Video: Altnagelvin innovations reduce admissions despite 7% rise in A&E attendances

Everyone hates the hospital, especially at Christmas.

Wednesday, 12th December 2018, 12:52 pm
Updated Wednesday, 9th January 2019, 8:18 am

But a series of innovations at Altnagelvin mean you’re now less likely to be unnecessarily admitted to the hospital overnight this Yuletide.

Although more of us are turning up at the local A&E for treatment, fewer are being kept in.

This is good for staff and good for patients, most of whom would rather spend the night in their own homes than in the discomfiting surroundings of a hospital ward.


All of this has been achieved through a number of changes that have been recently implemented by the Western Trust to try to reduce the number of avoidable overnights and, in turn, free up beds and resources for those who need them most.

Dr. Brendan Lavery, Clinical Lead at the A&E Department, told the ‘Journal’ how the number of people attending the Altnagelvin casualty department and its acute medical unit was up 7 per cent in one year. However, they’ve managed to reduce admissions by 8 per cent over the same timeframe.

Dr. Lavery explained that this impressive achievement was down to two main factors.

Firstly, there is now more discussion between medical and nursing staff in the A&E about whether or not patients really needed to stay overnight before they were admitted.

“What we’ve changed here is that we’ve got more shop floor cover by emergency medicine consultants and we are doing admission vetting, which means you are much more likely to be seen by a senior doctor or discussed by a senior doctor,” he said.

“A lot of my time involves supervising junior doctors. It’s not just seeing your own patients, it’s asking [junior doctors]: ‘What are you doing? What decision have you made? Oh, you want to bring those patients in.’”

Dr. Lavery said consultants then decide with their junior colleagues whether or not an admission is necessary.

“If you then think there’s an alternative to admission then you go along and see the patient, and potentially avoid admission via that route,” he said.

The second innovation, which has contributed to the impressive reduction in admissions, has been the establishment of a new ‘Ambulatory Care Unit’ down the corridor from the A&E.

This provides outpatient care including X-rays, blood tests and scans for patients who show up at A&E but don’t really need to stay. GPs can also ring the unit and avoid patients embarking on a needless trip to casualty.

“Before this service was there all of these people would have come in for an overnight stay and, to be honest, part of the problem with overnight stays is that the investigations process slows down and stops after midnight.

“So therefore how is the patient benefiting from it when they could be seen by a senior doctor and brought back the next day and get appropriate CT scans and blood investigations,” he said.

Dr. Lavery said the system was working well.

“Attendances are up by 7 per cent in one year and admissions are down by 8 per cent so those two figures together show that things are definitely improving.”