How would you sort out Hospital A&E Crisis - Long waiting times- trolleys in corridor's etc

Potatoeman

https://www.boards.ie/discussion/comment/121601604#Comment_121601604

Cancer screenings are a major concern, they should get these through asap with private or public as it costs more in the long run not to mention the misery it creates for all involved.

Wanderer78

https://www.boards.ie/discussion/comment/121601630#Comment_121601630

absolutely, and im hearing this part of the health system is still working well, sadly i know someone that did die from it during covid, i think the system truly did fail her, but the system was completely in disarray, which was completely understandable...

Big Bag of Chips

https://www.boards.ie/discussion/comment/121601188#Comment_121601188

TDs ringing asking where "Mick" is on the list pisses the hospital staff off no end. (Huge increase in the amount of enquiries around election time. We never hear from a TD otherwise!) TDs don't/can't do anything about it. At least not in the immediate term. But they think if they ask that the hospital will bump Mick up the list just because the TD is involved.

If Mick's appointment actually comes up naturally within a few weeks of the TD contacting the hospital, Mick thinks local TD is a great lad because he got him into the hospital. And local TD is happy to take the credit for getting Mick seen.

If you're on a long waiting list do not ask your local TD to contact the hospital on your behalf. But maybe ask your local TD what are their plans for reducing waiting lists and waiting time in ED etc.

Wanderer78

https://www.boards.ie/discussion/comment/121601950#Comment_121601950

...the fact that td's getting directly involved in such cases, shows how dysfunctional the whole system is, and clearly isnt truly functioning well at all....

mariaalice

What should happen to those with chronic conditions who might need say temporary oxygen support, severe asthma attack, or any other sort of urgent but temporary medical support, those with Parkinson's, heart failure, cancer, or any similar condition their GP has sent them to A&E?

downtheroad

Legalise euthanasia

mariaalice

https://www.boards.ie/discussion/comment/121603679#Comment_121603679

Do tell me how it will work, when the patient comes to A&E are they to be offered Legalised euthanasia?

https://www.boards.ie/discussion/comment/121601950#Comment_121601950

One thing I found by contacting local TD when I was finding it extremely difficult getting a neurologist to take me on, public or private between one thing and another, is that I actually found out that though I had been led by my GP to believe he had made a referral, turned out no such referral had actually got through as my GP didn’t actually understand how to use the computer system!

I returned to GP, had to pay another €65 to get him to type and print out a plain old fashioned referral letter, which I sent in registered post to a prominent MS Clinic. I got a reasonably urgent appointment and got diagnosed with longstanding MS. It shouldn’t have taken the TD’s help, but I was already almost losing the will to live over what was happening to me, and he was particularly responsive and followed up to make sure I was subsequently under care.

Big Bag of Chips

https://www.boards.ie/discussion/comment/121603666#Comment_121603666

If they need urgent attention, they will receive urgent attention. I'm not sure I understand your question.

mariaalice

https://www.boards.ie/discussion/comment/121603946#Comment_121603946

Maybe a better way of putting it is semi-urgent, they could have been dealt with by a better GP service but the GP sent them to A&E or they might need medical care but not need to be admitted A&E seems to have become a gatekeeper to a lot of treatment they could be had in a different setting or even by appointment to the right service, for example, why are people admitted just to get a scan, if they are not unwell but in need of a scan they should be given an appointment for a scan go home and come back for the appointment, or why is there no direct admittance to a private hospital in emergence or semi-emergency.

Andy From Sligo

https://www.boards.ie/discussion/comment/121603679#Comment_121603679

well look , its funny you should say that. Yes , great medical and science break throughs these days ... fantastic, it makes people live longer . Years ago people even died of something as simple as a cold ... but what is the point of getting to 80 or whatever and being in pain, things still wearing out still, in and out of hospital and GP's all the time, some people waiting game for the grim reaper to come knocking , people in pain every day they wake up, sometimes not even being to sleep at night, on a cocktail of tablets and medications every day ..... taking up hospital beds and family wondering what old peoples homes to place their 'loved ones' in.

maybe legalised euthanasia might not be too much of a bad thing and might solve a lot of problems in a lot of areas of the health services!

Big Bag of Chips

why are people admitted just to get a scan, if they are not unwell but in need of a scan they should be given an appointment for a scan go home and come back for the appointment,

Generally you don't just get sent to ED for a scan if there's no immediate indication. You will be given an apt and you will be sent home to wait for the appointment.

Someone who presents to ED in a certain condition, acute pain for example, may be given a scan as part of the treatment and investigations in ED. But you don't get admitted to ED for a scan if you are not unwell. If a scan is advised, but not urgent, it will be put up on the hospital system, the patient will be discharged from ED and will get an appointment out for the scan.

downtheroad

https://www.boards.ie/discussion/comment/121603820#Comment_121603820

See response below from Andy From Sligo.

It eases the burden on the overall health system.

mariaalice

I know someonw who was admitted so they could get a scan as the outpatient waiting list for a scan was huge, that was before covid. I also know someone who was told they can wait for an outpatient appointment they weren't urgently ill but the GP said that could be a years wait , then GP said go to A&E so they did and got a scan and was seen they were diagnosed with a serious illness, they were sent home and admitted a week later for treatment.

Why does that happen? Why do public patients often pay for scans privately? Or why do some GP tell patients to go to A&E in the hope that the person get a scan or treatment quicker?

mariaalice

I know a lot of the issues aren't to do with A&E or mor correctly ED.

https://www.boards.ie/discussion/comment/121604047#Comment_121604047

SVUH send a number of ED admissions to their private hospital when there is space, I had the pleasure of being transferred there as a public patient from A&E, own room, proper diet, good care. Had peritonitis from having had my uterus accidentally perforated during a procedure in the public hospital two days earlier.

A couple of weeks later I developed peptic ulceration, they didn’t know what was wrong with me, why I was still in pain or why the pain had shifted located, but admitted me “for a scan”. They said I might have to wait several days in the public ward to get that scan. In meantime I was denied hydration and simply had curtains pulled around me. I discharged myself and went to a private hospital for immediate diagnostics and treatment which I took at home. The public hospital would have happily had me blocking a precious bed waiting for diagnostics.

https://www.boards.ie/discussion/comment/121605674#Comment_121605674

A huge amount of the problem is lack of diagnostic facilities. I attend the MS Clinic at SVUH but Prof Tubridy gives out how he can’t have timely MRI scans done on patients and always refers me to Blackrock to have the scans done as I am insured.

https://www.boards.ie/discussion/comment/121605647#Comment_121605647

Yes it sometimes happens that a patient already with potentially serious symptoms do find they can better attack diagnostics by attending A&E, an example might be trying to get a timely colonoscopy when you have some symptoms that could be early bowel cancer, eg after an episode of passing a small amount of blood. In some centres you might be given a scope appointment a few months ahead and risk disease spreading. The way to go might be present at ED and saying you have some additional symptom like discomfort and are quite concerned that you aren’t feeling great. It’s possible they might pull forward the test if you lend a bit of urgency to your symptoms. Of course, this means somebody else goes back in the queue, but the system forces us to sometimes fight for our own survival.

Because I failed to make a “fuss” about neurological symptoms, I allowed MS to go undiagnosed and untreated for decades. So I don’t recommend keeping very low key when it comes to your health.

Andy From Sligo

https://www.boards.ie/discussion/comment/121607855#Comment_121607855

it always does feel with the HSE health service that he/she who makes the most 'noise' gets seen the soonest, if you just keep quite and dont keep phoning up how much longer you are on the waiting list I reckon you are just then forgotten about.

Even in A&E when I was in there last march or whenever it was , poor middle age lady with a broken arm in the waiting area i think she had , had been waiting for hours and hours - in the end she became very very distraught and cried unconsolably and a nurse came through the doors, tried to console her and was crouching down and talking nicely too her ... no long after they wheeled her off somewhere . I just wondered to myself I wonder how much longer she would have been sitting there in the waiting room had she not broke down like that. - as long as 19 hours I was in there at that time , but then again I was silent and didnt cause any fuss , and the rest of us that didnt cause any fuss had to wait overnight.

What I was most surprised about in a way on that occasion is that the GP had put a ECG on in his doctors surgery and didnt like the readings, and said to me I would like you to go to A&E , Nah I will be waiting in there ages I said "No, he said I will write a letter you can take in and give to the receptionist in A&E and they will see you quicker because you have already come into me first" .... well that didnt happen , still had to wait 19hours only to be told next morning by a doctor that it was Costochondritis and just got sent home with ibroprufen after 19 hours .

You know when many get fed up and leave and people go "if you get up and leave , or even think about getting up and leaving then you probably dont need to be in the emergency department then" , I must say that a lot of the time throughout that 19 hours it did cross my mind too a lot except for that I am 58 and you know a bit obese and the doctor (GP) had worried me when he said after the ECG that he didnt like my heart rate that it could be heart attack so strongly recommended me to go in. Of course after 19 hours waiting and in the waiting room overnight which was cold because the air conditioning was not working properly so pumping out freezing cold air and on uncomfortable hard plastic seats and not being able to even get a decent kip .. and then to wait for a doctor in the morning to do his rounds and send you home with a prescription for ibroprufen and paracetamol you feel a bit angry still and hard done by - no, but joking aside you got to get these things checked out , it was pretty painful and the pain was going down me left arm too and underneath my armpit.

https://www.boards.ie/discussion/comment/121609227#Comment_121609227

I’m very familiar with costochondritis, inflammation of the join of a rib or two on the breastbone, and the pain does radiate as you say, can be down the arm or through to the back. But it should have been easy for them to make the differential diagnosis. I have presented different times with costochondritis and a Takotsubo heart attack which affects the muscle of the left ventricle. A troponin blood test quickly reveals whether or not the heart muscle has been strained by a heart attack, it’s fairly definitive. A negative test should rule that out very quickly. When I had negative troponin I was discharged very quickly, when I had positive troponin I was given rapid emergency management of a heart attack and brought to cath lab. There was little waiting around.

The differential diagnosis might be pericarditis, inflammation of the sack around the heart which in its milder form is self healing and after a day or two monitoring and assessment for any conditions contributing to it, you often get discharged. Also listening to the chest can help rule out pneumonia with pleuritic pain, as can a chest xray. A clot in the lung is evaluated with D-Dimer and other tests, that can take a bit of time. Normally though, no need to keep people for hours on end with chest pain, it’s kind of either serious or musculo-skeletal and pressing on the breastbone will cause pain in that case.

Lack of experience of doctors working in ED can slow things down a lot. They can miss serious things by this lack of sufficient haste, and also detain people unnecessarily who if diagnosed earlier could be sent home with a management plan.

Andy From Sligo

https://www.boards.ie/discussion/comment/121609346#Comment_121609346

Thanks for that, here was my night/19 hours in ED how it panned out as far as I can remember it:

Doctor sent me in to ED with letter, Got into ED around 5PM . - 6pm Triage saw me , asked questions took BP and some bloods - that was it until 1am for more bloods (they put a catheter in my arm) then back to waiting room until 8am then called for more bloods (doctor said they didnt do d-dimer test at 1am) and then done ECG then chest x-ray, I had to wait for bloods and ecg and xray result to come back and wait for consultant . I see what you say about being discharged quickly, that would have been lovely , but you see how everything is dragged out and can see why your in for the long haul. I mean I cannot even understand why I goes in at 5pm and then between 8am-9pm the next day thats the time I finally get an x-ray , almost like the x-ray department does not 'open up' until 8am and is closed for the night! - but surely that cannot be the case surely? - but then in the morning aroud about the same time around the 8am mark people who had come in the night with arm in sling or needed x-ray, the same with them - it seemed things just started to move again and the department started livening up again whereas through the night apart from a couple of nurses walking up and down the corridor there was hardly any life, like the department had shut down or something!

Martina1991

https://www.boards.ie/discussion/comment/121609442#Comment_121609442

The Radiography dept operates routinely from 8am to 8pm Monday to Friday. Outside of those hours there is an emergency on call service.

That means one person is on for the night to perform emergency scans (Xray, CT, MRI etc).

Andy From Sligo

https://www.boards.ie/discussion/comment/121612574#Comment_121612574

thanks - 1 person , thats comical! - you can bet in a lot of cases someone is going to fall out of bed and break something , or slip up at evening/after 8pm and at weekends.

Going back to 2010 when i was in ward with PE blood clot I was in bed and a nurse came around Friday evening and said "now, you need a chest Xray - but it looks like you will be in with us over the weekend sorry , because the next time they can do a X-ray is Monday morning!

makes sense now

https://www.boards.ie/discussion/comment/121589322#Comment_121589322

Believe it or not, actual access to healthcare matters most.

Francie Barrett

https://www.irishexaminer.com/news/arid-41350855.html

The politicians seem to have totally lost sight on things that are actually important.

NSAman

Magic wand:

stop Monday to Friday 9am to 5pm health services.

24/7 access.

Instal old fashioned Matrons into hospitals again.

while there are without doubt some fantastic nurses out there, there are also many who shouldn’t be. Training should be more patient focused and not just about the “degree”.

hospital administrators. Sack 70% of them. Especially the HSE managers.

link all patient records together. Allowing full access no matter where the patient ends up.

……

primary healthcare in Ireland is a disaster. Health centers run on shoe strings by corporations, where the receptionist has more power than god… no thanks. Locals doctors are needed and LOTS more of them. Again no 9 to 5 Monday to Friday.…

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Ambulance service, it needs investment BADLY!

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Develop local first responders. Similar to the US model. One thing that is superb in the states where I am in the first responder situation, normal arrival time after notification is 2 minutes. It is a rural locale. Buying the patient time in serious cases of strokes etc.

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Doctors, we need more.

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proper time management and resource allocation for all equipment. Cts and mri’s should be working around the clock

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Hospital pharmacies should be available 24/7

AndrewJRenko

https://www.boards.ie/discussion/comment/121881270#Comment_121881270

Do you not see the obvious conflict?

Overheal

Last time I was in hospital my fiancé was in ER on a trolley in the hall, in the US. I don’t know there is a magic wand fix for this ironically named trolley problem as you see it in vastly different healthcare systems.

Bob Marley Park

https://www.boards.ie/discussion/comment/121604134#Comment_121604134

While legalising euthanasia may help some people, suggesting it or having it available to people because we refuse to tackle issues with the health service is Soylent Green level disgusting.

While the wealthy can go private the rest can 'go do something to themselves' if the pain and hardship become too unbearable.

shesty

https://www.boards.ie/discussion/comment/121881614#Comment_121881614

No because - if the IT systems are properly linked and everyone has a unique patient ID number accessible across the health system, you will probably find a degree of "natural wastage", ie not so many admin people will be required to get paper files every morning, wheel them between hospital buildings to different clinics, return them every evening to storage.(have sat and watched this happening in several big hospitals)On top of that, communication between hospitals if a particular patient moves between them, would be much easier and again, less people would be required to administrate that.For example, I was referred by Tallaght hospital to a clinic on Beaumont.I had to an FOI request in order to get my files from Tallaght, which I then brought to the Beaumotn clinic (hard copy) as there were test results in it that were relevant...If I hadn't done that Beaumont would not have had access to them.

Once you streamline patient records, you can then really start looking at the admin staff that you actually need and would be likely to see a percentage decrease as a result.

Primary healthcare centres, providing scans, stitches, casts for breaks and similar are another absolute must.

Step down care for elderly people who can be discharged but need alterations to their homes, or a care team put in place or similar, is another must.

An acceptance that we can and must, build new hospitals on brown field sites and not squished into campuses with existing hospitals, is another change of thought that is needed.