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Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance. The NHS in England is introducing a new digital triage system that could see some patients arriving at A&E being asked to return later or redirected to other services if their condition isn't urgent. Supporters of this say it will and does reduce waiting times and will ease overcrowding. But could a similar approach apply here as well?
Well, I'm joined now on the line by Professor Mick Malloy. He is chair of the Consultant Committee for the Irish Medical Organisation. You're very welcome to the programme. So, first of all, what is your understanding of this digital triage system that is being piloted in quite a number of hospitals across England?
Chapter 2: What is the new digital triage system being introduced by the NHS?
So there are two aspects to this, Ciara. One is the triage in the door of the emergency department and the other is the triage on the phone that happens at the NHS. And the difference between the NHS and our HSE is it's integrated from the emergency departments to primary care, to many of the other services around. And we don't have the same sort of integration currently within the HSE.
which would make it a little bit more difficult to achieve here. I agree it can lead to reduced waiting times, but the people that it reduces the waiting times for are those who would have had excessively long waits and the people who turn up in emergency departments with very low priority conditions can have excessive waits because there are always more serious conditions to be seen before them.
That's the purpose of triage, to make sure that nobody with a very serious condition has to wait excessively long periods of time. But if your rooms are already full and your emergency department rooms are full of patients who've been lodged or admitted the day before and waiting for an inpatient, in a hospital bed.
A digital system won't speed up the process for new people coming in the door because there's a capacity issue which we have to address.
The evidence coming out of the UK is that it is halving the waiting times for those urgent cases that are in A&E. But it doesn't say anything, I suppose, research to date about what happens to those who are redirected or those who are sent to come back on a different day or in a different time slot.
Would you have concerns around the digital triage of those patients who are told to come back at a different opportunity or to go elsewhere?
So triage in itself is a very brief process where it's computerized. The nurse who sees you in the triage room goes through what you believe are the relevant issues for you on that particular day.
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Chapter 3: What are the benefits of the digital triage system according to its supporters?
And by following particular algorithms, you end up with a code. One would be seen immediately. Two would be seen within a half an hour. Three within one hour. Four up to three or four hours.
Chapter 4: How might a similar approach to triage work in Ireland?
And five, you could be waiting for a long period of time. So it depends on the individual understanding everything that's wrong with them at that particular time to make sure people don't get incorrectly triaged lower than they should be. But it still is only a limited amount of information. And the UK system, I'm not aware of it. I haven't worked in that element in the UK system.
And that you're saying about it cutting the time for urgent patients, I'm not clear on that because the article I read from your researcher talked about cutting the waiting time. for those who had the long waits, which were the lower priority cases.
And it was referenced to another article which talked about inappropriate deaths or unexpected deaths because people were waiting long times, which was a different issue.
How do you think Irish patients would react if they arrived at an emergency department and they were told, no, you need to go back and see your GP or you need to go to a different clinic or you need to come back at a quieter period tomorrow?
That's the tricky part. And that really is a public opinion matter. I know in some emergency departments that does happen right now. So particularly where you've got minor injury services in a hospital which are front loaded to be operating maximally during the daytime and somebody may present at midnight or 1am and be told, listen, you could wait here all night.
And you will be seen by that group of people when they start work at 8 o'clock in the morning because overnight there are larger volumes of people with very serious conditions and less staff around. So you will still wait for that seven hours or you could go home, go to sleep, come back at 8 o'clock in the morning and be seen by that person or that service at 8 a.m. with a minimal wait time.
Those systems already operate in some hospitals quite effectively. Now, the difficulty with the hospitals is at the moment in Ireland, we can't complete the circle with somebody who should maybe be attending their GP because in the one instance, not everybody who attends emergency has a GP.
And number two, we have no linkage to the GP booking system to get an appointment for that patient if they should be with their GP.
So one of the difficulties here is that we don't have all of the alternative services in place and available to people when they need it.
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Chapter 5: What challenges does Ireland face in implementing a digital triage system?
But there are two essentially compounding issues here. One is the need to treat the people with the most urgent conditions as quickly as possible. And two, the larger number of people who've got more minor, easily treatable conditions, which could be turned around very quickly.
But if you have a system which prioritizes that group and you're encouraging that group to continue their attendances and continue their patterns, effectively you're going to be overwhelmed and swamped with the volume of patients. So it's a very difficult issue when we're balancing resources versus capacity.
It's an interesting one, though, because I think people would like to think that technology and AI could be used in some way to deal with the overcrowding, the chronic overcrowding that we do see in our emergency departments. But it sounds like we haven't quite worked out how to use it just yet. Dr. Mick Malloy, thanks so much for taking the time to speak to us on the Clare Byrne programme.
The Clare Byrne Show with Aviva Insurance. Weekday mornings at 9 on Newstalk. Conversation that counts.