Trolley numbers have one simple cause: a lack of hospital beds


ANALYSIS:Hospital misery drags on as initiatives by the HSE and Harney fail

THE PROBLEM of overcrowding in hospital emergency departments has been around a long time.

A host of initiatives have been announced to try to resolve the problem since Minister for Health Mary Harney took up her post in 2004 and since the Health Service Executive (HSE) was established in 2005. But, given the record numbers of patients on trolleys this week, with some waiting over 24 hours for beds, the steps taken have not worked.

First, there was Harney’s 10-point plan in late-2004 which included promises to improve out-of-hours GP services, more homecare packages, transferring more highly dependent patients to private nursing homes, and the provision of more acute medical units and minor injury units. Many of these were put in place.

Then came a report from an AE taskforce established in March 2006 after the numbers of patients on trolleys reached nearly 500 for the first time and the crisis was branded a national emergency by Harney.

The taskforce visited 18 hospitals with problems in their emergency departments and found seven unfit. These included the Mater and Beaumont in Dublin; Our Lady of Lourdes in Drogheda; Cavan, Letterkenny and Wexford general hospitals; and the Mercy hospital in Cork. A number of these have opened new and extended emergency departments since then.

But the core problem, according to the taskforce’s report, published in June 2007, was an obvious one: hospitals routinely do not have beds available, which results in patients spending significant periods in the emergency department. “At the current time, a significant number of hospitals examined by the taskforce are operating at close to 100 per cent capacity against a well-established international evidence base that states that the optimum level is approximately 85 per cent occupancy,” it said.

This optimum level of bed occupancy is rarely reached and, in some hospitals, the chances of reaching it are further away than ever due to hospital bed closures over the past year to cut costs.

The taskforce report also highlighted delayed discharges as contributing to emergency department overcrowding. It said it was vital hospitals had full access to existing beds but, at that time, up to one-fifth of beds in Dublin hospitals could be taken up by patients whose discharge had been delayed because of insufficient long-term care beds.

Yet latest figures from the HSE indicate some 539 beds in acute hospitals were still blocked by delayed discharge patients at the end of October. This is despite the introduction of the Fair Deal nursing home support scheme to alleviate the problem.

It has had some impact since it commenced in October – delayed discharges were as high as 900 in August 2009 – but not as much as expected.

Overcrowding in emergency departments across the State has not gone away. In fact, this week it is worse than ever. For the HSE to say on Tuesday, when the daily trolley count from the Irish Nurses and Midwives Organisation reached a record 511, that much of this extra pressure on emergency units was down to the increase in people suffering swine flu and other seasonal illnesses is to avoid the real causes of the problem, which have been the same for years.

It is true swine flu and seasonal factors, such as people putting off procedures until after the holiday season, have had some impact and maybe caused the figures to soar to a record high – as high as 569 yesterday – but they are not the major factor. The lack of availability of beds is the major cause of the current crisis.

The department seemed to acknowledge this last night saying some hospitals were reopening closed beds to deal with the situation, which undoubtedly is putting patients at risk.

Studies from Australia, Spain and the US have shown an association between overcrowding in hospital emergency departments and increased mortality and morbidity.

So apart from the complete lack of dignity afforded patients in overcrowded emergency units, there’s also the risk they will pick up infections from each other, particularly swine flu as cases continue to increase. It is likely this risk issue more than anything else has prompted management to finally see sense and order the reopening of closed beds.