'Satellite Mater ED will cut waiting times'

A newly-launched satellite clinic is aimed at relieving pressure on the hard-pressed emergency department at Dublin's Mater Hospital and to help reduce waiting times.

The rapid injury clinic in the Smithfield area of inner-city Dublin, which is being run by the Mater, is intended to divert minor injury and illness cases away from the hospital's main emergency department in Eccles Street.

According to the Mater, the Smithfield clinic will provide a hospital-level service in the community, catering for a wide range of minor injuries and illnesses. It says the new clinic has the capacity to reduce patient waiting times significantly.

The Mater says the satellite unit will allow it to deliver quality care to patients with less severe injury, allowing the main ED at the Mater to concentrate on managing serious illness and major trauma.

Treatment fees at the Smithfield clinic will be the same as in all publlc A&E departments - €100 for non-medical card holders, free to medical card patients and free to all patients presenting with a referral letter from their GP.

The €100 charge covers all aspects of treatment, including consultation, x-rays, blood tests and procedures. A €200 charge will be applied to short-term non-EU visitors.

Patients can access the unit directly, or through a GP referral letter, and some patients may be transferred from the main Mater hospital to the Smithfield unit for more appropriate care. Patients presenting to the satellite unit that who turn out to have more serious injuries can be transferred to the Mater.

According to Mater emergency medicine consultant Dr Eamonn Brazil, both he and another Mater consultant have a commitment to the satellite clinic. The unit is also staffed by a registrar and advanced nurse practitioners.

He said x-rays can be viewed electronically between the satellite clinic and the main Mater unit.

Dr Brazil said the new service, in its initial phases, is designed for low or moderate impact trauma, including minor head injuries, sports injuries, falls, broken bones and sprains, wounds and bites, skin infections and joint swelling.

"In general terms, these patients will not need to be admitted to hospital. Most patients in fact, usually know when they are injured whether they will need a hospital stay."

He said the Smithfield service would be supervised by consultants, but delivered mainly by advanced nurse practitioners according to set protocols.

Dr Brazil said it is estimated that the satellite unit will be able to see up to 30% of the ambulatory "walking wounded" group who would normally go to the Mater ED.

"We would normally see a total of 130 patients per day in the Mater ED. About 70% of the patients we would see there would normally go home without admission, following treatment."

Dr Brazil said it is hoped to get around 30 of these patients per day at Smithfield who would normally attend the Mater A&E. "If we get 30, that is a success for the new Smithfield unit, but it also has to show an impact on how we work in the main Mater department.

He said it is hoped that diverting many of the ambulatory cases from the Mater to Smithfield will create more space in the Mater and enable it to be used for cases there.

"The main Mater ED is so overcrowded that we can't physically find space to examine patients."

The measure of success of the Smithfield initiative, he said would be if the Mater can show that it can improve its six-hour target for waits from presentation to admission or discharge from the main ED, and also if patients are treated within around an hour or an hour-and-a-half in Smithfield.

Dr Brazil said sometimes the Mater regularly met its six-hour ED target while at other times "we don't have a hope of meeting it." Yesterday morning, there were 35 patients on trolleys awaiting admission at the Mater.

"The target for me as an emergency medicine physician is to see the patient from the door to going home. I don't have any control over the patients I subsequently need to admit to a bed."

"I would find it very difficult to assist in meeting the bed target because I do not have control of the beds, but I have difficulty meeting my six-hour target for non-admissions because I do not have any space to see the patient. The new Smithfield clinic will help give us this."

Dr Brazil stressed that emergency departments in hospitals should be designed towards looking after the really sick and the seriously injured. This type of patient has increased by 134% at the Mater in the past five years, he said.

He said the nub of the ED problem is always going to be dealing with the sick people who need beds.

Dr Brazil said the main problem in the Mater is that it has a cohort of patients who have finished their treatment but cannot get to a community setting so they have to remain in acute beds, thereby creating a bed shortage for new patients who need to be admitted through the ED.

He said the new Fair Deal nursing home funding scheme will alleviate the problem but it is a new system and seemed to be running a bit more slowly than was anticipated. "It is not giving us an instant solution but in due course it should help."

Dr Brazil said if the Smithfield clinical model was successful it could be rolled out to other areas.

The new service, which is supported by the HSE, is to run for an initial six-month trial period.

The new clinic is based in Smithfield Square and is being leased by the Mater from Charter Medical. This company, which still runs a medical centre on the site, previously ran a private walk-in urgent care facility there.

The Mater Clinic in Smithfield only caters for adult patients, and is open from 8 am to 6 pm. Tel 01 657 9000.

[Posted: Tue 13/04/2010]