Overnight stays in the emergency department of Tallaght Hospital and cancellation of surgery could be eliminated if enough long-stay beds were available for patients who are in its acute wards because they have nowhere to go, a new study suggests.
The study, reported in the current Irish Medical Journal, found almost 52,000 bed days were taken up by patients waiting for long-stay care over the six years to the end of 1999. Almost a quarter of these patients died while waiting for a placement.
Meanwhile, in the first half of last year there were over 2,500 overnight stays in the emergency department by patients waiting to be admitted to the wards. If only two thirds of the acute beds occupied by people awaiting long-stay placements were available, "this problem could be completely resolved," say the researchers Prof Des O'Neill and Dr Tara Coughlan.
"Elective operations are often cancelled due to unavailability of beds," they write. "Few if any theatres would have to be cancelled if even a proportion of these beds could be used." The only feasible solution, they write, "is to build State funded long-term care facilities in a number of geographically appropriate areas in the greater Dublin area." Private nursing homes may not be able to meet the need, another study by Prof O'Neill and senior social worker Mr John Brennan, suggests.
It found a significant number of nursing homes only accept the least dependent patients from hospitals. In the first half of last year, the Eastern Regional Health Authority offered the hospital the use of eight "contract" beds in nursing homes for long-stay patients.
However, there were six refusals by five nursing homes to take patients on the grounds that they were too highly dependent. "Many of the patients and their families were distressed by the refusal as the nursing place originally offered suited them well."
Prof O'Neill said yesterday he objected to these patients being described as "bed blockers." The patients did not want to be in hospital beds but in many cases were frail and in need of long-term care.
Two important psychiatric hospitals have told The Irish Times they cannot provide minutes of management or medical committee meetings under the Freedom of Information Act because they don't have formal meetings or minutes.
St Brendan's Hospital, Dublin, said the hospital is managed by three people who meet every Monday "to discuss operational and management issues but do not have a formal agenda, minutes or documentation."
St Mary's Hospital in Castlebar also has a three-person management team who "meet regularly on an informal basis" without producing minutes. If these were acute health board hospitals dealing with physical ailments they would have management and/or medical committee through which staff could seek to influence policy and practice and which would produce minutes to be forwarded to health board members.
While the management teams of St Brendan's and St Mary's are, no doubt, excellent, these hospitals do not have the structures enjoyed by hospitals dealing with acute physical ailments which enable them to exercise some degree of influence on the health boards.