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Comhairle na nOspid

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Mr. Joseph Cregan, Principal Officer, Department of Health & Children. Dr. Deirdre Lohan, Consultant Anaesthetist, Navan/Drogheda ... – PowerPoint PPT presentation

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Title: Comhairle na nOspid


1
Comhairle na nOspidéal
  • Report of the Committee on
  • Accident Emergency Services
  • Mr. Tommie Martin

2
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)

3
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.

4
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

5
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

6
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

7
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

8
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

9
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

10
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

11
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

12
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

13
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

14
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

15
  • 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..

16
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

17
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