PATIENTS WILL be guaranteed to be seen by a senior doctor within one hour of arriving in hospital under radical proposals to be adopted by the Health Service Executive (HSE).
The plan, which has been seen by The Irish Times, will see the creation of a national four-tier hospital system along with a new specialty of acute medicine. The initiative, which is being driven by Dr Barry White, the HSE’s director of quality and clinical care, and has the support of new chief executive Cathal Magee, is the latest attempt to deal with the problem of lengthy stays for patients on trolleys in emergency departments.
Sources have indicated the “Acute Medicine Programme” will begin in two or three hospitals in January 2011, with the aim of implementing the programme nationally within a three-year time frame. Significantly, it has the backing of the Royal College of Physicians of Ireland which has agreed to set up a completely new clinical specialty which will see doctors here being trained as acute medicine specialists for the first time.
The programme is also backed by organisations representing nurses, therapists and patients. Rebecca O’ Malley, the prominent patient advocate and representative of Patient Focus and the Irish Patients’ Association contributed to the document. A core element of the programme is the configuration of the State’s public hospitals into a four-tier system based on the complexity of care each institution offers patients. Model 1 hospitals are community hospitals offering palliative care and the management of mild acute illnesses by GPs.
Model 2, which will include hospitals such as Mallow, Dundalk and Nenagh, will admit low-risk patients referred by GPs to a medical assessment unit.
They will not have intensive care units (ICUs); patients whose condition deteriorates will be automatically transferred to a Model 3 or 4 hospital within each region. Model 3 hospitals will have an emergency department and an ICU.
They will also have acute medical assessment units open on a 12 to 24-hour basis. The highest level four hospitals will be staffed by full-time acute medicine consultants, who will focus on patients who have recently arrived in the emergency department.
They will have access to beds in an adjacent 48-hour admission unit; any person unfit for discharge within this timeframe will be admitted to a normal ward bed. Model 4 hospitals will include the Republic’s largest teaching hospitals in Dublin, Cork, Galway and other cities.
Those closely involved have described the plan as a “ground up” approach based on the reaction of clinical staff to ongoing problems in public hospitals. They point to the concept of “clinical justice” – equal access to a senior clinical decision maker for all patients.