Tuesday, 12 February 2013
I thank the Senator for raising this issue. In the notice for this Adjournment debate, the Senator used the phrase the "most appropriate hospital" for treatment of those serious conditions which he described and I also note his appreciation that transfer to such facilities is essential. One of the key functions of pre-hospital emergency care is stabilisation. On arrival at an incident, paramedics and advanced paramedics assess, treat and stabilise the patient, prior to transporting him or her to the most appropriate, which is not necessarily the closest, facility. This treatment continues during transit.
Given this and the fact these types of patient, in particular those suffering cardiac arrest and stroke, are time-critical - which the Senator emphasised and was correct to do so - there is no clinical value in diverting to a stabilisation unit before continuing to a level 3 or 4 hospital, when stabilisation has already been done by the ambulance crew. It is worth noting also that a bypass protocol, diverting ambulances to level 3 and 4 hospitals for life-threatening cardiac, respiratory and other serious conditions was put in place for Roscommon County Hospital before the emergency department was closed in 2011, in line with national clinical care protocols for best practice and safe management of a patient with a heart attack or stroke. These protocols require such patients to be treated in a level 3 or 4 hospital as a level 2 hospital does not have a critical care unit.
Accident victims should only be managed in a hospital with a full emergency department with the necessary available acute care backup, including ICU. The essence is that patients should go to the hospital best able to treat them. This is particularly important for heart attack and stroke victims whose survival rate and long-term prognosis is dependent on how quickly they reach an appropriate hospital.
None of the national clinical care programmes envisages the development of "stabilisation units" in model 2 hospitals. It is debatable whether these would improve outcomes for patients or whether they would actually delay them from reaching the necessary level of care in an appropriate facility with the necessary clinical expertise and equipment to fully meet their needs. Having said that, I and the Minister for Health acknowledge that Roscommon County Hospital is leading the way by demonstrating the range of services that can be developed in a smaller hospital. In July 2011, Roscommon County Hospital commenced a process of reconfiguring services in line with HIQA recommendations. I respectfully disagree with the Senator's description of HIQA as a chopping block for the HSE. HIQA does important expert work through its role in our health services and is a very important institution. It is also a requirement for excellent health services that we have a body such as HIQA doing the type of work it does.
Roscommon County Hospital now has a medical assessment unit that is open from 9 a.m. to 5 p.m. from Monday to Friday for the assessment of medical patients who are referred by GPs, after initial phone triage with one of the medical consultants to ensure the medical assessment unit is the appropriate care pathway for the patient. In addition, it has an urgent care centre open 8 a.m. to 8 p.m., 7 days a week, which deals with minor injuries and trauma, as the Senator is well aware. Developments in 2012 include plastic and reconstructive surgery, sleep studies, urology services, a radiology upgrade, a newly-developed endoscopy suite, dental service, nurse prescribing and re-accreditation for student nurse training.
Roscommon County Hospital played a key role in the Galway Roscommon hospital group, with more than 520 endoscopy procedures transferred from Galway to Roscommon. Future plans for Roscommon County Hospital will see increases in elective inpatient care, in particular in endoscopy, plans for which are well advanced with design agreed, site identified, tender documents complete, funding secured and awaiting planning permission. Roscommon County Hospital is an excellent example of delivering appropriate care in the appropriate setting to maximise patient safety and resources.