The braveness and dedication to care
Dr. Peadar Gilligan, Emergency Medicine Consultant, thank you Dr. Michael Gaffney for a very thoughtful and thought provoking article and agrees with his reflections on the urgent need to address acute hospital capacity shortages in Ireland
I write to congratulate Dr. Michael Gaffney Who wrote the article entitled “Health Matters: Do We Worry Enough?” (IMT August 2020). I would also like to congratulate him on his personal courage to enter into a specific purpose contract with the Health Service Executive due to the temporary contingency measures to manage Covid-19. It points to the courage of those working in the health system and, on behalf of those currently working, I want to acknowledge the retired workers who have returned to help in the fight against the Covid-19 pandemic.
Given the nature of Covid-19 disease and its particularly serious effects in the elderly, I feel it is important that Irish society explicitly recognize those who have taken another risk to their own health by advocating facilitating patient care while the pandemic.
Dr. Gaffney writes with great clarity on the subject that has shaped my entire career as a consultant. That problem is the inadequate bed capacity in the Irish acute hospital system, which leads to overcrowding in emergency rooms (EDs) and delays in providing patient care both on an emergency and on a scheduled basis. He notes that while working in the "Accident Department" of Richmond Hospital in 1978, there were emphatically no problems with ED overcrowding or delays in admission. It also notes that this was because there was sufficient acute hospital bed base at the time to meet the health needs of the population.
Peer-reviewed literature
Dr. Gaffney, referring to the available literature, notes that in Ireland approximately one third of the acute hospital bed base was removed from the system between 1980 and 2015. This will not come as a surprise to any of your readers. The problem of EDs overcrowding and the cancellation of scheduled hospital stays became a problem in the 1980s and has since increased year over year.
Bed capacity deficits
I agree with Dr. Gaffney absolutely admits that the only way to address the inadequate bed base is to deal with it directly and provide the acute hospital beds that the Irish people need. As Dr. Gaffney will know, the Covid-19 pandemic made it very clear to us that the occupancy rate in acute hospitals of more than 80 percent is affecting the timely delivery of care to those in need of scheduled and unscheduled care.
The physical distancing required to reduce the risk of hospital-acquired infection, and particularly the risk of Covid-19 spreading in hospitals, means we need to reduce the number of patients in the ward areas. This is only possible if we actively develop a plan to increase our acute bed capacity in the hospital and implement that plan now. In the context of a world with Covid-19, at least 5,000 additional acute hospital beds are urgently needed, with additional beds in nursing homes, nursing homes, convalescent and rehabilitation facilities being required.
I am fully aware that this is a very significant investment in health in Ireland, but without this significant investment patient suffering will be exacerbated.
Dr. Gaffney is clearly concerned about the impact of an initiative that will reduce the current income of the public hospital system. He made explicit reference to the Sláintecare report by the Committee on the Future of Health Care and the intention to remove all private practices from public hospitals. He fears that doing so will reduce hospital incomes and thus the ability of these hospitals to fund the care they provide. I agree with Dr. Gaffney agrees that providing timely access to health care based on clinical need and solvency does not delay access to that care and can only be achieved if there are sufficient acute hospital beds and staff for patients in need of hospitalization.
The big challenge
My daily life includes providing accessible care in the emergency room. The biggest challenge is when I see a patient so sick they have to be hospitalized. The biggest delay is waiting for a ward bed to be available. The Irish health system is constantly overburdened and inadequate. Sláintecare can only be further developed in connection with very substantial investments in order to significantly increase the available acute hospital bed numbers.
Resolving the access problems
The increased bed numbers must appear first to resolve the access issues.
Regarding the question of the historical rule that general practitioners could induce their patient to go straight to a hospital bed, Dr. Gaffney points out that this was a system that worked very well from his experience in the 1970s and 80s.
When our general practitioners refer a patient to ED, they sometimes look for expedited exams. They may be looking for a second opinion on their patient. They may be seeking hospitalization for the patient. It is the experience of most EDs in Ireland that approximately 20 to 24 percent of GP referral patients continue to be actually hospitalized, and the majority of more than 75 percent of GP referral patients can be graciously returned to care for theirs General Practitioner After Nursing in ED.
The challenge to delivering care on time in EDs is that many of them are over 200 percent busy and all of their clinical supply rooms are either occupied by patients waiting to be admitted to hospital or by patients who are one Undergoing assessment or awaiting assessment.
It is clearly a totally inappropriate use of ED to have a situation where patients who have completed their emergency medical examination and are waiting for a hospital bed after the admitting services have agreed that admission is required face the challenge of the “long and painful "creating purgatory" that Dr. Gaffney relates.
Political failures
As I mentioned earlier, EDs need to be facilitated in providing the care they can afford now. Treating EDs as human warehouses where very sick patients have to wait until a hospital bed is available can no longer be the standard position of Irish health care.
Our politicians felt the need to convene the All-Party Oireachtas Committee on the Future of Healthcare in June 2016. What this special committee has not really addressed are the massive capacity bottlenecks in the system. It is very good that our politicians are telling us how they think the health service should be provided, but it is politicians who have failed to obtain and provide the necessary health care equipment over a period of four decades , and this inadequate endowment has led to access problems that our entire population faces.
Every doctor in Ireland wants to be able to treat patients in a timely manner based on their clinical needs. Surgical colleagues are frustrated at being unable to admit patients for a scheduled operation. Medical specialists are frustrated with their inability to fully screen patients and initiate therapy on a scheduled basis because the system does not have sufficient capacity. Emergency medical professionals have been at the forefront of the need to address Ireland's acute hospital capacity shortages for over two decades.
I would like to thank Dr. Thank you Gaffney for a very thoughtful and thought provoking article. His 44 years of experience with the Irish healthcare system clearly shaped this article. I hope that those who wish to improve access to care in Ireland will understand that access to care can only be improved through access to beds and that those beds need to be built now.
author
Dr. Peadar Gilligan, a past president of the Irish Medical Organization, is an emergency medicine consultant.
Comments are closed.