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You do the maths…

Limerick is an awful mess. Hopeless. Patients tell me ‘ABL’ — ‘anywhere but Limerick’. If they’re well enough, they’ll drive somewhere else. Of course if they’re really sick, they’ve no choice: go to hell on an emergency department (ED) trolley. It’s a pity, mind you. The place is full of good people but they’re drowning in patients.

When you hear ‘40 patients on trolleys’ in Limerick ED, what does it mean to you?

I dunno — 40 patients waiting to see a doctor in ED? Forty patients seen by an ED doctor and waiting for the medical, surgical or God-knows-what team to bother to come and assess them?

No. Let’s call them ‘Level 1’ and ‘Level 2’ trolleys. By the time you’re on the news as a trolley patient, you’ve passed those two hurdles. You’re a Level 3 trolley, accepted for admission. You’re in the queue for a bed, but the wards are all full.

We’re treating more patients all the time but getting no credit. Why do we bother? 

I didn’t know that.

Don’t worry about it! I’ve met Limerick consultants who didn’t know either.

Let’s hope the Minister’s people have it right.

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I’m in shock. Breaking news! Trolley patients don’t count as admissions. Even though they’re being treated by medical and surgical teams, the computer simply shows an ED attendance only.

What’s that about?

Did you ever hear of an ‘approved’ ward? No? Neither did I. Well, if you’re not in an ‘approved’ ward, the admission didn’t happen.

So who decides what’s approved? Oh right, some crowd up in Dublin.

Yes. Guess what? ED trolleys are not ‘approved’.

But trolley patients are very ill. D’you know, a consultant told me he’d never seen such complex patients treated on ED trolleys until he came to Limerick.

Well, they don’t exist as admissions, the file isn’t HiPE coded after discharge, and the hospital won’t be paid.

I thought the new funding system was going to fix all this, link activity to funding.

We are looking at a big black hole in the funding.

It’s daft. It’s like playing a match and not bothering to keep the score. Does anyone know?

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Yes, lots of our surgical cases are not documented, like wires removed from a broken wrist in the fracture clinic, or the ENT guys doing more and more procedures in the outpatients department (OPD). It keeps waiting lists down. If they queued for the day ward, they’d all be recorded, HiPE coded and funded. But OPD is not ‘approved’ in Limerick. The surgical assessment unit (SAU) isn’t either, I understand. Crazy!

Isn’t it true everywhere?

No, some Dublin hospitals have approved areas for procedures. It seems some hospitals are more equal than others.

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This is interesting! Actually, it’s scary. The medical teams must have a real hole in their data. After all, nearly all the trolleys are medical. So they’re slogging around EDs, seeing 40 patients on a post-take round, but the stats show nothing?

Correct and right. If the consultant sends the patients home from the ED, or transfers to the smaller hospitals, there is no record at all.

It must make them look really inefficient. But at least patients who get to a ward will be coded?

Yes, but no backdating allowed. Even if they are three nights in ED (and it happens), the first day on the ward is day one. Every day on a trolley is a day lost.

No wonder Limerick looks such a hopeless case, an unsolvable problem. We’re treating more patients all the time but getting no credit. Why do we bother?

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So what? It happens everywhere.

Hmm. If you look at Trolleywatch, Limerick is right up there, especially since reconfiguration.

Well, if you close stuff in the outlying hospitals and don’t add ‘approved’ wards in the centre, what can you expect?

Do you know what I find really weird? The medical assessment unit is ‘approved’ and every patient sent home counts as an ‘admission’.

Meanwhile, sick people in EDs are ignored? Bizarre.

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Yeah, yeah, we know our medical admissions in EDs are not recorded. Everyone knows.

I think it’s safer to assume that people don’t know.

How could they not know? Maybe they don’t want to.

Look, if some Limerick consultants didn’t even know about the trolleys, who else doesn’t know?

(SILENCE).

I think the medical consultants should be a bit put out about it.

You’re right — it’s disgraceful, disgusting, immoral… HOW DARE THEY IGNORE OUR PATIENTS!

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