24-hour ED waits deemed serious incidents

The Department of Health has told hospitals that any patient waiting more than 24 hours on an ED trolley for hospital admission in future is to be classed as a serious clinical incident.

The Department's Special Delivery Unit (SDU) says it is to increase engagement with hospitals where it has a major concern that a hospital will not achieve the national target of a maximum A&E wait of nine hours for all patients by July of this year.

In a new strategic plan on improving emergency care in hospitals, the SDU says maximum waiting times are being set with reference to the risks associated with prolonged ED waiting times.

Consequently, anyone exceeding a 24 hour wait in ED will be a notifiable serious safety incident, the report says.

This means anytime a patient has to wait over a day for admission through an ED, it should be treated by a hospital as a serious clinical clinical incident, such as a missed or delayed diagnosis.

The report stresses that prolonged occupancy of EDs leads to poorer outcomes for patients.

This not only involves longer in-patient length of stay but increased illness and mortality rates in hospitals, the report says.

"Therefore, the need to address this is not simply an issue of poor resource utilisation but one of patient safety."

The report says meeting ED patient experience times is fundamentally about the overall quality of the patient journey and not merely about a set target on waiting times. The strategic plan from the SDU is aimed at improving performance in EDs in hospitals throughout the country.

The SDU says its strategic plan for emergency care outlines accelerated efforts to be made by hospitals towards key targets balanced with enhancing capacity and capability building.

Its report says opportunities offered by the Croke Park deal and recent Labour Court rulings on consultants with reference to extended working days and flexible working are opportune in terms of improving emergency care.

It says changes associated with issues such as senior decision making and weekend discharges are important in the context of achieving the desired improvements in performance.

The report says a new escalation policy is to be adopted where trolley numbers nationally exceed 300 or where individual hospitals have large trolley numbers and there is limited confidence that their escalation measures will enable a significant reduction.

Where hospitals have repeated problems with large volumes of trolley patients in EDs, the SDU will implement a number of measures, including support from its liaison officers, from the HSE's Quality and Patient Safety Directorate and from the Health Information and Quality Authority.

The strategic plan includes new measures to improve patient flow through hospital beds in order to ease pressure on EDs.

These measures include hospitals undertaking proactive discharge planning so that each patient has a defined estimated discharge date decided on within 24 hours of admission. This date is to be agreed by the relevant specialty treating the patient and proactively managed against a treatment plan by a named accountable person.

The report says discharges of patients from hospital beds should be completed no later than 11am on the day of discharge to align with times of maximum bed demand for new admitted patients.

It also says medical teams should conduct discharging ward rounds at weekends and diagnostic facilities for patient tests should be more flexibly available in order to facilitate weekend discharges.

The Special Delivery Unit, which was set up by Health Minister James Reilly, is tasked with reducing treatment waiting lists and ED trolley waits.

It helped achieve a 23% reduction in trolley numbers in 2012, along with a significant reduction in the numbers of patients waiting over nine months for treatment. However, these numbers have started to increase again.

Shock rise in hospital waiting lists







[Posted: Tue 19/03/2013]


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