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Mystery of the disappearing trolley patients solved

By Dermot - 08th Jul 2015

A 101-year old woman recently spent 26 hours on a trolley in Tallaght.

No patient should be forced to wait for a bed, said the hospital. It’s an abuse of human rights, said the emergency department (ED) consultant.

The Irish Patients Association (IPA) said if she had gone to a private hospital, she would probably be tucked up in bed in an hour with a cup of tea and a Marietta biscuit.

What a fuss!

Maybe someone should tell the IPA that private hospitals try hard to avoid such patients; they’re too costly.

As for Marietta biscuits, last month a patient told me how much she enjoyed the food in Nenagh Hospital, much more than during her private hospital stay. “They didn’t even know what a rasher was!”

Anyway, not long ago, there was a photo in the <em>Nenagh Guardian</em> of a local woman, aged 100, smiling at Minister for Health Leo Varadkar. She was on a trolley in Limerick, waiting for a bed. Before reconfiguration, she would have been admitted in Nenagh.

<em>But a Greek chorus of ED consultants said small EDs are not safe and should close.</em>

Meanwhile, the number of ED attendances at Portlaoise is in dispute. Is it 20,000 or 40,000? I wonder which figure HIQA is using.

Some time ago, I went back and looked at the HIQA report on Ennis Hospital. The data on surgical procedures looked bizarre, so I contacted the Department of Health. They provided figures that were completely different, much higher and in line with my experience at that time.

That’s very awkward. The Ennis report is often used to justify closing surgery in small hospitals, based on low volumes of inpatient procedures.

If this was clinical research, doctors would not accept such discrepancies in the data.

Here’s another problem: we have no inpatient data at all for small private hospitals. As for ED attendances, 10,000 is a cause for celebration. Remember when Charlie McCreevy was Minister for Finance? He gave tax breaks to private hospitals if they opened an ED, size not important.

<em>(The Greek chorus was silent.)</em>

Then again, maybe it’s the wrong debate. Maybe volume is not the key to safety. What about stuff like having doctors on site at night? A ‘small’ public hospital like Portlaoise probably has more than a private hospital.

<em>Now the Greek chorus of ED consultants is telling us that overcrowded EDs are not safe, so more people are dying.</em>

Isn’t it odd? The headlines on Portlaoise were all about the maternity service and, thank goodness, the HSE has added lots of extra staff. But it’s the surgical service there, and ED, which will wind down. How weird is that?

I reckon I know what will happen. After a bit, the HSE will announce it’s all a great success and much safer. That’s what they said in the mid west.

What really happened? Well, some patients, the healthier ones with surgical problems, went to private hospitals. As for the rest — the medical patients and the elderly — we know where they are. They landed on trolleys.

<em>Now the Greek chorus of ED consultants is telling us that there are record numbers of patients on trolleys, up to 600 this year.</em>

And now for my latest discovery! Trolley patients don’t exist. That’s right, they disappear. Here’s how it’s done.

The HSE and Department of Health only look at HiPE data. It’s the official record of how busy a hospital is. Next year, hospitals will be paid based on HiPE records. It’s called ‘money follows the patient’.

But alas! Trolley patients are not recorded for HiPE. Not just the queue of trolleys waiting to be seen. No. All trolleys are equally invisible. Patients, admitted under medical and surgical teams, are simply not recorded unless they get a ward bed.

When Limerick is drowning in trolleys, nothing is recorded.

No wonder the HSE and Department of Health think reconfiguration in the mid west is such a success. Portlaoise next!

Worse still, no HiPE record means that money will not follow the patient. Imagine a hotel that’s so full they’ve put camp beds in the foyer. But they can&rsquo;t bill. The staff are worn out and there’s nothing to show for it.

Worse still, head office thinks they’re feckless wasters, whingeing about the workload while doing nothing.

If our 100-year-old was discharged home from her trolley, there’d be no record — other than the photo with the Minister.


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