Saturday hospital unit staffed by consultants saw just five patients over three months

Consultants rostered to work on Saturdays under new contracts with the State saw just five patients over the course of a 12-week pilot project at a hospital in northwest. The weekend rostering of senior doctors under the provisions of the new public-only consultant contract is a key healthcare reform championed by Minister for Health Jennifer Carroll MacNeill.However, a report on the Saturday consultant-led acute medical assessment unit pilot at Letterkenny University Hospital found there had been “no measurable improvement in emergency department flow, hospital avoidance, admission rates or inpatient length of stay”.It said the pilot, carried out between April and June, project, incurred additional agency staffing costs while reducing weekday consultant availability. The report recommended that the “current Saturday acute medical assessment unit model be discontinued”.READ MOREAn acute medical assessment unit is a facility aimed at providing immediate evaluation, diagnosis and treatment for patients presenting with various conditions or referred by GPs. The Health Service Executive West and North West region, which runs the hospital, said that as a result of capacity pressures in Letterkenny during the pilot duration, the acute medical assessment facility had to be used for inpatient surge capacity on a number of weekends.“This limited the extent to which the pilot could be run as originally designed, and affected the hospital’s ability to evaluate the new approach during this period,” it said in a statement to The Irish Times. “Letterkenny University Hospital is now reviewing how patients are referred into weekend services and how the diagnostic capacity needed to support this model will be secured. HSE West and North West is committed to the provision of consultant-led services over weekends.”Under the initiative one consultant physician at Letterkenny was rostered each Saturday to operate the acute medical assessment unit from 9am to 5pm. The pilot aimed to evaluate whether such Saturday rostering could improve patient access, reduce emergency department pressures and “support hospital avoidance”.“The pilot demonstrated very low activity (five patients over 12 Saturdays; mean 0.42 patients per Saturday) with no measurable improvement in emergency department flow, hospital avoidance, admission rates or inpatient length of stay.”On eight of 12 Saturdays (66.7 per cent), it found, the unit “had no patients”.“Independent evidence from radiology, cardiac investigations and pathology confirmed that the supporting diagnostic infrastructure required for scheduled weekend care could not be provided within existing workforce and contractual constraints.”The report, drawn up by an assistant clinical director at the hospital, said agency nursing staff and agency non-consultant doctors were employed specifically to support the pilot and that the rostered consultants received time off in lieu, usually on the following Monday.It noted that GP practices were closed on Saturdays and while the GP out-of-hours service in Donegal had been informed of the service “no referrals or telephone enquiries were received”. It said in the cardiac investigations area there was no staff interest in routine Saturday overtime, weekend staffing shortages already existed, annual, sick and maternity leave were not routinely backfilled and industrial relations issues prevented additional duties.It said there were insufficient consultant radiologists, radiographers and sonographers and that Saturday pathology operated as an emergency on-call service only.“We are engaging with our consultants on Saturday working to ensure our services, including acute medical assessment unit services, are meeting the needs of our population across weekends,” the HSE West and North West region said.