Elderly patients hit with ‘double whammy’

VULNERABLE elderly patients with serious medical conditions have been dealt a “double whammy” following a dramatic change in admission policy, a Mid-West leading consultant physician has claimed.

Acknowledging the reduction in acute services at Mid-Western Regional Hospital Ennis are not ideal, Professor Declan Lyons pointed out this was more palatable when elderly patients from Clare were automatically admitted under specialists in Elderly Medicine at Mid-Western Regional Hospital Limerick.

However, Professor Lyons warned the abrupt ending of this long-standing process this week could adversely impact patients in this area, who often have multiple illnesses.

In an unusual move, Professor Lyons, who is Professor in Medical Science and Consultant Physician, issued a statement with Consultant Physicians Dr Margaret O’Connor and Dr Catherine Peters opposing new changes in the admission policy in Limerick where they work.

However, the Mid-West HSE insists these changes are designed to ensure patients, of all age groups, will be treated faster, safer and more appropriately with access to all subspecialty requirements.

With between 33% and 50% of night admissions from Clare, Professor Lyons noted on average five or six of these could be over 75 years of age.

“The model of Elderly Medicine that has been operational at Limerick Regional for the past 15 years has been painstakingly built up to deliver high clinical standards, with activity data for elderly patients demonstrably the best in the country.

“The approach has been to rapidly diagnose and treat the causes of ‘age-associated diseases’ from the time of admission under the care of a specialist consultant-led team.

“The new changes deny automatic access to this service without any particular rational being advanced for the change,” he said.

Highlighting the consultants’ statement, Senator Martin Conway asked that the HSE give a more comprehensive response to reassure people.

“I am deeply worried about the effect that these new arrangements are going to have on elderly people from Clare who find it necessary to present at the emergency department in Limerick,” he said.
Deputy Timmy Dooley claimed the axing of the service would cause extreme concern for patients. “This will lead to poorer levels of diagnosis and delayed access to appropriate treatment for elderly patients. Elderly patients could end up being admitted for longer periods,” he said.

The Mid-West HSE stated, in line with national clinical programmes, the process of providing safer care continues with the announcement that patients with emergency medical problems will now be assessed and treated in the Acute Medical Assessment Unit at University Hospital Limerick.

This development has come following the employment of three additional consultants, the refurbishment of a new assessment unit and extensive consultation and planning with all doctors and nurses who are involved in the delivery of care to patients, many of whom are over 75 years of age, who present to the hospital as an emergency.

“Historically, patients who attended the emergency department (ED) with acute medical problems, were referred to an on-call doctor for medicine.  This on-call system operated from 8am each day for 24 hours and patients would often have to wait in ED to be seen as the consultant on-call and their team would have other commitments in the hospital. The doctor who saw the patient in ED was not always the most senior doctor on the team and international best practice suggests that patients have better outcomes the earlier they can be seen by a senior doctor.

“The new system will allow prompt access to higher-level assessment with a senior doctor and team who will be available from 8am to 10pm daily in this unit, when the majority of patients attend the hospital. The on-call system will continue incorporating all specialists in medicine at the unit from 8pm to 8am,” the HSE stated.