Four simple steps to saving the health service — top doctor
A LEADING neurologist has criticised our obsession with hospital beds and highlighted a four-point plan as a key to solving the Irish health crisis.
Harvard-educated Dr Colin Doherty, who works at St James’s Hospital, Dublin, is imploring Irish health experts and the public to overcome their obsession with increasing the number of hospital beds. Dr Doherty says Ireland has a ‘‘bizarre’’ tendency to fixate on a ‘‘trolley watch’’, when no other country judges the efficiency of their healthcare system this way. Instead, he says, they use ‘‘patient wait times before and after seeing a doctor’’.
Because of ‘‘trolleywatch’’, he says Ireland is “obsessed” with bed numbers in its approach to the crisis, putting blinkers on our view of the problem and stopping a solution by seeing it from other angles. He questions the “ludicrousness” of allowing the Irish nurses union to take charge of the trolley data. “It would be like the Dublin Bus Driver’s union overseeing the data on bus scheduling problems,” he says, pointing to their vested interests.
Looking abroad, he says: “There are many healthcare systems which have significantly less beds than Ireland but a far better functioning system.
“Look at the facts — the number of beds international hospitals have per 1,000 of the population. Ireland is 31st out of 37 on the international league table. The country with the most beds is Japan, another is South Korea, while Russia has four times more beds than Ireland per 1,000 of the population. Yet all of these have much poorer functioning healthcare systems.
“Now look at who sits below Ireland on the league table — Denmark and Sweden. Yet both are recognised worldwide as being highfunctioning health systems and performing better than Ireland with less beds. So let’s get away from this debate once and for all that ‘we need more beds’. That is a fundamental error. It is wrong.”
Instead, the neurologist proposes four evidence-based and internationally agreed solutions by experts around the world. They are: ÷ Revamp front line scheduling processes.
“We are now all aware of the annual winter crisis. So we need to schedule more elective surgeries during summer months when the Emergency Department (ED) is not full. This means we are not cancelling procedures at the last minute. ‘Smart scheduling’ should also apply weekly. Schedule surgeries during quieter times of the week. Not, for example, on Monday morning when you are dealing with the Friday and Saturday night deluge from the Emergency Department. ÷ Make reducing wait times part of hospital culture.
“Most doctors in other departments don’t see ED overcrowding as their problem. So at peak times, we need to open up the whole hospital to the ED. Put an extra person in each ward. When an extra patient is on my ward, I am suddenly invested in fixing the problem. It’s just one more patient on each ward but it means a lot more people trying to fix that problem, whereas, as the situation stands, they are all buried down in the ED. Everybody needs to shoulder part of the burden to make it better overall.” ÷ Incorporate patient preferences.
“Ask the patient ‘what would you like to happen?’ So, for example, if you have bad lung disease and your GP says ‘you should go to hospital’, ask the patient: ‘Would you like to wait 10 hours on a hospital trolley or, alternatively, we can put you up on a ward until we sort a bed?’ If you ask the nurses’ union, they will say ‘no way’ but which do you think the patient would choose?
“Similarly we have found, given the choice, patients opt for our ‘care-based pathways’.
“Traditionally, this is the story: a doctor admits a patient. They wait on a trolley for up to 24 hours, then they are in a bed waiting for something to happen. A test is ordered. Another day goes by. Meanwhile, they are sitting in the cafe downstairs in a dressing gown, having a cup of coffee. We have turned this practice on its head in my department where we treat epilepsy.
“Instead, we offer a specialised pathway service. So when I discharge a patient, we ring them the next day — ask how they are doing. If they say ‘not great,’ then we tell them not to bring their overnight bag with them, but we’ll treat them as an out-patient, get their tests done and we won’t have them on a trolley or waiting in a bed at all.
“By doing this, we have reduced the number of admissions of epilepsy patients by a full third — down from 500 per year. And we followed all of those discharged patients for a full year and there was no excess mortality rate. In fact, of all the patients who died from their epilepsy were not on the pathway.” ÷ Recognise there are alternative ways to treat patients, from ‘Tele-care’ [phone consultations] to replacing the spend on beds with employing more urgentcare specialists.
“Nurses are the solution to this. I have a team of four who are now specially-trained in epilepsy and they run the place. We build trust with patients.”
‘Get away from the debate that we need more beds. It is wrong’