Friday 30 September 2016

At last, one hospital has slashed its waiting lists

Beaumont patients offered prompt surgery in Cavan, thanks to Toyota

Terence Cosgrave

Published 27/03/2016 | 02:30

'More than 80 patients in the last two months have transferred from Beaumont to Cavan General Hospital to have surgery' Photo: Lorraine Teevan
'More than 80 patients in the last two months have transferred from Beaumont to Cavan General Hospital to have surgery' Photo: Lorraine Teevan

A new management system for dealing with waiting lists in Cavan Hospital - based on an efficiency model pioneered by car giant Toyota - has been so effective that patients on Beaumont Hospital's lengthy waiting list are now being offered the choice of having their surgery done immediately in the north-east.

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More than 80 patients in the last two months have transferred from Beaumont to Cavan General Hospital to have surgery.

The system - described by surgeons in Cavan as the Lean model - has already resulted in the border region hospital having some of the quickest treatment times in the country for certain surgeries.

And it has attracted the attention of the Director General of the Health Service Executive, Tony O'Brien, who is said to be looking at extending the pilot programme to other hospitals.

The Lean model was also inspected on-site last week by Dr Colm Henry - the National Clinical Adviser and Group Lead for Acute Hospitals in the HSE.

Lean is a management model first used by Toyota in the 1950s and created to cut costs and improve efficiency by eliminating waste.

The model gives medics much more options than currently available where the choice is often to either admit a patient to the Emergency Department, or send them home, a decision that is usually made by a junior hospital doctor.

Because the system is consultant-based, more options can be explored based on the medical need of the patient.

Designing care around the patient means allocating a point-scoring system to patients and identifying which patients need which services, and how quickly they need them.

If a patient is in pain, or unable to work, they receive more points, so that those with the greatest need get their surgery first.

Patients also have the option of being referred to out-patient clinics or diagnostics if they are not in need of immediate hospital admission.

Cavan hospital also has a discharge mechanism that allows the discharge of patients as soon as possible, with diagnostic results coming later - often in the consultant's surgery. Crucially, patients do not wait in a hospital bed for test results.

The system has been used in several other countries to reduce or eliminate waiting lists and the pile up of patients in Emergency Departments, resulting in many patients having to spend extended time on trolleys.

Canada and Australia are two countries that have used the system to virtually eliminate waiting lists.

The effects in Cavan have been dramatic and suggest that it is the systems in Irish hospitals which are causing delays and long waiting times, rather than any lack of money, staff or resources.

Cavan, for example, has waiting lists no longer than three months for general surgery, but in reality a couple of weeks for the average patient.

There are similar figures for minor surgery, colonoscopy and gastroscopy procedures.

While the average length of a hospital stay in Ireland was 6.1 days in 2014, in Cavan it was 3.87.

The hospital also compares very favourably with the rest of the country in terms of average length of stay per patient for a range of procedures - just two examples being appendectomies where the average national stay is 3.2 days, while in Cavan it is 1.56 days.

In the case of a colectomy, the average national stay is 18.2 days, while in Cavan it is 11.83 days.

Terence Cosgrave is the Editor of Irish Medical News

Sunday Independent

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