The care gap: How our largest hospitals are failing patients

Have busy and understaffed Irish hospitals lost some of the personal touch, leaving many patients feeling stranded, alone and confused?

Although the majority of patients questioned about their hospital stay this year spoke highly of staff, some major gaps have also emerged.

They reveal rushed care, a lack of consultation time with doctors, limited emotional support and many worried patients being sent home unclear how to manage their condition.

Significantly, patients discharged from larger hospitals were less likely to give a “very good” rating of care.

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According to the health watchdog Hiqa, patients in these hospitals are typically “more acutely unwell” than in smaller hospitals and are more likely to have been admitted through A&E.

The latest findings, which raise concerns about the extent to which poorly organised discharges of patients in particular are affecting quality and safety of care, are revealed in the National Inpatient Experience survey from Hiqa.

It showed more than half of patients leaving hospital were not fully informed about the side-effects of medication to watch for when they went home. One-third were not properly advised about the “danger signals” to be alert for when they got home.

And high numbers also felt their home situation was not taken into account when planning their discharge.

More than one third did not always have enough time to discuss their care and treatment with a doctor while treated in a ward.

Patients also complained of not always being involved in decision making.

And there was limited availability of emotional support.

“The night before surgery was a very scary experience… I felt I was bothering staff when I asked questions,” one patient wrote.

The survey was released yesterday as the number of patients on trolleys in University Hospital Limerick reached a record high of 85 in need of a bed.

Hundreds of patients in the survey said they waited at least two days for a bed, and seven in 10 were still on trolleys after six hours, the limit set by the HSE.

Hiqa pointed to studies showing the risks to patients who have prolonged waits in A&E. Eight in 10 said they were always treated with dignity and respect in A&E.

But one said their consultation with a doctor took place in a corridor with people walking up and down.

The distress felt by many elderly in particular, however, cannot be underestimated, although they come across as quite stoic in the survey.

A separate study from University Hospital Galway captured some insight, showing one group of elderly patients got only an hour’s sleep over 24 hours during their trolley ordeal.

The survey found younger people were less likely to report a very good experience. Among patients aged 66-80, some 14pc described their stay as fair to poor.

Areas of good experience included 96pc of patients saying their ward was clean.

Three-quarters of patients said nurses answered their questions in a manner easily understood.

Some 82pc who needed pain management reported staff did everything they could to control it and 84pc felt they were always treated with respect and dignity.

But 28pc had a bad review for hospital food, including “cold tea”, describing it as poor or fair.

“Although the majority of patients reported positively on their time in hospital, a large number of patients did not. Significantly, women and younger people tended to report less positive experiences than men and people over the age of 50, as did patients of larger hospitals,” said Rachel Flynn, director of the National Care Experience Programme at Hiqa.

While discharge planning has improved, there is still more to do, with many patients saying they did not receive enough information on their condition, their medication or how to care for themselves at home.

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