Did Not Attend

March 30, 2009

I recently wrote a post about ways to save our health service. One of the issues I spoke about was the problem of patients not turning up for out-patient appointments. I proposed that the high DNA (did not attend) figures in our hospitals were due to a lack of respect for our inefficient health service. The first comment I received in response suggested that the problem was most likely caused by patients not receiving notification of their appointments in time. I now have reason to believe that Ian is absolutely right.

patient-centered-care

It’s been 5 weeks since I last had an out-patient appointment with my surgeon. I was advised and given a prescription lasting two months. This new treatment failed within a couple of weeks so I was seen by my GP. He mentioned that he’d had a letter from the hospital detailing my treatment and saying that I would be reviewed again in 3 weeks. This was the first I’d heard about any review appointment so I joked with my GP that it was only the stuff of routine dictation and meant nothing. However when I became ill again 10 days later, my GP decided to phone the hospital himself to see if he could get an appointment. He was told that my name was already on the list for the next out-patient clinic in two weeks time (the surgeon was away in the interim) and that I would be notified by post. Again we laughed at the absurdity of a system that forgets to inform the patient.

I’ve still heard nothing and as the appointment is scheduled for tomorrow, I phoned the hospital today to query the appointment. It was confirmed that I was on the list for the morning but no explanation could be given as to why I’d not been notified. The fact is that had I not become ill since I last attended the hospital, I would never have known that an appointment had been made for my return. Through no fault of my own, I would have been registered tomorrow as a ‘DNA’  and my appointment which could have benefited another patient, would have been wasted.

Our health service is being bled to death by administration costs and it seems that patients no longer matter. What ever happened to the concept of patient-centred care?


Save our Health Service

March 4, 2009

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

save-our-health-service“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.


Rapid MRSA Identification

February 5, 2009

Ireland is one of only three countries in Europe where antibiotic prescribing outside of hospitals, is on the rise. Antibiotics are frequently taken for viral colds and flu, when in fact they are only effective against bacterial infections. The more frequently antibiotics are used, the more resistant forms of bacteria become to them. The HSE recently launched a national education programme to change prescribing patterns in a bid to curb the use of antibiotics. The level of superbugs like MRSA and C. difficile in our hospitals would fall if antibiotic use was reduced. However, there’s another side to the superbug problem in our hospitals which I believe, has been overlooked.

When I developed serious symptoms of infection some years ago, it took three days for a nasal swab report to come through from the laboratory. In the meantime, I was treated in a ward shared with four other patients, two of whom were recovering from surgery. When my positive MRSA status emerged, I was quickly moved out of the ward and into isolation. You have to wonder at how many patients were cross-infected as a result of this delay in diagnosis. Multiply this by the huge number of MRSA cases passing through our hospitals each year and you get some idea of the scale of cross-infection.

The sad fact is that there is a Rapid MRSA test available which gives same-day results but it appears that the HSE restriction on budgets has ruled out it’s use in Irish hospitals. This decision is short-sighted as rapid MRSA identification can help hospitals make cost savings.

mrsa2“The 3M BacLite Rapid MRSA test allows fast, affordable screening of patients for MRSA. It also has the potential to improve patient outcomes and decrease treatment costs. Rapidly identifying MRSA colonised patients provides hospitals with another tool to assist in pro-actively managing health care associated infections (HCAI).”

If I’d been rapidly screened, the result would have been available in hours, not days thereby enabling infection control teams to act quickly. My MRSA infection was hospital acquired (HCAI) following surgery and resulted in six weeks of expensive in-patient treatment. The infection recurred a year later and since then I have frequently been screened for MRSA as an out-patient. I always have to wait 2-3 days for a result and as far as I know, a similar delay still applies for in-patient screening.  I’d be very interested to hear if anyone knows different?

Everyone has a role to play in stopping hospital infection, patients and their families included.  However, if the HSE seriously wants to reduce MRSA figures and make reductions in their budgets, then it should address the problem of delayed identification. The rapid MRSA test would ultimately lead to huge cost savings for hospitals and more importantly, save lives.


Why, Oh Why?

July 2, 2008

I accompanied my elderly mother to a high-tech private hospital yesterday for a check-up with a specialist. While she received nothing but the best of care, I couldn’t help but feel very uncomfortable with the whole experience. The gap between the public service and the private sector seems to be ever widening and I really fear for the future of our health service if privatisation continues to be seen as the way forward.

My mother is a long-term resident in the dementia unit of a large public nursing home. She is severely physically disabled and suffers from an unusual form of dementia. When she was admitted to the nursing home some years ago, I was told that she would no longer require health insurance as all care is fully covered by the public health system. Knowing what I do about the state of our health service, I ignored this advice and opted to maintain my mother’s basic insurance cover. Every citizen in this state is entitled to a bed in a public hospital but the reality is, only the very sickest patients and accident victims succeed in getting a bed when they need it. Otherwise, the waiting lists for specialist appointments, out-patient services and elective admissions, are atrocious. I wanted to keep her insurance as a safety valve in case we ever needed to access specialist intervention for her.

As things turned out, my mother developed a nasty auto-immune condition recently and required urgent specialist attention. The nearest appointment we could get for her at the local public hospital involved a four-month wait. A private appointment was available at the Beacon Hospital for the following day so naturally I gave the go-ahead to proceed with this appointment. Her insurance policy covers out-patient expenses incurred for investigations carried out in a private hospital but it offers little or no help with appointment charges. Frankly, I didn’t care how much it all cost as long as my mother got the urgent help she needed. As it transpired, she required day surgery and her insurance thankfully covered this expense so the charges for her appointments pale into insignificance by comparison. She will have to be carefully monitored until her condition settles.

The Beacon Hospital is quite literally a beacon of the private healthcare market. It’s quiet and efficient but it’s also ‘over the top’ in luxury and exudes wealth out of every corner. The leather armchairs were so huge in the waiting area where we checked-in yesterday that it was almost impossible to manoeuvre a wheelchair. The sight of my poor mother slumped in her wheelchair could not have been more incongruous with the exclusive surroundings we found ourselves in. Her world in the nursing home is very far removed from this plush hospital environment and I felt sick just thinking about how inequitable the whole health system has become. Why are we forced to access care in ‘over the top’ facilities like this when all that’s needed is a basic health service that works efficiently? Why does there have to be such a contrast between public and private care? I hasten to add that my mother was treated with the utmost respect at the Beacon and I’m very grateful for the treatment she’s received there. However, she’s also treated with the utmost respect at the nursing home but her surroundings there leave a lot to be desired. Why does it have to be so different? Why can’t we have a public health service that treats all citizens and especially it’s oldest ones, with the dignity they deserve?

The Beacon Medical Group has won the tenders to build three of the co-located hospitals that are due to be built on public hospital sites (Beaumont Hospital, Cork University Hospital and Limerick Regional Hospital). If what I saw at the Beacon Hospital yesterday is what our Minister for Health envisages as the way forward for our health service, then I despair. When are people going to wake-up to what’s happening to healthcare in this country, and shout STOP?