Sepsis deaths in hospitals.

csirl

To follow on from my previous post. UHL has 3,600+ staff and a budget of 383m, but it cant find room in its budget to allocate an extra few doctors to A&E.

cnocbui

https://www.boards.ie/discussion/comment/122061942#Comment_122061942

"18,000 Admissions". That's BS worthy of an HSE statistician.

The number of Australians who survive sepsis each year is unknown. Estimates suggest in Australia there are over 48,000 hospital admissions each year where sepsis is the main reason for admission and approximately 1,400 deaths each year where the underlying cause of death is sepsis.

https://www.safetyandquality.gov.au/sites/default/files/2021-02/report_-_sepsis_survivorship_-_a_review_of_impacts_of_surviving_sepsis_final.pdfThat's a mortality rate of 2.91% in Australian hospitals

This report shows that the associated in-hospital mortality rate for sepsis in 2020 has remained relatively stable at 19.0% when compared to the 2019 data (18.4%).

https://www.hse.ie/eng/about/who/cspd/ncps/sepsis/resources/national-sepsis-report-2020.pdf

The differenece in mortality rates for hospital admissions for sepsis is stark.

Anita Blow

https://www.boards.ie/discussion/comment/122062415#Comment_122062415

You're right that delay in being seen is not acceptable. However it's not due to a doctor doing non-patient facing tasks, it is again due to staffing. If I spend 15 minutes seeing a patient, I'll probably spend 10-15 minutes doing my notes and investigations etc. (sometimes longer if need to review medical notes or speak to other teams) but this isn't wasted time because it's necessary for me to think about the case and clinically reason. It might also be time reviewing the results of investigations. It also gives me a bit of breathing space to think between patients. This is all just as important as directly assessing the patient and contributes to safe and effective care. The answer is not to cut this time but to improve staffing so people can still safely do all the aspects of their job for the patient whether they are patient-facing or not.

crusd

https://www.boards.ie/discussion/comment/122062505#Comment_122062505

You are really struggling to keep up you Ireland is terrible at everything schtik.

Irish Hospital mortality rates

Australia by comparison from your own report

Again you are attempting to not compare like with like.

The figures you quoted are for Sepsis as underlying cause of death and does include all cases in which Sepsis was present which includes cancers and other comorbidities, which are counted in the Irish report.

Flinty997

https://www.boards.ie/discussion/comment/122062525#Comment_122062525

No one's arguing about needing to do admin and due diligence work.. But no one's seeing staff going between patients and admin on a 1:1 ratio as you describe.

That someone rang to check was there even a doctor on suggests others see what I'm seeing.

Again I'm not blaming staff. But the system. Or as you stay staffing. But if there are workflows that soak time, throwing staff (and beds) at it won't fix it. Will fix a lot of things.

tarvis

How about an electronic system - armband or such which recorded the need level of each patient as they went thru triage. The tags on level 1 and 2 high risk patients would emit an alarm after the magic 15 minutes had elapsed.

These alarms should ring in the A&E and in the higher hospital management offices during office hours. Out of hours the bells would transfer to the homes of top HSE and Dept of Health management. Would we get action then?
Would reinforcements arrive?

Ok so maybe alerting the entire govt is a step too far but I very much doubt that the numbers on level 2 could have reached anything like 66 if some sort of alarm system was pinging all that night in University Hospital Limerick.

People are tired of saying we need better staffed A&Es - time to make managements hear the calls.
Somehow.
Anyhow

mariaalice

I wonder in this case if how the patient presented was an issue, a teenage girl stereotyped as a bit a bit hysterical or as having a panic attack if it was a middle-aged man or woman would have been treated differently due to unconscious bias?

A friend of one of my daughters friends has a cancer diagnosis and she was told she was having panic attacks by her GP, in fairness when she went to an ED they knew it wasn't panic attacks she was having and she got a diagnosis.

The White Wolf

https://www.boards.ie/discussion/comment/122063129#Comment_122063129

You could tell this story a million times over, though admittedly in most cases it will be stress/anxiety/panic.

But I don't know, I'm essentially approaching middle age myself and I have my own experience of harsh treatment in A&E. They seem to only want you in A&E when you're crawling or being carried into the place. I went with a doctor's note in 2022, didn't make any difference to them. The nurse who signed me in was basically spitting in rage that I had the temerity to be there, and this was just a normal Wednesday afternoon.

Long story short I don't think it matters whether you're making a "big fuss" or just quietly waiting to be seen, if you walk in on your own 2 feet they don't want you there.

tohaltuwi

Medical staff bias is, IMO, very evident from my own personal experience numerous times over. As a young woman my neurological symptoms were dismissed many times over and I was only diagnosied with quite bad secondary progressive MS last year. I have a history of colitis, panproctocolectomy, cardiac issues, so a lot of stuff was either dismissed altogether or put down somehow to those issues.

In recent years I have got all my medical records by FOI requests and saw for myself comments by a neurologist I incidentally got to see for nerve pain: his report mentioned hyperintensities on MRI but that “this patient’s symptoms are IMO more likely to be functional”. He diagnosed me as having “mild cognitive deficit, and prescribed a drug to treat early symptoms of dementia. Having since met a lot of people with MS, a couple of women reported similar experiences when younger with same consultant. Either dismissive or barking up the wrong tree.

Podge_irl

https://www.boards.ie/discussion/comment/122061632#Comment_122061632

You could try not completely misreading comments as something they are not. I didn't even mention Irish hospitals, it was a general comment, and crusd literally put stats in their post about Ireland performing worse than average. You're just looking to get angry over invented things here.

tohaltuwi

Such tech could theoretically be adapted from the existing barcodes armbands, ie sending time-based sounding alarms via the ED computer. I reckon it would end up being a very noisy environment, a bit like tons of alarms going off simultaneously in an aircraft cockpit during an emergency, overwhelming the pilots where things have already badly gone wrong. But in principal it would be a good idea.

tohaltuwi

Some years ago I was an inpatient in a private hospital, when one of the patients in my room developed sepsis during the night. It was so sudden, she was chatting away in the phone at 10pm to her young son, advising him to pack a proper lunch for school, she was lively, full of chat, didn’t seem a thing was wrong.

An hour later the picture was quickly changing. She got sudden torrential diarrhoea, followed by increasing breathlessness, & intense headache which got progressively worse. The house doctor on duty was clueless as to what was happening, but two very experienced ICU agency nurses who had reported on duty in another ward, were called to see the patient and knew immediately what was happening and advised vasopressors, antibiotics , etc and quick transfer to ICU.

The trouble back then in the private hospital was that protocol required the patient’s own consultant to sanction the transfer to ICU and he was asleep at home and uncontactable. It was 7am before he answered the phone and ordered the transfer. I will never forget the distress of the patient, the sound of her drowning in her own fluids. I believe e she was placed on a ventilator and survived, but she could so easily have run out of time simply because of the protocol then in place in the hospital.

Cluedo Monopoly

https://www.boards.ie/discussion/comment/122062525#Comment_122062525

Sincere thanks for your insights on the health system Anita. It's very enlightening. I don't know how you work in such a dysfunctional and under resourced environment.

ProfessorPlum

https://www.boards.ie/discussion/comment/122062505#Comment_122062505

"That's a mortality rate of 2.91% in Australian hospitals"

That statement in itself should raise a large red flag that you are not comparing like with like, or that you're interpreting the statistics incorrectly.

mariaalice

https://www.boards.ie/discussion/comment/122064789#Comment_122064789

It is a difficult one to get correct, if someone is presenting to ED several times and it is anxiety and panic attacks and not anything else how do ED staff proceed? As far as I can see GPs need to be much better and if they were maybe not as many would end up in ED.

Red Silurian

Is medical misadventure really enough for what happened to Aoife Johnston? Were manslaughter charges considered?

ProfessorPlum

https://www.boards.ie/discussion/comment/122065456#Comment_122065456

Manslaughter charges against who?

Also, this is an inquest, so there are no criminal charges attached as such. It would be up to the DPP to take a criminal charge.

Red Silurian

https://www.boards.ie/discussion/comment/122065497#Comment_122065497

The HSE, the dept of health, the management at the hospital, the health minister

I hope the DPP looks at this in detail

ProfessorPlum

https://www.boards.ie/discussion/comment/122065520#Comment_122065520

Yup. Just reading some of the testimony from Dr James Gray, the consultant in charge.

Why anyone would want to do that job. The entire department sounds like near permanent chaos. For a ED seeing that volume of patients, there really should be a consultant on site 24/7. But he was doing a 48 hour call, as well as covering the local injury units, and working the 'day' shift on the saturday and sunday. I would genuinely be anxious if I was in their catchment.

The Minister for Health and the HSE have known for years now that UHL has issues, but it seems not much has been done.

The White Wolf

https://www.boards.ie/discussion/comment/122065440#Comment_122065440

I think it depends on the GP. You can see from this thread alone some people are very lucky in the care they have received. But a lot of people seem to be stuck in these mass clinics now where you're unlikely to see the same doctor twice in a row, where both are likely to give wildly differing opinions.

Maybe it's a postcode thing in Dublin, as I doubt there's many of these mass clinics in D4.

cnocbui

https://www.boards.ie/discussion/comment/122065421#Comment_122065421

I gave a link to the source of the figures, which was an Australian government publication.

tohaltuwi

I have MS and quite a medical history. To be frank, when it comes to a decision about whether or not to go to a hospital, I’m long in the tooth enough to have a good idea about what’s going on in my own body and not to fully rely on my GP’s judgement. I use my Apple Watch to do a background monitoring, and I keep a peak flow meter, spirometer, good thermometer, pulse oximeter and BP monitor, and urine testing sticks. When I don’t feel well I run through the simple tests. If anything is out of parameter I have a very good idea, and when and where to get help.

ProfessorPlum

https://www.boards.ie/discussion/comment/122065657#Comment_122065657

Do you want to cite the part that says Australia has a 2.91% hospital mortality for sepsis?

It is so far off the mark that it couldn't possibly be correct, or at least it's not comparing the same thing that the HSE or NHSE is reporting

cnocbui

https://www.boards.ie/discussion/comment/122065520#Comment_122065520

You can't be serious, this country is a world leader in the art of sweeping unpleasant facts under the carpet. There is probably a unit in the OPW who are kept incredibly busy evening out the bumps to maintain a flat appearance. /s

Cluedo Monopoly

Playback this morning on Radio 1 was tough listening when they covered the Aoife Johnston death. The family were literally begging for help for hours and hours until it was too late. Very sad.

Meeoow

Happened a relative of mine a few years ago. He was in hospital already, had cancer. Was improving one day, next day, went downhill. Day after, even worse. We begged the nurses to take a look at him as there was clearly something wrong with him. They couldn't give a crap. Told us to come back the next morning and speak to a doctor. In the mean time we got a call to say he was in septic shock. I can't understand why the nurses in UHL couldn't have spotted the urgency in Aoifes case. It shouldn't have been all on the one doctor to deal with everyone.

The White Wolf

https://www.boards.ie/discussion/comment/122070331#Comment_122070331

I would happily pay the highest of tax like the Scandinavian countries if we could sort this out.

That being said, we as a country need to tear up the script and rewrite it in regards to who can enter these professions. We are excluding so many people that actually want to be doctors and nurses through antiquated school and college systems.

tarvis

https://www.boards.ie/discussion/comment/122064878#Comment_122064878

Yes, more sound is a bad idea in what is already a noisy environment but an alarm message on the central computer which cannot be cancelled unless the case is signed off as treated by a senior doctor.

Cluedo Monopoly

Very good discussion with medical professionals on Brendan O'Connor this morning. One consultant said he does not believe the reported number of beds in the system. He said there was approx 11,000 beds in 2000 when a report was produced saying there was a major bed capacity problem. It was the same number in 2020. Brendan said that he heard 2000 beds were added since 2020 but the consultant said he did not believe that and would love to see each bed get a tracking barcode so they could identify the accurate number. He said the government were always announcing new beds but never mention when beds are taken away.

Mrs OBumble

https://www.boards.ie/discussion/comment/122072913#Comment_122072913

"Beds" does not mean horizontal thing peope lie on. Its a proxy measure for staffing.

corner of hells

https://www.boards.ie/discussion/comment/122070331#Comment_122070331

Septic shock is the end game for sepsis with a high mortality rate, your relative was in hospital , had cancer and no medical staff checked blood pressure for three days or noticed any signs of infection or distress at all ?

Meeoow

They probably checked blood pressure, can't recall. As I said above they didn't act on signs of infection or distress. Are you trying to insinuate that I'm lying about it? Cause that's what your post looks like.

corner of hells

https://www.boards.ie/discussion/comment/122079123#Comment_122079123

Not at all , I’ve had sepsis too.