Table 1 Reconfiguration of emergency care systems in Ireland
From: Variation in resource allocation in urgent and emergency Care Systems in Ireland
Region | Characteristicsa | Summary of regional changes |
|---|---|---|
North East (Cavan, Meath, Louth and Monaghan) | Population: 440,211 Area (km2): 6395 | • Region-specific reconfiguration plan partly implemented from 2006 to 2010. • Two emergency departments reconfigured to local injury units. • Some centralisation of trauma, acute stroke and coronary care (to Cavan and Louth) with rehab support in other hospitals. • Mater [Dublin North] is the percutaneous coronary intervention (PCI) centre with supporting ambulance protocols. • Roll-out of general practitioner (GP) out of hours care. • Limited regional clinical governance. |
Dublin North East (Fingal, Dublin North City) | Population: 578,317 Area (km2): 532 | • No major changes. • Three large emergency departments with limited governance integration and differentiation of services (PCI centre at Mater [Dublin North]). • Out of hours GP co-operative established. |
Dublin South (Dublin South City, Dun Laoghaire Rathdown, Wicklow) | Population: 563,560 Area (km2): 2168 | • One emergency department reconfigured to local injury unit in 2013, with reduced hours in another. • Centralisation of acute stroke, coronary and trauma care to two hospitals (both in Dublin South City) but limited differentiation and integration between both. • Multiple out of hours GP co-operatives. |
Dublin Midlands (Dublin South, Longford, Westmeath, Laois, Offaly, Kildare) | Population: 761,324 Area (km2): 8442 | • Centralisation of acute stroke (Kildare, Westmeath, and Dublin South) coronary care (Dublin South) and trauma (Offaly and Dublin South) at several hospitals, supported by ambulance bypass protocols. • Limited integration of clinical governance. • Several out of hours GP co-operatives operating. |
South East (Carlow, Kilkenny, Wexford, Waterford and Tipperary South) | Population: 497,305 Area (km2): 9451 | • Designated hub for major trauma, and acute coronary care (Waterford – PCI centre supported out of hours by Cork) with ambulance bypass protocols. • Acute stroke care available at all 4 hospitals. • Informal clinical network with shared regional rota for emergency medicine consultants. • Single GP out of hours co-operative. |
South (Cork and Kerry) | Population: 663,176 Area (km2): 12,161 | • Region-specific reconfiguration plan largely implemented, beginning 2012–2013. • Two emergency departments reconfigured to local injury units, with another closing. • Acute stroke, coronary and major trauma care provided at hub CUH [Cork] with support of ambulance protocols and outlying centres (Kerry can thrombolyse and deal with most trauma and myocardial infarctions (MIs), Bantry [Cork] does thrombolysis). • Region-wide clinical governance structures established. • Single GP out of hours co-operative. |
Mid-West (Limerick, Clare and Tipperary North) | Population: 378,210 Area (km2): 8252 | • Region-specific reconfiguration plan largely implemented, 2009–2013. • All emergency care centralised to one hospital (Limerick), former emergency departments reconfigured to local injury units. • Ambulance bypass protocols and region-wide clinical directorates established. • Single GP out of hours co-operative. |
West (Galway, Roscommon, Mayo, Leitrim, Sligo, Donegal) | Population: 702,966 Area (km2): 22,649 | • Reconfiguration of one emergency department to a local injury unit in 2011. • Single hub for acute coronary (Galway is the PCI centre but Sligo and Roscommon have a mobile cath. Lab 1 day a week) and major trauma care with support services provided at other centres (Mayo, Donegal and Sligo take most trauma cases). • Acute stroke care available at all centres, excluding Roscommon. • Clinical directorates established across the region. • Several out of hours GP co-operatives. |