For this column to praise our public health system is something of a rarity. So I would like to say at the outset that it gives me great pleasure to report on how one Irish hospital has turned its performance around in quite a dramatic way.
Beaumont Hospital on Dublin’s north side is an 842 bedded, level-four hospital. It provides a wide range of secondary care services and a number of key tertiary level services at a national level. A voluntary hospital, it is managed by the Royal College of Surgeons Ireland Hospital Group on behalf of the Health Service Executive. Earlier this month the Health Information and Quality Authority (Hiqa) issued a report following an unannounced inspection of the hospital’s emergency department that took place in April.
The inspectors found that the emergency department of Beaumont Hospital had a good overall level of compliance with the National Standards for Safer Better Healthcare. It had a full complement of nursing staff in the emergency department and had established greater access to consultants and senior decision-makers. Both Beaumont and University Hospital Waterford (UHW), which was also the subject of a Hiqa inspection in April, had good access to step-down facilities which facilitated efficient patient flow from the hospitals. And in a key finding Hiqa noted that “in recent years both services had managed to move from a situation of persistent overcrowding in the emergency departments to one where such crowding was well managed or not present”.
The reason I am focusing on Beaumont and not Waterford (which it must be said achieved even higher compliance with national standards than its Dublin counterpart) is that in the same week as the reports were published, I became aware of a patient experience that confirmed the absolute transformation of the Beaumont emergency department.
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Aged in their early 70s, the person had become progressively unwell with breathing problems. Despite the efforts of carers and the local GP, they continued to deteriorate to the point where an incipient pneumonia was a real possibility. And so the decision was made to refer them to the emergency department of Beaumont in the early hours of a Sunday morning. On arrival, there was a relatively brief period spent in the waiting area before they entered the department proper.
An obviously well-oiled and fully resourced machine swung into action at about 5am. Within the space of five hours a chest X-ray, an electrocardiogram and a full range of blood tests were carried out. This ruled out pneumonia and any acute heart problems. An elevated white blood cell count confirmed the clinical signs of a chest infection; in turn this allowed an informed decision to prescribe antibiotics and other supportive measures and a discharge home.
Apart from the excellent and timely treatment of the patient, what absolutely blew me away in this case was the provision of a detailed printed summary of their care as they left the emergency department. This detailed all the person’s test results and clinical findings – a rare occurrence in a system that usually limps along with a dismissive and unfulfilled promise that “we will be in touch with your GP”. But the Beaumont experience was of seamless care of the highest standard.
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Ironically, some eight years earlier the same patient was repeatedly seen in Beaumont’s emergency department while clearly unwell with an abdominal infection. On this occasion, the best a dysfunctional department could do was stonewall a badly-needed hospital admission.
It is particularly striking to see the degree to which a hospital can turn around its performance. There is no single lever that can be pulled to achieve this; the Hiqa report details how hospital managers as well as health professionals work closely on the ground to immediately deal with any issues that arise.
The message to other highly dysfunctional hospitals in the State? Please learn from the UHW and Beaumont experiences.