Looking Beyond The Hospital For Solutions

Mar 18, 2016 - Author: Tony McNamara, CEO, Cork University Hospital Group


The challenge to deal conclusively with the Wicked Problem of multiple challenges to remove patients from trolleys in our Emergency Departments (ED) remains evasive. This is notwithstanding the multiple change management initiatives that have been implemented in our acute hospitals including Cork University Hospital where over 120 different changes have been implemented over the past three years. We have achieved a length of stay of c. 6 days for medical patients - the target set by the Acute Medicine Programme - and yet we continue to experience significant numbers of patients waiting for admission in our ED. 

There are always opportunities for continued improvement and following the implementation of recommendations following studies using Lean and Six Sigma principles significant internal efficiencies have been achieved. Specifically using the results of this study and far greater use of data we can now with some certainty observe the following norms; 

  • CUH will see on average 170 new patients in ED every day;
  • Of this number (170) 33% will require admission with the balance of patients being discharged from the hospital;
  • In addition to admissions from ED there are a further 13 unscheduled admissions per day from OPD etc;
  • There are an average of 16 other elective admissions to CUH each day;
  • A minimum of 70 discharges are required each day to address this bed requirement. 

This poses a significant challenge for CUH each day and with an occupancy of 100% leadership must look at all options to meet these challenges. 

However as our understanding of the complexity of the problem evolves we are increasingly focused on exploiting the opportunities that present to work with our community colleagues towards admission avoidance, early discharge and the creation of alternatives to excessive lengths of stay in the acute hospital. 

The focus of our 2nd annual Patient Pathway Symposium last week was the interface between the acute hospital and the community with the theme of “Looking Beyond the Hospital for Solutions”. Future Blogs will provide reflections on some of the specific presentations that are available here but the overall themes of integrated care delivery in areas as diverse as admission avoidance and discharge planning strategies provide an indication of the potential to optimally use the significant resources that currently reside in acute hospitals and in community services.  

A key challenge for health leadership is to demonstrate to our political masters, to media commentators but most of all to the taxpayer that we are working collectively to maximally use the resources in our collective gift before we seek more staffing, funding etc. In this regard we must demonstrate a capacity to improve performance and in 2016 both Cork University Hospital Group and Community services in Cork will be agreeing a programme of collective work within the resources available to address several key patient centered initiatives that will improve access and the quality of care for our population. 

We very much hope to demonstrate the potential for a large acute teaching hospital to work with community services to change thinking in the way we deliver services to patients and to be innovative in the way we deliver care using new models. In this regard those Care Programmes that focus on admission avoidance strategies or those that focus on interplay with General Practice offer real opportunities to provide alternative pathways for patients.  

However it is not enough to make claims that pathways will improve for patients, it is necessary to demonstrate that this has in fact happened (or not) and the focus of our 3rd Symposium in 2017 will be on reviewing the extent to which admission avoidance strategies have been effective in reducing the demand for acute hospital care.

Comments and feedback welcome. Thank you.


2 Comment(s) on this page



In the U.S. we utilize ancillary departments to aid the hospitals. I don't understand why Ireland doesn't have Respiratory Therapists.????? They are wonderful with patients who have breathing problems and they make house calls. Most RT's have a college degree (AAS) and take a huge work load off the Dr's and nurses. I know A LOT of RT's who would love to do an assignment in Ireland if only given the chance. Just something to think about.



It is to be highly commended the work that has been going on now for many years and not just in the previous three years but i fear our failure politically to address the issues that were obvious i.e Aging population is now having an enormous effect on our service and will do so for many years to come. As was suggested on a Prime Time programme during the recent general election the health system needs to be de-politicised only then can our health system flourish with decisions based on evidence and research which we have so much of. Don't think that i am off the wall on this as obviously there would need to be stringent controls in place as regards Finance, Access and so on.

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Last Modified Date: 23/05/2016 15:30:52