The IMO plans to develop a paper detailing the criteria to be used in implementing a safe medical staffing framework in all healthcare settings.
Safe medical staffing in public hospitals was discussed at a session during the Organisation’s AGM in Killarney on 11 April.
Speaking from the NCHD perspective, Dr Rachel McNamara noted that medical staffing levels had “not kept pace” with the growing complexity of care. “There is one medical registrar on call for the wards overnight, now, in many model 3 and model 4 hospitals. There was one medical registrar on call overnight when the standard of care for a stroke was an antiplatelet and physio referral,” said Dr McNamara, who is Chair of the IMO NCHD committee.
“Things have moved on so much in terms of the amount of things we can do for patients to optimise or stabilise them…. But the staffing complement has not kept pace with that.”
Dr McNamara also said extended hours for routine service delivery was leading to increased breaches of the European Working Time Directive. She referenced the increased risk of adverse events associated with under-staffing. The impact for doctors included burnout, attrition, and litigation.
She said there was no specific framework to determine a minimum level of safe medical staffing in Irish healthcare. Such a framework should account for patient acuity, the nature of presentations, the skill mix required, and the requirements for an in-hours versus ‘out-of-hours’ service.
Prof Anthony O’Connor, a member of the IMO consultant committee, spoke from the consultant perspective. Prof O’Connor is a Consultant Gastroenterologist and General Physician in a model 4 hospital in Dublin.
“Across all the domains we work, it is getting busier, and it is also getting more complicated,” he said.
Prof O’Connor placed a focus on general internal medicine (GIM), which he described as the “anchor tenant in most hospitals”. He highlighted that the pressures on GIM manifested across the system.
He also noted that an increasing number of presentations were falling under GIM due to changes in practice. Prof O’Connor said consultants were often performing three roles – specialist, generalist, and hospitalist.
“I don’t think this is sustainable for us to do three jobs. I think we can do two… that needs to be looked at,” he added.
Prof O’Connor also reflected on training for GIM, which he considered needed to evolve. He said this was outlined in the OPTIMISE report he authored for the RCPI.
Prof O’Connor expressed concern about aspects of the Minister for Health’s address to the AGM, which had focused on moving to a six- and ultimately seven-day service.
He told the session he had been working weekends since graduation and was “sure everyone in this room is the same”.
“But it kind of feels like it is being done by vibes rather than on plans or data….Actually, you can’t just do this on vibes, you have to figure out and do some data on what is exactly needed, which certainly hasn’t been done in Ireland in the past 25 years.”
Prof O’Connor emphasised that safe staffing “saves lives” and the principal considerations must be patient safety and staff welfare.
Chair of the session, Prof Rónán Collins, said the “joy” of GIM had been lost for many consultants due to the “intolerable” workload. He also said it was imperative for doctors to lead the debate on medical safe staffing, “before it gets led for us.”
Prof Collins said nobody would ask a High Court judge to do ‘X’ number of cases if it was going to compromise decision-making. “Yet we are tolerating this unsafe workload and that is what is causing burnout.”
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