Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

To ask the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in the accident and emergency department in St. James' Hospital, Dublin; the impact of these measures [7561/13]

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context | Oireachtas source

In St. James' Hospital in the first five weeks of 2013, compared to same period in 2011, there has been a 13% decrease in the number of patients waiting on trolleys.

Immediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit (SDU), as set out in the Programme for Government. The SDU is working closely with hospitals to unblock access to acute services by improving the flow of patients through the system. Since its establishment, there have been significant improvements in waiting times for unscheduled care, against a background of reduced funding for health, reconfiguration of services, a very challenging socio-economic climate, a growing number of older people and an overall increase in life expectancy.

In December 2012, there were 20,352 fewer patients waiting on trolleys in comparison to December 2011, representing an overall reduction of 23.6%. However, the overall progress made has to be secured and continually improved upon, and the SDU continues to engage at all levels with hospitals to do this. The work of the SDU with executive management teams in hospitals (CEOs, Directors Of Nursing and Clinical Directors) has seen local leaders and experts driving the change required to reduce the numbers of patients waiting on trolleys and improve standards for patients.

Another major contributing factor in reducing waiting times has been the implementation of new clinical care pathways, based on international clinical evidence, which has enabled improved planning of services to ensure optimal resource utilisation. An escalation protocol has been introduced by SDU liaison officers to assist with hospitals which are experiencing particular difficulties. This involves conference calls between key decision makers to review the situation and agree actions. This usually includes Directors of Performance, Directors of Unscheduled and Scheduled Care, the National Clinical Director, the National Director of Clinical Programmes and senior HSE managers, including all HSE Regional Directors.

Key actions agreed during this conference may include:

- Opening of additional capacity in the hospital;

- Ensuring the presence of senior clinical decision makers to maximise patient discharges from occupied beds;

- Utilising available capacity in residential facilities for approved patients;

- Consideration of adjustments to elective (scheduled) care in the short term.

The SDU has therefore planned well for the possibility of surges in demand in ED-related hospital services and the better management of the surges has mitigated their impact. The system has been clearly responsive in the way this has been done. It is very heartening to see the level of commitment and actions that have been taken to cope with very difficult winter circumstances.

There are consistent reports of high attendances at emergency departments at present, with increasing numbers of frail elderly presenting with acute viral and respiratory-related illness. Clinical Directors across the country have reported that all staff, including consultants, nurses, allied health staff and management have been working extremely hard to address these pressures. These exceptional efforts will continue but the nature of many of the patients is such that they require extended inpatient care, which is resulting in additional trolley waits in emergency departments. The SDU has been in constant contact with regional management teams, the National Clinical Directors and National Leads for Clinical Programmes. The situation is being actively managed at a national level and in addition, small teams of SDU staff are visiting key hospitals to ensure that all possible actions to ameliorate the present situation are being implemented. The impact of these measures is seen in the reduction of numbers of patients on trolleys during the day. The objective of the measures being implemented at hospital level and by the HSE is to continue to manage the downward trend on the number of patients waiting until the system stabilises.

Trolley figures in hospitals are managed a number of times a day through an internal counting system known as TrolleyGAR – which refers to the trolley count and alert levels: green for within acceptable limits, amber for approaching acceptable maximum limits and red for above acceptable maximum limits. These counts take place at 8am, 2pm and 8pm each day.

With specific reference to St James' Hospital, the hospital has advised that they have robust internal controls and processes in place to ensure that Emergency Department volumes and wait times are managed consistently and appropriately. The hospital has also advised that it constantly seeks to deliver improvements in terms of Emergency Department access and overall patient experience. The figures from 18 January 2013 to 11 February 2013 (25 days, 75 counts) show red for only 21 counts, red for all three daily counts on only one occasion and one day with green for all counts. The hospital has invoked its escalation procedures in response to the ED demand surge. It has opened additional beds and is working with the HSE on accelerated discharge of patients to home care and long term stay. The monitoring of numbers of people on trolleys in St James's will continue.