Sunday, January 07, 2007

Curing A&E?

The HSE task force set up to address the problems with A&E will propose a target for all patients to be admitted to a hospital bed or discharged within six hours of arriving in an emergency department by the end of the year. They will set an interim 12-hour target – from time of a decision being made by medics to admission – to be achieved within the next three months.

Unsurprisingly, Liam Doran of the Irish Nurses Organisation claims such targets are unrealistic and impossible without additional resources.

I’m only familiar with the activities in one hospital, St Vincent’s in Dublin. If a patient is not discharged when the consultants do their rounds on a Friday morning, he/she will not be discharged over the weekend.

I’ve long suspected that this approach may be particularly applied to those in-patients who have private health insurance, typically VHI or BUPA. Such weekend stays allow the hospital to bill the insurers and generate incremental revenue for the hospital.

However, the weekend is also the busiest time in A&E. Surely doctors should be actively discharging appropriate patients on Saturday and Sunday as well? The unavailability of beds in the hospital means that patients who need to be admitted and kept overnight have to be housed within the A&E unit itself - something it was never designed for. This leads to the chronic overcrowding, lack of privacy etc which have generated all the negative, but deserved, publicity.

In addition, a policy of temporarily discharging suitable, non-critical patients on Friday, to return on Monday, might free up a substantial number of beds, and also be welcomed by the “paroled patients” who get to go home for the weekend?

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