Update 02: Progress within the Programme

The programme working-group has met four times since my last update. We now have representation from nursing and the allied health professions and will shortly be joined by a representative from the ambulance service. Caroline McGuinness, whom many of you will know from ATLS, has been appointed as administrator for the programme.

Barry White spoke positively about the future of Emergency Medicine at the IAEM conference in Waterford. The most important points he made were that:

(a) The importance and future potential of Emergency Medicine in Ireland is recognised.
(b) The will be expansion in Consultant numbers.

Progress within the Programme

The working group has scoped the scale of the programme and the amount of work to be done is quite daunting. The key work-streams are:

Models of care

A strategy for the future delivery of emergency care including paediatric EM is being developed. This will include staffing (medical, nursing and other disciplines, including consideration of skill mix), governance, the Pre-hospital interface, infrastructure, IT and support services.
The proposed model of care will be aligned with models developed by other programmes.
A business case for the future model will also be developed

Process Improvement

A survey will be circulated within the next few weeks to all EDs to determine current staffing and support. Please ensure your senior nursing colleagues are aware that this survey will reach them soon and is filled in accurately.
The working group is planning a series of ‘best practice” information sessions across the country. These will involve meetings of representatives from each ED to learn what aspects of their service can be recommended as good practice to be shared with other EDs and what areas EM staff consider need improvement. The programme will then focus on developing solutions for the most common problems identified.
We will also develop national recommendations on key issues in EM such as triage, rapid assessment, review clinics and CDU work.
The Academic Committee of IAEM will review existing best practice guidelines to recommend those that should be implemented as national guidelines in Ireland.

Outcomes

We have circulated data definitions, which will be used to develop agreed data sets on which process KPIs can be based.
The recommendations of the IAEM KPI Delphi project will be included among a number of structural, clinical and process KPIs to be proposed to DQCC for national implementation. HIQA will be working with the DQCC to ensure that all such KPIs meet their standards.

Subgroups

Mark Doyle is leading a subgroup which, in conjunction with the HSE Emergency Planning Office, will develop a template for hospital major incident planning.
John McInerney, Peadar Gilligan and Brendan McCann will consider the EM/Primary Care interface • Emily O’Conor and Kieran Cunningham have kindly agreed to do some work on Acute Psychiatry issues in EM.
The Academic Committee of IAEM has been asked to prepare a short section on the development of Academic Emergency Medicine for inclusion in the programme report.

Other subgroups will be needed, so volunteers will be sought.

National Clinical Programmes

The EMP is now positioned as one of the five key acute programmes for DQCC, along with Acute Medicine, Critical Care, Acute Surgery and Medicine for the Elderly. Condition specific programmes (eg Acute Coronary Syndrome, Stroke) will feed into these key programmes and the Chronic Disease Programmes are intended to provide out-patient services and disease management strategies to reduce the demand of chronic illness on the acute hospital system. Implementation of the five key programme plans will be co-ordinated on a regional basis.

The following issues are likely to be barriers to the implementation of the EMP:

NCHD crisis – We met with Barry White about this issue and considered his response to be very supportive. We submitted a proposal for a strategy to mitigate patient risk to the HSE and I have met with HSE MET and HR in response to this.
ED overcrowding – We have consistently highlighted that overcrowding remains the primary barrier to delivering safe and efficient EM services. It is not the programme’s responsibility to solve this but we have not wasted any opportunities to flag this as a key safety issue.
The historic underdevelopment of EM – We are starting from such a relatively low point in terms of consultant numbers that it will take some time to train the numbers of consultants needed, notwithstanding the recruitment of currently trained consultants and Irish consultants working abroad.
The economic situation – We have to be realistic and anticipate that funding cutbacks in health may hamper the development of our specialty. Nonetheless, we have an opportunity through the EMP to develop a plan for the structured development of our specialty and the services we provide.
Reconfiguration – Although this is not within the remit of the EMP, it is clear that in the future there will not be as many EDs in the country as currently exist. The DQCC is becoming increasingly involved in reconfiguration, so we have cause to hope that clinical and service quality issues will be considered in future reconfiguration planning.

Please contact me directly, if you have any questions about any of the above issues.

Una Geary.