected data on attendances in each hospital in
  the country
• Reviewed national and international literature

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Impact of Prolonged Waiting Times

• Additional risk to patients outcome due to delays
  between presentation and assessment
• Risks that delays may be further extended where
  triage not undertaken
• Increased number of patients leaving department
  before treatment
• Overcrowding
• Restricted access to emergency services and
  delays in treatment of patients on arrival
• Public perception of service

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Main causes of delay in Emergency Department

• The absence or partial implementation of formal
  triage process
• Restricted access to inpatient beds
• Restricted access to pathology and radiology
  services
• The treatment and management of large number of
  patients with minor injuries and illness who
  could be treated elsewhere
• Limited availability of senior clinical decision
  makers
• The design of, and resources available to, the
  Emergency Department

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Structure of Hospital Emergency Service

• PROPOSALS
• Regional Emergency Departments
• Located in major regional hospitals
• Serve catchment population of about 250,000
• Be major trauma receiving hospital for region
• Provide a referral service for local general
  hospitals
• Staffed by a number of consultants in emergency
  medicine
• Multi-professional team
• Department led by a Director

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Hospital Emergency Departments with access to
some specialist surgical and medical services
on-site

• Be linked to the Regional Emergency Department
  for trauma services, subspecialty services and
  certain diagnostic services
• Able to manage most emergencies, including
  stabilisation assisted ventilation
• Staffed by 1-2 consultants in emergency medicine
• Multi professional team
• One consultant act as head of department

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Hospital Emergency Departments with access to
specialist services off-site

• Consultant (Physician or Surgeon or other
  consultant) on hospital staff to function as
  lead clinician in, and have responsibility for,
  the organisation and of the Emergency
  Department
• 24 hour access to medical staff on-site
• Provide nurse led services for minor illness and
  injury
• Access to consultants in emergency medicine in
  the regional department for support,
  development training purposes

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Staffing the Hospital Emergency ServicesProposals

• Regional Co-ordinator of Emergency Services
• One per health board
• Advise on operation, organisation of emergency
  services
• Responsible for development and implementation
  of agreed protocols across region
• Director of the Regional Emergency Department
• Post could rotate between the different
  consultants in emergency medicine in department
  or filled from a competitive process
• Have overall clinical and administrative
  responsibility for department

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Consultants in Emergency Medicine

• Large majority of sessional commitment should be
  to clinical as distinct from administrative
  duties or legal work
• Duties centre on the stabilisation of patients
• Responsible for ensuring that patient is
  admitted to the most appropriate service to
  further explore problem if required.
• Depending on the number of consultant posts in
  emergency medicine in a service, different
  rosters and cover arrangements will apply
• At least one of the consultants in emergency
  medicine in the regional emergency department
  should have a special interest in paediatic
  emergency medicine

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Increase in consultant posts

• Designed to be implemented on a phased basis
• At present 21 posts of consultant in emergency
  medicine
• First stage - increase to 55 posts
• Final stage recommend increase to 74 posts
• Allows sufficent time for changes in organisation
  service delivery
• Training recruitment of additional consultants
• Achievement of a contractural environment which
  allows on-site rostering of consultant staff to
  cover busy periods in AE

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Staffing Issues

• 75 of patients attend AE between the hours of
  8 a.m. and 8 p.m.
• Committee aims to put in place structures which
  facilitate the on-site presence of Consultants
  in Emergency Medicine in Regional Emergency
  Departments between the hours of 8 a.m. and 8
  p.m., 7 days a week, 365 days a year

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Re-organisation of Hospital-Based Emergency Care

• The aim of hospital services
• right care
• right time
• right place
• right people
• System-wide problems - System wide solutions
• Emergency services be reformed restructured in
  conjunction with the rest of hospital

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• The organisation of hospital services -
• emergency care,
• in-patient elective care,
• day outpatient care
• Distinct management structure for the hospital
  emergency services
• Hospital emergency service committee
• chaired by consultant in charge of emergency
  services
• supported by administrative structure including
  Hospital Emergency Service Manager
• Comprise acute surgical, acute medical,
  paediatrics, psychiatric, radiology pathology
  staff, nursing, anaesthetic, GPs etc..

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Further measures

• Introduction and use of common triage systems
• Better interaction with primary care
• Timely transfer of patients to appropriate
  treatment location within hospital or other
  facility
• Greater role for nurses
• Minor injury and illness areas
• Observation wards
• Dedicated and accessible diagnostic facilities
• Better access to and management of inpatient beds

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