The timing of ward rounds at Galway University Hospitals are to be changed to ensure the earlier discharge of patients who have been treated and are waiting to go home or move to another health service.
This was one of the key priorities drawn up at a meeting between local hospital luminaries and members of the national A&E forum [an advisory body which addresses emergency department overcrowding] in Galway on Tuesday to tackle overcrowding and delays which continue to dog University Hospital Galway’s ED.
Ward rounds, whereby consultants and their teams review patients, generally take place early in the morning and additional rounds are organised as required. A surgeon who has undertaken an early morning round would generally review his patients post surgery, for example. The reconfiguration and designation of specialties within wards will make it easier for consultants to see their patients as they will be on the one ward.
Other areas pinpointed for immediate action include:-
• Liaising with the ambulance service to improve the transport and transfer of patients to other hospitals and nursing homes. Patients are often delayed and this slows down the movement of patients from the ED.
• Re-organising wards to allow new assessment services and direct referrals to the hospital.
• Training and upskilling of nursing staff in community and private nursing homes to reduce the need for older people to come into the ED for intravenous treatments, catheter and PEG insertion [a percutaneous endoscopic gastrostomy tube is put directly into the stomach to provide nutrition, fluid, and medications.] Many older people could be treated in their residential service and this would reduce the stress of a transfer to a busy ED.
The forum aims to reduce numbers waiting in EDs It focuses on improving systems and discharge planning.
Pat Commins, acting general manager for GUH, [UHG and Merlin Park] traced the planned re-organisation of wards and the new developments coming on stream to reduce the length of time patients have to wait in the ED at the meeting.
“Our aim is to ensure that seriously ill patients do not have to wait to get an inpatient bed. We have been re-organising and rearranging our services so that we can treat and assess more people outside of the ED and we are currently implementing the National Discharge Protocol. As healthcare providers we do not wish to have any patients waiting longer than necessary in our ED department.”
Dr John O Donnell, consultant in emergency medicine, said patients must have access to the “right service at the right time”. He described the medical assessment unit - which facilitates a direct GP referral system whereby family doctors may now bypass A&E when referring patients and send them directly to the unit if necessary - as a positive example of this.
John Hennessy, regional director of operations for the HSE West, outlined the quality of the service and care patients get at GUH is second to none. However, everyone wanted to see the delays reduced.
“But this isn’t an ED problem, it will be solved by a whole hospital approach with innovative ideas such as the medical assessment unit, the surgical assessment unit and ideas such as an older person assessment service. Ensuring that the emergency department offers the best service and meets the national waiting time targets is a priority for the HSE West and GUH.
“We want to make sure that seriously ill patients, be they older citizens or the youngest child, gets the best possible care in a dignified way and access to a bed when they need it.”
GUH management and clinicians recently introduced new measures aimed at reducing the need for people to attend the ED. These include:-
• Direct GP referral to the medical assessment unit (MAU ) which came into being last month. This means GPs can ring a specialist consultant about patients and receive advice and support or be advised to send them directly to the unit bypassing the ED. This has resulted in patients being assessed, diagnosed and treated quickly. On average only one in four patients at the MAU needs to be admitted to the hospital. The GP advice system has also led to a reduction of GP referrals to the ED since it started 10 days ago.
• A surgical assessment unit is also being planned to provide a similar service for surgical patients. This is due to open in the next few weeks.
• A new service for nursing home referrals will begin shortly. Older patients often require an intravenous drip or a catheter to be inserted. By training staff in nursing homes to do these procedures this will reduce the number of older, less seriously ill patients being assessed and treated at the ED.
• GUH has recently reconfigured wards and re-designated beds. This will lead to a more co-ordinated discharge planning process. Patients will know their planned discharge date on admission to the hospital.
• New pre-operation assessment clinics are being put in place so patients can have any necessary tests or assessments done prior to surgery. This will reduce the number of patients coming into GUH a day or two before their operation for assessment - again this will reduce the number of beds being used inappropriately and will reduce the length of time a patient has to stay in hospital.
• A new oncology assessment unit is planned to open by July. This will enable cancer patients to bypass the ED, reducing the length of time being spent in hospital.
• The staff at GUH are also looking at developing direct referrals for patients with lung problems, again reducing the time spent at the ED.