Sir, – Jim Lawless, who sadly lost his wife to a brain haemorrhage in 2005, deserves our thanks in highlighting a serious issue regarding the treatment of patients who suffer a brain haemorrhage in the community (March 10th).
At present anyone suffering a stroke or brain injury in the community must first be assessed in the nearest hospital (as a brain scan is necessary to differentiate a brain haemorrhage from the more common brain infarction or non-haemorrhagic stroke).
However, even after a diagnosis of brain haemorrhage, patients do not automatically transfer to the neurosurgical “centre of excellence” in Beaumont Hospital in Dublin, as one would quite properly expect. The reasons for this are unclear.
Mr Lawless rightly seeks evidence that this management (or lack of) does not adversely affect patient outcomes (that is, has the HSE compared morbidity and mortality rates between the patients who were transferred to Beaumont Hospital and those who were not?). One would think this would be a basic audit target of any new protocol in the management of patients with brain haemorrhage.
However, Mr Lawless indicates that the HSE has not even collated the numbers of patients involved and appears to have no intention of doing so due to a lack of resources. This is simply shocking.
The Phillips report on traumatic brain injury, commissioned by the Department of Health in 2008, specifically recommends a national trauma registry to help structure the provision of services.
The HSE is on record as saying this is not a bed issue. How is the HSE able to say with any certainty that there is an adequate number of beds in Beaumont Hospital if they do not know the number of patients who could possibly need treatment? How does it know it is following what is best for patients if it does not measure outcomes?
Supermarkets do better audits of new products than the HSE appears to be doing for patients with brain haemorrhage (up to 1,290 people per year, we have been informed by Mr Lawless).
I would like to see the HSE take this matter very seriously and move to audit its past and current activity as a matter of urgency and show us the numbers and some clinical evidence. Then and only then can we be assured of what is best practice for patients with brain haemorrhage. – Yours, etc,
Dr STEPHEN MURPHY,
Ashbourne Family Practice,
Ashbourne,
Co Meath.