A&E doctors call for more beds to end crisis

Overcrowding in accident and emergency departments will continue until capacity in hospitals is increased by 2,000 - 3,000 beds to produce an occupancy rate of less than 85 per cent, the Irish Association for Emergency Medicine said yesterday.

In a position paper on overcrowding, the association, which represents consultants working in emergency departments, said the issue of capacity would not be addressed simply by greater health service efficiencies.

It stated that international research had shown that once occupancy rates exceeded 85 per cent, there would be regular occasions on which no beds were available for patients requiring admission. The association said the fundamental issue was a lack of capacity in the health service in terms of beds, access to diagnostics and access to specialist and community services.

"There is a debate currently as to whether there is an absolute or relative shortage of beds in the system. This is irrelevant to the patient lying on a trolley in an emergency department. The fact remains that there is not a bed available for them when they need it. More efficient use of beds requires increased access to specialist diagnostics, specialist out-patient services and to community care," it stated.

The association said that in the absence of a major incident, it was unacceptable for any patient to remain on a trolley beyond the time of the decision to admit them to a ward. International research showed that clinical outcomes were adversely affected for patients who had to remain on trolleys for periods after the decision to admit them to a ward.

"This relates to the reality that emergency departments cannot adequately fulfil both their primary functions and also function as an inpatient ward. As a result, both functions are performed sub-optimally with consequent predictable adverse effects on patient outcome," the position paper stated.

Persistent overcrowding in emergency departments resulted in patients having confidential medical histories taken within earshot of other people.

"Often medical staff have no choice but to examine patients on corridors and discuss diagnoses within earshot of the public. This practice is totally unacceptable and an affront to patient dignity", it stated.

The association also said the inability of emergency departments to adequately carry out their primary function had a negative impact on the morale of medical, nursing and ancillary staff.

"This is increasingly manifested in decisions being taken by staff members, particularly nursing staff, to either change their contracts of employment to go part-time or to leave emergency nursing completely.

"No service can continue to function in such a pressurised environment on an ongoing basis, particularly if it is losing key staff," the association said.

Chief executive of the Health Service Executive Prof Brendan Drumm said last night the agency believed capacity was adequate if efficiencies in hospitals were brought up to a level similar to the rest of the developed world.

A&E consultants: their diagnosis on A&E problems

• The fundamental issue facing emergency departments is the lack of capacity in the health service in terms of access to diagnostics, specialist and community services.

• Until capacity is expanded so that hospitals operate at occupancy rates below 85 per cent, the overcrowding will continue.

• The single greatest threat to safe and efficient functioning in the emergency department is the overcrowding caused by constant large numbers of inpatients lying on trolleys.

• The term A&E crisis is a fallacy. There is indeed a crisis. However it is not an A&E problem. Both the causes and solutions lie outside the emergency department.

• Where a patient is detained in the A&E department beyond the time where the decision is take to admit, clinical outcomes are adversely affected.