July 10, 2014
Accident and Emergency - a small story of a hospital that worked.Posted in Irish Independent · 42 comments ·
Today I am going to tell you about something that happened to me in a not very rich European country, which got me thinking about our health system.
Before I start, there will be no moral to this story. There will be no “We should do this” or “We should do that” and no finger-pointing at possible culprits. I’ll just tell you what happened.
I brought a child – a good friend of my son’s – to an A&E in a small city called Sibenik in Croatia. You may remember the name Sibenik because it was under siege during the opening months of the war in Yugoslavia. It’s a provincial town of maybe 25,000 people with one public hospital.
We had left Ireland earlier that day and the boy initially complained of a sore knee in Dublin Airport. On the flight his knee had swollen and by the time we had landed in Croatia, the knee looked like a balloon.
We thought it was a ligament or similar problem maybe picked up playing football. But during the evening it continued to swell so we thought we’d better see a doctor in the morning.
We headed to the A&E in the local hospital. Given my experience with children in Irish hospitals, I braced myself for a long wait.
But something quite shocking happened. We didn’t wait at all.
We arrived into a new wing of the hospital into a spotless A&E ward. Just to put things in context, Croatian GDP is half of Ireland’s with a similar population.
There were lots of patients milling about but there were also five nurses on standby. One spoke English. She immediately started with the paperwork and told us not to worry.
She produced a wheelchair and whisked us in to the doctor. He diagnosed an infection and said that they’d operate without any delay, to drain and clean out the wound. The doctor reckoned there was about two litres of fluid on the knee and this had to be sorted. On establishing the boy had eaten something just before we headed to the hospital, he postponed the operation for five hours to make sure the general anaesthetic would work. The surgery time was set. We had been in the hospital for 10 minutes at this stage.
Just in case there could be some underlying damage to the knee itself, he suggested an X-ray and ultrasound. An orderly appeared immediately.
If you are getting the impression that we were the only people there, we weren’t. The hospital was extremely busy, with nurses and doctors bustling around. They explained to us that this was, in fact, the busiest time of the year because the local population doubles with all the tourists. They joked that drunk tourists are much more likely to end up in hospital than the locals. We waited 16 minutes for the four X-rays to be carried out.
The radiographer told us to wait for the radiologist. We waited on the trolley in the corridor, which I suppose to an Irish person was a pretty familiar experience. About ten minutes later, the radiographer came out with the photos and reassured us that there was no knee damage but that he’d still need surgery. He also explained in perfect English that he was thinking of moving to Ireland because a colleague had moved to Limerick and was getting what he described as “good money”. He walked with us and chatted for a while about the World Cup, how Croatia had been awful and how we now needed to get the boy some blood tests, which were also done immediately.
We had been in the hospital for about 40 minutes and we’d seen three nurses, three doctors, had had four X-rays and ultrasound, blood tests and had already had a bed allocated in the surgical ward. The nurse asked for our EU blue card to cover the costs of the operation. We (typically) didn’t have it but she said an EU passport would suffice.
At no stage did they ask for money. Within the hour of arriving through the door, we were in a children’s ward in bed with a big TV in the room, showing the tennis. The nurses were extremely kind and said we’d be seen by the consultant surgeon who’d be doing the operation.
Before we had settled in, he’d arrived and straight way asked who was better, Messi or Neymar?
Sitting on the bed, he explained to the 12-year-old exactly what he was going to do, why and how long it would take. As he spoke the nurse hooked up the boy to an intravenous drip and chatted away about how she dreamt of visiting Ireland some day but it was unlikely on her Croatian salary. By the way, the hospital uses generic not branded drugs. The consultant announced he was a big Pogues fan and explained that Shane MacGowan was a genius. They then offered me lunch. A few minutes later, the paperwork was done. They’d have to get a parent’s permission to operate. So they phoned Dublin and then emailed the necessary consent forms. All this was done without any delay. They said the operation would be at 4pm and told us to kick back and watch Wimbledon.
The consultant anaesthetist came around, explained what she’d do and said the kid would be out cold for about an hour. The surgeon came back a few times and smiled, told us not to worry because he’d personally take out, what he called, the “garbage” in the knee.
At 4pm on the dot, they operated.
The boy stayed in hospital for five nights. We could visit at any time of the day or evening. He will head back tomorrow at 8am to get the stitches out. The entire patient experience was simple, straightforward, pleasant and remarkably efficient. There was no waiting at all, no charge at all and the boy will be swimming by Friday.
I have no idea why it worked so well. Maybe we were just lucky. But I’ve taken kids to Irish hospitals and I’ve waited hours for two stitches. This Croatian episode was a totally different patient experience in a hospital that can’t even afford branded drugs. I don’t understand how hospitals work, why they get clogged up and why Irish patients end up waiting for hours on end. But it is clear that it doesn’t have to be that way. I have just seen, in a country with half the income per head of Ireland, a patient experience that is in a different league. You have to wonder why.