Can someone please explain the workings of A&E UCHG please?

2rkehij30qtza5

Galwayguy35 wrote: »

I went to the A&E in UCHG once and can only describe it as organised confusion, 12 hours I was there.

I take it you live in the city OP but personally I go to Ballinasloe, it's 10 times quicker and just as good.

UCHG holds my relative's file, hence we had to go there. But next week, once everyone is back to work in there, I'm demanding that we get a copy of his file so we are never limited to going there again.

Shakti

100200 shih wrote: »

They now charge for parking !!! so yes, they do

I wish I was surprised,

Shakti

confusedquark wrote: »

Yeah, am a GP Trainee, so have worked in a fair few hospitals along the way.

As a GP would you be comfortable sending a patient to be treated in UCHG knowing that they will have to wait anything from 8 to 16 hours and beyond for treatment of an acute condition?

also.....
Do GP's ever complain to hospitals on behalf of their patients and how they have been treated and find out who?/why? etc.

confusedquark

Whitney Tiny Skit wrote: »

I figured as much...well, that you were a medic of some type. Must be frustrating having to work in such a system...although you are probably out in a GP practice now. Thanks for all the input. Has certainly enlightened me somewhat.

Yeah, it's not the healthiest system to work in, esp when compared to the likes of Australia, hence droves of Irish doctors are leaving the country. Yeah, in a GP practice now, so it's not as crazy. No worries for the input, I know it's very frustrating to deal with the system, and it does help to get a few answers. Hope your relative gets better.

confusedquark

Shakti wrote: »

As a GP would you be comfortable sending a patient to be treated in UCHG knowing that they will have to wait anything from 8 to 16 hours and beyond for treatment of an acute condition?

No, but there usually isn't an alternative. If they're bad enough to need admission, they need to go to A&E.

Shakti wrote: »

Do GP's ever complain to hospitals on behalf of their patients and how they have been treated and find out who?/why? etc.

Yes, depending on the exact nature of what happened.

Shakti

confusedquark wrote: »

No, but there usually isn't an alternative. If they're bad enough to need admission, they need to go to A&E.

But doesn't sending someone to get treatment to a care centre were you know they will at worst not receive treatment and at best receive sub-standard treatment after an inordinate amount of time, defeat the purpose of trying to treat your patient in the first place, in other words shouldn't you be making sure your patients receive the treatment they require by sending them somewhere were they will receive that treatment and not somewhere like UCHG as a matter of course in your practice.

Yes, depending on the exact nature of what happened.

Glad to hear it, does anything ever come of it?

cuana

I am grateful to the A&E staff in Galway who have taken care of myself, family & friends over the years. I have been left waiting, in pain & even frustrated at times but I just have to look around me very clearly see that the staff are under pressure & know that it is not for lack of trying on there part. I also am very conscious that there are some seriously ill people who need urgent medical attention & they have to be the number one priority. I can honestly say that when I eventually did get medical attention & treatment that they have been extremely helpful but also when I needed urgent medical attention I got it.


I do think GP's are wasting a lot of time particularly when it comes to minor injuries. I sometimes feel that my GP has sent me in over the years for fear of making the wrong decision & off loading the problem on someone else; A system already under pressure. Now I don't have any medical background so I could be talking sh!te for all I know but surely GP's could actually provide more services within there practices in order to support A&E. I'm sure there is much more they could do like Xrays for minor injuries etc. I know there is cost involved but there must be a better more efficient way. I have had to sit in A&E for hours one day for an Xray on my foot I knew it wasn't broken but hurt like hell! I went in on the advice of my GP and yes feeling miserable for myself but what a waste of time for those involved.

Shakti

Easiest way to relieve the pressure on UCHG is to stop closing and re-open the hospitals surrounding it, the staff in UCHG have been shafted by management and the minister time and time again and it shows and I can empathise with them but not half as much as I do with the patients,

confusedquark

Shakti wrote: »

But doesn't sending someone to get treatment to a care centre were you know they will at worst not receive treatment and at best receive sub-standard treatment after an inordinate amount of time, defeat the purpose of trying to treat your patient in the first place, in other words shouldn't you be making sure your patients receive the treatment they require by sending them somewhere were they will receive that treatment and not somewhere like UCHG as a matter of course in your practice.

I don't know what encounters you've had with UCHG, and although no hospital is perfect, the vast majority of people that are seen in A&E (after however long the wait) receive good and appropriate treatment. Do you honestly believe that every single person that attends there receives sub-standard treatment?

Shakti wrote: »

Glad to hear it, does anything ever come of it?

Sometimes yes, sometimes not.

confusedquark

cuana wrote: »

I do think GP's are wasting a lot of time particularly when it comes to minor injuries. I sometimes feel that my GP has sent me in over the years for fear of making the wrong decision & off loading the problem on someone else;
A system already under pressure. Now I don't have any medical background so I could be talking sh!te for all I know but surely GP's could actually provide more services within there practices in order to support A&E. I'm sure there is much more they could do like Xrays for minor injuries etc. I know there is cost involved but there must be a better more efficient way. I have had to sit in A&E for hours one day for an Xray on my foot I knew it wasn't broken but hurt like hell! I went in on the advice of my GP and yes feeling miserable for myself but what a waste of time for those involved.

Yes, GPs can do a lot more, but the services are set up so they don't have access to them. In your case, I'd be perfectly happy as a GP to bypass A&E and send you straight to the x-ray department for an x-ray, and if the report was back to me the same day and all was clear, it would save both you and the A&E staff the hassle. However, the way the system is set up, GP's can't request x-rays like that, and you'd often wait up to 2 weeks before you get the report back. Clearly if you do have a fracture, you don't want to be sitting around that long without treatment. Hence, the GP doesn't have a choice but to send you in just so you'll have the x-ray the same day and somebody can look at it in A&E. I can cite countless other examples of such inefficiencies, but the HSE don't interact with or listen to GPs to improve things - they think they know best and unilaterally decide on such matters.

Shakti

confusedquark wrote: »

I don't know what encounters you've had with UCHG, and although no hospital is perfect, the vast majority of people that are seen in A&E (after however long the wait) receive good and appropriate treatment. Do you honestly believe that every single person that attends there receives sub-standard treatment?.

Unfortunately I've had pretty appalling encounters to understate it with UCHG A&E but no I do not believe every single person receives sub-standard treatment in UCHG but if a patient has to wait 6-18 hours to be treated then this in itself constitutes sub-standard care from the outset. Waiting lists in public health seem to have obtained an expectational status as the default rather than the constant consistent failing day in day out of public health that the waiting lists actually constitute, not to mention the harm physically and emotionally that they do to patients and carers or family members, in short waiting lists kill and dis-ease.

flynnlives

welcome to Angola!

mikom

Remember the A & E that FG closed in Roscommon...........

Galwayguy35

I know that staff are under pressure but it's crazy that people have to wait so long to be seen.

Noone should have to wait more than 3 or 4 hours at most, we are a small country of about 4 million people and successive Governments have been bladdering on about making things better for over 20 years.

I thought Reilly might be better than what went before him but he is about as useful in that job as tits on a bull.

Looks like things will never change.

2rkehij30qtza5

Galwayguy35 wrote: »

I know that staff are under pressure but it's crazy that people have to wait so long to be seen.

This is my issue. If A&E is so busy, then there should be more staff on to ensure people are seen within a reasonable timeframe. There should at least be a contingency plan in place whereby if A&E starts filling up and is busier than expected, then extra staff should be able to be drafted in at short notice...and all patients seen within a reasonable timeframe.

Nobody should be left sit on a plastic chair with zero care for 16 hours etc.

If a GP deems that a patient is sick enough to warrant A&E care, then how is it reasonable for that person to be left for that number of hours with NO treatment whatsoever.

Confusedquark explained how A&E is staffed.

So from what i can see, there appears to be failings in the HR Dept of UCHG and in the Overseeing doctor and nurse down in A&E.

Yes, undoubtedly you do get good care ONCE YOU ARE SEEN in UCHG. But consider this...you are sent in to A&E in bad shape by your GP. Sixteen hours later with no sleep & no treatment...how do you think the patient will be by then?...clearly in a worse state than when they were initially referred. It's so wrong on so many levels.

On a positive note we are now in the Galway Clinic, he has been admitted, already has seen a doctor and he is getting the treatment he badly needs. We are lucky that we can afford this as an option. It's a shame that we had to go down this route but unfortunately we felt we had no choice. There are more people out there who would not be in a position to pay out the A&E charge to the Galway Clinic or do not have private health insurance & must endure the crazy waits in A&E.

And why I'd like to know???.....whoever is making the staffing decisions in A&E in UCHG should be ashamed of themselves. Supply should meet demand. It is UNREASONABLE to expect a very sick patient to wait for a full day and not be treated or seen. It's seriously 3rd world carryon.

BhoscaCapall

ArtyC wrote: »

How helpful.....

If the information provided in this thread is correct then that is the most helpful advice anyone has given the OP thus far.

jugger

Whitney Tiny Skit wrote: »

On a positive note we are now in the Galway Clinic, he has been admitted, already has seen a doctor and he is getting the treatment he badly needs.

any chance you can give us a time frame

how long from when you entered the building untill you were treated just so we can see the difference

if you dont mind of course

Reventon93

Just wanted to give my 2 cents because I was in A&E on St Stephens night. I was told by a nursing friend that i'd be there all night waiting to be seen. Luckily I wasnt!

I arrived at 7pm and was seen about 8:30 pm. Was then shortly sent for an x-ray within about 10 mins i'd say. After that I was seen by the ortho team and was finished with around 11. All and all the longest I was waiting was 3 hours for a bed for the night which was around 2am

I think that it depends on what youre there for. The man in front of me was in for chest pain, I think. And by the looks of it, there were people who didnt seem to be in much trouble

I hope your relative is ok and has gotten the treatment he needed.

cuana

confusedquark wrote: »

Yes, GPs can do a lot more, but the services are set up so they don't have access to them. In your case, I'd be perfectly happy as a GP to bypass A&E and send you straight to the x-ray department for an x-ray, and if the report was back to me the same day and all was clear, it would save both you and the A&E staff the hassle. However, the way the system is set up, GP's can't request x-rays like that, and you'd often wait up to 2 weeks before you get the report back. Clearly if you do have a fracture, you don't want to be sitting around that long without treatment. Hence, the GP doesn't have a choice but to send you in just so you'll have the x-ray the same day and somebody can look at it in A&E. I can cite countless other examples of such inefficiencies, but the HSE don't interact with or listen to GPs to improve things - they think they know best and unilaterally decide on such matters.

IMO that is just tragic truly shocking! It clearly lacks any insight for management of the HSE not to mention disrespectful to those in your area. Even I can see that GP's can influence & deliver on positive change within this sector.

cuana

Whitney Tiny Skit wrote: »

This is my issue. If A&E is so busy, then there should be more staff on to ensure people are seen within a reasonable timeframe. There should at least be a contingency plan in place whereby if A&E starts filling up and is busier than expected, then extra staff should be able to be drafted in at short notice...and all patients seen within a reasonable timeframe.

Nobody should be left sit on a plastic chair with zero care for 16 hours etc.

If a GP deems that a patient is sick enough to warrant A&E care, then how is it reasonable for that person to be left for that number of hours with NO treatment whatsoever.

Confusedquark explained how A&E is staffed.

So from what i can see, there appears to be failings in the HR Dept of UCHG and in the Overseeing doctor and nurse down in A&E.

Yes, undoubtedly you do get good care ONCE YOU ARE SEEN in UCHG. But consider this...you are sent in to A&E in bad shape by your GP. Sixteen hours later with no sleep & no treatment...how do you think the patient will be by then?...clearly in a worse state than when they were initially referred. It's so wrong on so many levels.

On a positive note we are now in the Galway Clinic, he has been admitted, already has seen a doctor and he is getting the treatment he badly needs. We are lucky that we can afford this as an option. It's a shame that we had to go down this route but unfortunately we felt we had no choice. There are more people out there who would not be in a position to pay out the A&E charge to the Galway Clinic or do not have private health insurance & must endure the crazy waits in A&E.

And why I'd like to know???.....whoever is making the staffing decisions in A&E in UCHG should be ashamed of themselves. Supply should meet demand. It is UNREASONABLE to expect a very sick patient to wait for a full day and not be treated or seen. It's seriously 3rd world carryon.

Delighted to hear that there seen & your happier. IMO this is also a big part of the problem within the HSE, some people are willing to pay for private health care thus I can only assume that this would influence negatively on the public services in terms of budgets, funding & resources available to them. Now I don't blame people using this alternative. There may be some positive elements I can only assume the point of introducing private care was to lessen the burden on the public sector & influence, generate income for the state but again it must come at a price for those in the public sector.

mathepac

I'm glad to hear the OP's relative get the medical attention they needed and I hope they make a speedy recovery.

I also worked in the HSE (not in the West and I'm not a medic) and the entire organisation is an administrative shambles - shambolic from top to bottom. The finest medics, paramedics, nurses, etc cannot hope to function when they have no real input to or influence over staffing levels or budgets.

The HSE collects masses of data. From these data-collections, given the computing power the HSE has at its disposal, it must be possible to build a simple forecasting system that would pre-warn the planners what days, nights, week-ends or weeks are busiest (numbers of patients, level of care required, etc) and to ensure enough staff are available to meet the demand for services. It is not rocket science to block out these periods on the calendar and say "sorry folks, no annual leave, no days in lieu, no training during the periods marked in red on the calendar."

This thing that the HSE refers to as triage isn't working and of course it isn't triage; it's causing bottle-necks and queues where they never existed before and has not cleared the big one with people waiting in the same one big queue, but now they are not waiting to be seen; in reality they are simply waiting to join another queue!

These queues require managing and the more queues you have the more managing they need, so to free up staff, time and the other hospital resources needed to store the queues of patients, eliminate the queues. Immediately stop this entirely obstructive "triage" process.

Patients get divided into two categories, allocated to one of two treatment teams:

• those who need immediate medical treatment
• those who can afford to wait for treatment.

Because there are only two categories of patient, if someone's status changes, they can easily be transferred between teams. The initial assessment would probably need to be done by a medic for this suggestion to work properly.

Intoxicated people get intercepted and treated slightly differently, but still get assessed and allocated to one of two treatment teams working on :

• those who need immediate medical treatment
• those who can afford to wait for treatment.

Theses patients are treated in a different section or in a different hospital.

Surely it is not outside the scope of some task-force or manager to try to change the current shambles? It currently doesn't work for anyone and in its current state it never will.

For historians the triage process was used in military situations where battle casualties were allocated to one of three queues to await treatment based on these criteria:

• those who would die whether treated or not (lowest priority)
• those whose injuries did not require immediate treatment (medium priority)
• those who would survive if they received immediate treatment (highest priority)

This is triage; nothing that requires more than three ("tri") categories is triage.

Shakti

^^^^^^^
best post so far on the subject

Mrs OBumble

cuana wrote: »

IMO that is just tragic truly shocking! It clearly lacks any insight for management of the HSE not to mention disrespectful to those in your area. Even I can see that GP's can influence & deliver on positive change within this sector.

Something worth noting: we all "go private" to when we see a GP - because (virtually) all GPs in this country operate as small business people. Some folks have their GP care subsidised via medical cards - but GPs are not under direct HSE control. And that is why they don't get ready access to HSE diagnostic services - because if they did the hospital would lose control of how many x-rays they do, and of prioritising the queue.

leanonme

Whitney Tiny Skit wrote: »

Didn't realise that some people are exempt from the €100 charge and don't see why it isn't applied to all. Might stop the influx of all the people who appear to be clogging up A&E unnecessarily.

Afterall....if they are sick enough to be admitted they get the €100 back, or can claim it back at least. If they are not sick enough to be in A&E then they lose the €100 and it might make them go to their GP next time...where they get free treatment anyway. Makes more sense.

Anyway, bottom line is- WHO MANAGES A&E and lets it operate with insufficient staff levels???????

Some people are exempt from the charge because they cant afford it. How do you decide who gets there money back and who doesn't. Not everyone who attends a and e is admitted, some just receive the treatment they need and are sent on there way.

I dont believe that charging people will make a difference, however I do believe that how they assess a patients needs will make a difference.

I have been in a and e 3 times this year with 3 different family members and you be surprised at how people are assessed for treatment.

On one occasion I was in with a family member who had bad chemical burns to his face, neck, and arms, these burns had blistered, were weeping and extremely sore, we were left waiting five hours, and two seperate children who had sprained wrists were seen within two hours.

On a separate occasion I was in with another family member who had a deep cut to his finger, so much so that his bone was on display, he lost a good bit of blood, and was very pale when we got to the hospital, he was left waiting 6 hours, again with kids with sprains being admitted first, and by the time he was seen his finger had swelled to much that they were not able to stitch it, so he had to wait till the weekend was over to go to James to have the stitches done, get to there and they inform him that he had serveded 90 percent of the tendons and nerves and require surgery, to cut away the swelling so that they can fix it.

Neither of these occasions were at busy times, both during the middle of the day during the week.

cuana

Mrs OBumble wrote: »

Something worth noting: we all "go private" to when we see a GP - because (virtually) all GPs in this country operate as small business people. Some folks have their GP care subsidised via medical cards - but GPs are not under direct HSE control. And that is why they don't get ready access to HSE diagnostic services - because if they did the hospital would lose control of how many x-rays they do, and of prioritising the queue.

I never knew this! I always just thought they were all part of they same system thanks

confusedquark

Mrs OBumble wrote: »

Something worth noting: we all "go private" to when we see a GP - because (virtually) all GPs in this country operate as small business people. Some folks have their GP care subsidised via medical cards - but GPs are not under direct HSE control. And that is why they don't get ready access to HSE diagnostic services - because if they did the hospital would lose control of how many x-rays they do, and of prioritising the queue.

Yes, GPs operate as small business people, but a decent portion (and in many cases, the majority) of their income comes from the HSE - so they're not all that independent either. Yes, there is concern that if GPs were given more access to HSE diagnostic services (e.g. same day x-ray reporting by a radiologist), there would be an increase in referrals, and possibly unnecessary referrals, but there is a way to regulate that - GPs can be notified beforehand of the strict rules for the service, inappropriate referrals can be rejected, or even have a system where a GP has to speak to a radiologist in the hospital to confirm that the referral meets the criteria. Every A&E referral avoided saves the patient a long wait, saves a space in A&E, saves the triage nurse time, the A&E doctor's time, and after all that, the radiologists still have to report on every x-ray done in A&E anyway (even after the A&E doctor looks at it and makes his decision), so there won't be extra work for them - it'll simply be tomorrow's work done today, with A&E time saved. It's a very workable system, only the specifics need to be hammered out with everyone at the table, but nobody's looking that way. The NHS invest a lot of time and money in primary care, and GPs are the ones who decide where the government health budget is spent - yet here, they're barely consulted.

wintersolstice

100200 shih wrote: »

They now charge for parking !!! so yes, they do

There are no prking charge I merlin park but it is getting harder to find a space.

Brennans Row

Parts of hospital closed due to burst sewage pipes (Irish Times)

Local Fine Gael councillor Pádraig Conneely visited the hospital last night and said the incident was “unfortunate” as it was “not good for the public perception” of hospitals.

“It’s in the prefabs quite close to the entrance to the Accident and Emergency.

It seems there was a problem with the sewerage under the floor.

“They will probably have to decontaminate the area,” he added.

Another nice task for the HSE to tackle after the recent flea outbreak.

blackdog2

Still, the country hasn't the money to run a real health service, at least not like is currently run, and even if it is properly run, who knows if it could actually serve the public

mathepac

"Local Fine Gael councillor Pádraig Conneely visited the hospital last night and said the incident was “unfortunate” as it was “not good for the public perception” of hospitals. “It’s in the prefabs quite close to the entrance to the Accident and Emergency. It seems there was a problem with the sewerage under the floor.

“They have brought in a suction lorry to clear it all out. The affected areas will therefore be closed tomorrow. There are no beds in there – it’s just for examinations – but there is expensive machinery and equipment.

“They will probably have to decontaminate the area,” he added."

I'm aghast at this guy's antediluvian attitude. Not once has he mentioned a patient apparently or the idiots who decided to site the trailers over the main sewer.

As for “not good for the public perception of hospitals"; the public knows what to think and public perception IMHO can't sink any lower, despite his own best efforts.

This crowd just beggar belief.