HSE at odds with medical training body over treatment of emergency department patients

Hospitals told to allow specialist teams outside ED review patients suffering delays

The Health Service Executive and the main training body for medical hospital doctors have clashed over who should treat patients waiting long periods in emergency departments.

Hospitals across the country have been instructed by the HSE to ensure specialist teams from outside emergency departments are available to review patents experiencing long delays in EDs.

The letter from HSE chief clinical director Dr Colm Henry flatly contradicts an instruction by the Royal College of Physicians of Ireland, which last week said medical hospital trainees should not be reviewing patients in the ED until staff there have seen them.

At issue is whether it is better for the longest-waiting ED patients to at least be seen by a junior medical trainee rather than no one in the short term. Dr Henry says there are “significant concerns” over current levels of overcrowding and this is a safety risk for patients in hospitals nationally.


The RCPI’s Institute of Medicine, which is responsible for training more than 500 medical doctors in hospitals, has threatened to remove accreditation from any hospital where senior house officers (SHOs) are evaluating patients before they are seen in the ED, The Irish Times reported on Wednesday.

The letter sent by the RCPI’s Prof John McDermott prompted a swift riposte from the HSE, in a terse two-paragraph letter sent on Wednesday by Dr Henry to hospital group chief executives and clinical directors.

“Significant concerns remain regarding the degree of overcrowding in our emergency departments. Given the numbers of presentations, this remains a patient safety risk for patients in our hospitals nationally,” Dr Henry says in the letter.

“Clinical directors should continue to take all the necessary actions to alleviate overcrowding by facilitating the flow of patients through hospitals by early review, diagnosis and timely discharge. Where there are significant concerns with delay in reviewing triaged patients, specialist teams can be contacted to review patients directly, working within their scope of practice.”

ED patients continue to be “trolley cases” regardless of whether they are seen by ED staff or doctors from the rest of the hospital, according to David Menzies, an emergency medicine consultant at St Vincent’s hospital and associate professor at UCD’s school of medicine.

“A patient in ED may wait to see an emergency medicine doctor initially and wait again to see a medical/surgical/orthopaedic, etc doctor after that, but the waiting for a bed on a ward only starts after a ‘decision to admit’.

“If a medical doctor sees the patient first, that doesn’t change the metric of when they are/aren’t waiting for a bed.”

There were 647 patients waiting to be admitted on Wednesday, according to the daily count by the Irish Nurses and Midwives Organisation.

University Hospital Waterford had had patients on trolleys in the past week for the first time in more than 1,000 days, due to the knock-on effects of the taking in patients destined for Wexford General Hospital, which is closed due to a fire.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times