Report calls for new models of emergency care


A NEW blueprint for the development of emergency care in Ireland has recommended that services be delivered through networks of hospital facilities offering different levels of emergency care.

It says the proposed networks should be made up of emergency departments in hospitals that operate on a 24-hour basis, as well as new local emergency units and local injury units with more limited opening hours.

The report of the national emergency medicine programme, drawn up by representatives of virtually all grades of staff in the emergency medicine service and published by the HSE yesterday, forms part of a series of reviews of specialities across the health sector.

Calling for the development of new models of care, it says patients should be assessed, discharged or admitted within six hours of arrival in an emergency department.

It says patients should receive the same high standards of emergency care irrespective of the location.

The report proposes that the new networks would work closely with pre-hospital care as well as with hospital-based services and primary care. Paediatric emergency care would be integrated within the new system.

New clinical governance structures and practices should be put in place to drive improvement in the quality, efficiency and cost-effectiveness of patient care, it says.

Standardised, evidence-based processes for patient assessment in all emergency departments is recommended, with an emphasis on effective patient streaming and minimisation of delays.

National clinical guidelines would be developed and implemented for the top 20 high-risk and high-volume conditions.

The report suggests there could be different types of hospital emergency facilities, categorised as types A, B and C.

* Type A emergency departments would operate on a round-the-clock basis.

* Type B facilities, or local emergency units, would aim to provide unscheduled emergency care for lower acuity patients within the network. They would, however, open from 8am to 8pm only, seven days a week.

“Local emergency units are likely to be bypassed by ambulance services for high-acuity or complex care such as coronary reperfusion, stroke thrombolysis and major trauma in accordance with national protocols,” the report says.

* Type C facilities, or local injury units, would aim to provide unscheduled emergency care for patients with non-life-threatening or non-limb-threatening injuries.

The document proposes that type C units could operate from 8am to 8pm (or 6pm), followed by two hours of clinical work for the completion of patient care.

The report does not spell out either the number of or possible locations for the proposed different types of emergency facility.

Speaking at the publication of the report, Minister for Health James Reilly said the proposals in the 600-page document were not aspirational.

He said they had been drawn up by doctors, nurses, therapists and others who knew what was required to reorganise the system so they could deliver the care they can deliver.

He said the HSE’s central command and control system had disempowered them from delivering this in the past.

Dr Reilly said there had been suggestions the report could be used as a stalking horse to close some emergency units, but nothing could be further from the truth. “I anticipate the footfall in all of our smaller hospitals will increase, but they will be delivering safe services that are appropriate to the setting.”

The Minster said that since January of this year, in every month there had been 20 per cent fewer people on trolleys in emergency departments.