Improving Performance

Unscheduled Care/Trolley Waits

The Department and the HSE (National Clinical Care Programmes, SDU, and the Acute Hospitals Directorate) are seeking to achieve sustainable change through the use of key metrics, aligned with a suite of resources to support hospitals to:

  • Deliver on performance measures
  • Build capacity and
  • Enhance capability, so as to improve the overall quality of the patient journey

Each hospital with an Emergency Department has a fit-for-purpose operational framework, including an escalation protocol, to respond to surge pressures in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care.  Such measures involve the full health system including primary, community and continuing care services to ensure that all available capacity and options are utilised and brought to bear on the situation.

Generally patients who require admission from Emergency Departments may be placed on a trolley in instances where the number of patients awaiting admission exceeds the available inpatient capacity of the hospital.  Both clinical staff and management try to maximise the available capacity by undertaking regular measures such as:

  • Directing patients to primary care or minor injury units where appropriate, to promote efficient use of specialist
  • Regular ward rounds
  • Identifying estimated date of departure as early as possible following admission to ensure a planned, co-ordinated discharge of inpatients

When all other options have been utilised, admitted patients who are still in situ in ED may be moved to in-patient areas, resulting in additional patients in wards.  Whilst far from desirable, this action can reduce risk, both for patients waiting for admission and for the ED department.

In 2015, additional funding of €117m was made available to the HSE to implement a range of health system-wide initiatives to address the challenges of ED overcrowding by:

  • Improving access to primary and community care services, such as Community Intervention Teams and the OPAT (home IV antibiotics) programme;
  • Increasing hospital capacity through opening / reopening over 300 beds and employing more than 750 nurses and almost 80 consultants;
  • Reducing delayed discharges, through:
    • Decreasing Nursing Home Support Scheme application wait times,
    • Increasing transitional care fund to support over 3,800 patients in 2015,
    • Increasing home care packages (an additional 1,650 provided in 2015),
    • Opening additional short-stay nursing home beds,
    • Establishing a bed bureau for the Greater Dublin Area to improve access to nursing home beds;
    • Improving hospital processes in preparing for, and managing, surges in emergency care demand.

Inpatient/Day Case and Outpatient waiting lists

All hospital groups have been instructed to focus on managing scheduled procedures and waiting lists. More than 300 extra hospital beds have been opened, more than 750 nurses and almost 80 consultants have been recruited to support scheduled and emergency procedures. The HSE has set up a Scheduled Care Governance Group to continue reducing waiting list numbers. The Special Delivery Unit is developing systems to meet the 2016 National Service Plan targets and the NTPF is supporting this through the development and delivery of a Waiting List Management Protocol, Guidance, Training and Development Programme.

In a concerted effort to reduce the longest waiting times, a maximum waiting time of 18 months was set by the Department for June 2015 and of 15 months by the end of 2015.  By June 2015, the targets were met for 99.6% of all inpatient cases waiting more than 18 months, and for 92% of all outpatient cases. By the end of 2015, the targets for the shorter waiting time of 15 months were met in 95% of inpatient cases and 93% of outpatients. The HSE Service Plan for 2016 sets out further improvements in waiting times for 2016.

As hospitals are aligned into groups, this will increase the potential to maximise the use of capacity across multiple sites to ensure that challenges at individual hospital sites can be addressed in a timely fashion.

Waiting list information is published by the NTPF. In addition to the current year, the NTPF is also building up a repository of waiting list information for 2014 and 2015, which may be found by selecting the relevant year in the drop-down menu on the link above.