HSE to take radical steps to tackle bed 'gridlock'

THE HEALTH SERVICE Executive (HSE) is considering radical options for tackling the problem of delayed discharges such as effectively converting wings of hospitals into nursing homes or transferring staff and resources from the acute sector to allow patients to be treated in the community.

The Irish Times understands that the HSE considers the issue of delayed discharges to be one of its priority areas for next year.

The move follows new official figures which show that the number of patients, who no longer require acute hospital care and who are occupying a bed inappropriately because of a lack of step-down or other facilities, had increased significantly over the last year.

Highly placed HSE sources said the current situation did not make any sense from a clinical or financial perspective and that changes were needed.

It is understood one option being considered is to move all delayed discharge patients in a hospital into one particular wing or part of the building.

Sources said once the patients were “cohorted” within the hospital, this particular unit could be run more like a nursing home. This would involve the provision of less intensive levels of care.

However, the sources said this option was not ideal from a clinical point of view and also had industrial relations implications.

Another alternative under consideration is the transfer of staff and resources from the acute sector to a community setting to allow greater numbers of patients to be treated there.

However, sources said that this could result in a belief that hospitals were being downgraded and also present some industrial relations problems.

In its most recently published figures, the HSE said there were 899 delayed discharge patients in hospitals at the end of June 2009 compared with 722 at the same time a year previously. This represented an increase of about 20 per cent.

Fine Gael health spokesman, Dr James Reilly, last week obtained figures from the HSE which revealed more than 144,000 bed days had been lost in the first half of the year due to so-called “bed blockers”.

Dr Reilly said this was an increase of 70 per cent on comparable 2008 figures and if this trend continued the numbers of bed days lost would top 360,000 by the end of this year.

“The true meaning of these figures must be understood. The number of bed days lost to delayed discharges is like one of our major hospitals being closed down for a year,” he said.

“I dislike the term ‘bed blockers’, but there is no doubt the health service is effectively gridlocked. Patients can’t get in on one end or out on the other.

“This entails a massive waste of resources as well as seriously hindering the recovery of patients who require discharge to appropriate rehabilitation, convalescent or supported home care settings.

“It is alarming that despite claims of improvement from the Government the situation has deteriorated so badly. Bed days lost due to delayed discharges at the end of May 2008 were at 85,172 compared to 144,565 at the end of June 2009.

“It is clear that the end-of-year picture will be significantly worse than the 216,885 bed days lost in 2008 and could surpass 360,000 if the half-year trend continues.

“This would be more than double the number of bed days lost by the end of last year,” he added.