The current hospital / A&E crisis

Today’s Indo details a plan to have GPs stationed to triage patients presenting at the overcrowded Emergency Dept of UL Hospital.

https://www.independent.ie/irish-news/hospital-will-station-gps-at-aande-doors-to-screen-patients-who-are-not-sick-enough/a2015031849.html

It seems that there are a significant number of people presenting with quite minor conditions or ones that can be easily managed by a GP, primary care centre or pharmacy. The plan is to redirect them out of the Emergency Dept to new primary care set-ups as trying to manage them in a setting where there are very seriously ill people needing full attention is just not appropriate and distracts from the care of critical cases.

NIMAN

We always knew that so many of those blocking emergency depts shouldn't be there at all.

Its the elephant in the room, but was rarely mentioned in the media when the topic was being discussed.

Of course a lot of that is down to lack of GP availability, but there are some people who go for medical attention for very little reason, or for something non-serious that will resolve of its own accord.

I can think of one such instance related to me by a colleague years ago. My colleague was giving out about how badly her daughter was treated in A&E the previous night. The story went that she, a very healthy young girl without any medical issues, had eaten some food that was off, and not unsurprisingly developed diarrhoea that went on for several hours. She had her husband there to look after the young children, so no problem in that respect. Her mother accompanied her to the hospital as “she needed a drip”. Why she couldn’t have sipped dioralyte I don’t know. She wasn’t even vomiting at the time. Of course she was left sitting in A&E for hours, with mummy distressed that she still had the runs and was in and out to the loo every five minutes, as happens. Tests proved nothing serious going on, just a harmless form of short-acting food poisoning that would resolve, advised to go home and take dioralyte and have soup etc. Mammy absolutely insisted on a drip, they conceded to do that and then sent them home by taxi. As it turned out she was fighting fit again next morning. “Because of the drip” Mammy insisted. I had to nod politely, but I was thinking, what a waste of resources clogging up an emergency department where seriously ill people were competing for attention.

BrianD3

GPs screening people at UHL A&E? I'll believe that when I see it. Is there a surplus of GPs in the Limerick area? I could see some GPs doing this alright if a ball of money is thrown at them. Ring your GP, be told there are none available, attend A&E - ah so that's where my GP is.

But it sounds more like a HSE version of TV Detector Vans. Don't attend the A&E as otherwise the boogeyman GP will stop you at the door - except there won't be any GP. It might actually work too but if that is their tactic, it shows how desperate they are.

https://www.boards.ie/discussion/comment/121953818#Comment_121953818

just put some geezer in a white coat with a stethoscope by the door asking one or two questions, but like passport/visa control.

jimmyrusseII

https://www.boards.ie/discussion/comment/121953438#Comment_121953438

I can see some GP's getting their asses beat when they tell the wrong person to go home there's nothing wrong with them.

jackboy

https://www.boards.ie/discussion/comment/121954218#Comment_121954218

It will never happen. Assessing people without any testing or scans is 100% guaranteed to kill people.

jimmyrusseII

https://www.boards.ie/discussion/comment/121954247#Comment_121954247

Yeah if I come in complaining of a pain in my leg I could be taking the piss but I could have blood clot or something.

GloriaBog

I've always, always gone to our GP. But it's so hard now to get an appointment. So I thought of going to the emergency dept at county hospital, then my neighbour told me they were hours there with their child who had a nasty looking cut. It's all very worrying.

Goldengirl

I don't know . Just shows how desperate the situation has become in UHL .

That poor man found dead , and so many other stories .

If people actually do need further tests then that GP will refer them in to the A&E .

It sounds like an ED version of DDoc / Care Doc / South Doc etc .

If people can't get to see a GP why go to A&E ? Just book an appointment with your local after hours GP service .

Like why would you not , I don't get it ?

Mrs OBumble

If people can't get to see a GP why go to A&E ? Just book an appointment with your local after hours GP service

If you have a medical card, A&E is free and so is your GP. But the after hours isn't.

Goldengirl

Very good !

Wouldn't you think that that is the first thing that should be changed ?

https://www.boards.ie/discussion/comment/121954218#Comment_121954218

Especially with the high profile tragic deaths that have taken place in recent years there. All it would take would be one GP turning someone away “it looks like a tummy bug, take some Imodium & go back to your GP he opens on Monday”, then the person goes home, appendix ruptures and own GP sends back to A&E with the person now in sepsis.

I think the following cases a GP could typically redirect without deadly consequences:

Relatively minor orthopaedic stuff like a broken foot in an otherwise healthy person.

A small gaping cut on the arm that needs treating at a minor injuries clinic.

But so could a Nurse Practitioner.

MEGA BRO WOLF 5000

https://www.boards.ie/discussion/comment/121954436#Comment_121954436

Id think a GP would know the difference between a tummy bug and appendicitis.

Goldengirl

https://www.boards.ie/discussion/comment/121954450#Comment_121954450

Also a triage nurse .

Imagine the uproar if the triage nurse had another code besides green , orange and red , and told those put in say " purple " go home and go to your GP tomorrow !

mykrodot

https://www.boards.ie/discussion/comment/121954470#Comment_121954470

doctors differ, patients die. The young girl from Shannon, Aoife Johnston, who died in UHL in 2022 had every symptom of sepsis, her parents and other patients in A&E begging the doctors to take care of Aoife and that she had sepsis symptoms but they were brushed off and ignored ….by doctors.

Following on from that another 16 year old girl died in UHL in January, again after being sent home with breathing difficulties a few weeks earlier, then presenting again with worsening symptoms.

https://www.independent.ie/irish-news/health/new-inquiry-at-limerick-hospital-after-a-second-girl-dies-suddenly-aged-16/a2080668124.html

Mrs OBumble

https://www.boards.ie/discussion/comment/121954450#Comment_121954450

Where would they send them to, given that GPs don't have x-ray facilities or have minor injury clinics?

jackboy

https://www.boards.ie/discussion/comment/121955217#Comment_121955217

Yes it is a mess. Large blocks of the population cannot get a doctor and that is not going to change.

The out of hours service is basic and they warn people not to go to them unless urgent but they also say if an emergency go straight to hospital. This confusing nonsense means that patients essentially have to assess themselves to decide where they need to go.

BrianD3

https://www.boards.ie/discussion/comment/121955374#Comment_121955374

In my area (I presume it is similar elsewhere) people routinely contact the out of hours service if they can't get an appointment with their GP in a timely manner. The GP encourages this - telling people that they are booked up for 2 weeks and suggesting they contact out of hours service while also putting the onus on patients themselves to make a decision "if you are concerned about your health just do x and y"

What happens when someone calls the out of hours services? A very basic service, phone consultation from a nurse and a recommendation to go to A&E is often the result.

This can also easily escalate to a recommendation to call an ambulance. When ambulance arrives, ambulance crew complain bitterly about being called out on the basis of a phone consultation.

The system is a shambles with multiple parties trying to blame and deflect/fob off problems onto others and cover their own arses.

Also, surely, the out of hours service should primarily be for issues that arise out of hours, not as a relief valve for GP day services.

Dr Turk Turkelton

Last couple of times my family have needed a doctors appointment the wait is 2/3 weeks.

We are now using the vhi clinic- amazing service.

MEGA BRO WOLF 5000

https://www.boards.ie/discussion/comment/121954789#Comment_121954789

Yeah I know. I work in ED in UHL.