Hospitals can get €10,000 fine for A&E overcrowding - report

Hospitals can be fined €10,000 each time they fail to deal adequately with emergency department overcrowding under a newly published framework designed down to tackle the problem.

The document gives effect to a directive issued by Minister for Health Leo Varadkar and HSE officials late last month aimed at cutting trolley numbers.

Trolley numbers are down 13 per cent in the first half of December compared to the same period last year, giving rise to optimism in health circles a repeat of last winter’s spike in overcrowding will not be repeated.

Hospitals have been told to take particular measures to ensure overcrowding does not surge immediately after the Christmas holiday period, as has happened in previous years.

The framework published by the HSE proposes a “tiered and incremental suite of actions” by named managers to deal with overcrowding in emergency departments.

Hospitals are regarded as operating in a “steady state” when all patients are seen and admitted or discharged within nine hours, but a series of escalation measures kick in when this target time is exceeded and the number of admitted patients surpasses the available bed capacity.

Where escalation measures fail to make an impact on the overcrowding problem the plan provides for a range of “extraordinary special measures” to be activated “as a last resort”.

The document says the Irish Nurses and Midwives Organisation has not agreed to the use of full capacity protocol, which involves the placing of extra beds on wards but this can be implemented, along with the diversion of ambulances to other hospitals, as a last resort.

HSE director general Tony O’Brien and INMO general secretary Liam Doran, who jointly chair the emergency department implementation taskforce, must be informed if full capacity protocol is implemented in any hospital, the union pointed out.

“The temporary placement of patients to extra beds is implemented as a final institutional response to continued overcrowding after all other possible measures have been implemented to facilitate the delivery of safer patient care across the health system.”

The INMO welcomed the publication of the revised and strengthened escalation policy, saying it brought clarity to the actions needed to deal with the problem. Mr Doran said the agreed policy had “real potential” to reduce current levels of overcrowding.