In Support Of Investment In Community Beds Rather Than Acute Hospital Beds Apr 26, 2016 -
Author: Tony McNamara, CEO, Cork University Hospital Group
It is a little known but vitally important statistic that in Cork University Hospital, as few as 3% of medical patients occupy c. 30% of bed days at any one time. Interestingly data presented at our recent Patient Pathway Symposium indicates that other large teaching hospitals in Ireland demonstrate similar patterns suggesting that addressing this challenge may significantly impact positively on Emergency Departments (ED) and on the performance of acute hospitals generally.
The following table demonstrates that in other large teaching hospitals in Ireland there are also a disproportionate numbers of bed days used relative to the numbers of patients in hospital, which must raise questions in relation to the often stated idea that “we need more acute beds in our hospitals”.
Table 1 - Medical Bed Days Used
Total Medical Bed
Number and % Patients with Length of Stay > 30 Days
Number and % Bed Days Used by Patients with Length of Stay > 30 days
Cork University Hospital
St. James Hospital
St. Vincent's Hospital
Mater Hospital Dublin
Galway University Hospital
In fact in the acute hospital system in Ireland it is astonishing to find that 34% of patient days are used by patients with a length of stay of over 30 days. Is it any wonder that we have a capacity problem in our acute hospitals? It is also worth noting that the average length of stay for medical patients in CUH has increased by one day to 6.8 days since the beginning of Winter 2015 and each increase of one day in length of stay equates to a requirement for 60 beds in the hospital.
We have been giving a great deal of thought to what this data means to the Hospital in respect of strategies that might be employed to improve the patient pathway and the overall unscheduled care performance of the Hospital. The emerging realization that the resolution of the difficulties that ultimately manifest themselves in delays in the ED lies as much in the community (pre and post hospital care) is in our view both welcome and correct.
In Cork and Kerry the contraction of community beds in recent years in response to more stringent HiQA care standards, budgetary constraints and policy, despite an aging population has ultimately resulted in fewer options for the discharge of patients to community settings. This is not a sustainable position.
It is clear to the leadership in CUH that the discussion on the perceived need for a second acute hospital (a scale of 300 beds has been mentioned) has not been carefully thought through and is not sustainable either in respect of the capital investment required of c. €300m or the annual revenue costs of perhaps €150m based on similar modern acute hospitals.
We take a different view and consider that the challenge in Cork has to be to free up the acute bed capacity that exists in CUH by creating increased capacity in other settings and specifically we support the following strategies;
- Continue to implement change programmes designed to increase the efficiency of acute hospitals in terms of length of stay, appropriateness of care in an acute setting and use of data to support the development of strategies to improve patient flow;
- Invest in much needed Intensive Care and High Dependency beds as a necessary part of the infrastructure to support increasingly complex care in CUH;
- Increase bed capacity in community hospitals to provide alternatives to acute care;
- Change governance arrangements in community hospitals to provide for admission and discharge to be led by Consultants in Elderly Care based in acute hospitals working with locally based General Practitioners;
- Construct a number of strategically located community nursing units primarily in the great Cork area to increase patient flow thereby creating up to 150 acute beds in CUH and the Mercy University Hospital;
- The National Rehabilitation Hospital in Dublin provides an excellent service but with a large Trauma, Neuroscience and ED service there is patently a need for a Rehabilitation Hospital to support the acute services in Cork;
- Some services can and should be provided outside of the acute hospital setting in Cork including outpatient services, elective diagnostic services and a range of day services. The relocation of these services should be considered to free up capacity for services that are more appropriate to a large tertiary hospital.
These are the priorities that we believe have the potential to create significant capacity for acute care in Cork University Hospital / Mercy University Hospital and that have the potential to radically transform the delivery of acute care in the region. We need to change the focus of the debate in support of alternative policies that help build a truly integrated health system for the betterment of society.
Comments and feedback welcome. Thank you.