Hospitals use ‘last resort’ measure to handle overcrowding 1,900 times in a year

Full Capacity Protocol sees beds placed in wards and hallways to ease pressure on EDs

Hospitals used a plan regarded as the “last resort” available when dealing with overcrowding in emergency departments (EDs) more than 1,900 times in the year to the end of September, new figures show.

Full Capacity Protocol (FCP) is the final step in a hospital’s escalation plans and involves additional beds being placed on wards and in hallways to reduce the number of people in EDs. In some hospitals the protocol is being used more than once every three days.

University Hospital Waterford deployed the measure on 208 days between September of last year and last September, according to Health Service Executive (HSE)figures obtained by the Irish Patients’ Association.

University Hospital Limerick had the second highest rate of protocol usage at 184 days, followed by University Hospital Galway (176 days).


Connolly Hospital in Blanchardstown, Dublin used it least often, deploying the measure only once in the 12 month period, followed by University Hospital Kerry, which used the measure four times in the year.

Stephen McMahon, of the Irish Patients’ Association, expressed concern at how frequently the measure was being used. He likened the protocol to Level 5 in the Government’s Living with Covid-19 roadmap.

“It is a serious event and one that should be an almost never event,” he said. “Activation of FCP is the result of many moving parts that are not in alignment such as staffing, capacity, infection control, and or the lack of management of those moving parts locally nationally and indeed politically.”

‘Serious questions’

Mr McMahon added that the figures “raise serious questions about the capability of hospitals in certain areas to manage emergency care this coming winter despite the €600 million band aid” of extra funding.

Mr McMahon, a member of the emergency department taskforce, which aims to find ways to reduce overcrowding, said the body had not met since the Covid-19 crisis began.

The directive which allows for use of the Full Capacity Protocol was signed in November 2015 by the then minister for health Leo Varadkar, now the Tánaiste. The directive states that the protocol should only be used as a “last resort” when “all possible escalation steps have been exhausted and overcrowding persists”.

Use of the measure met with opposition from the Irish Nurses and Midwives Organisation, with the union previously warning it was “likely to be abused”.

Acute pressure

University Hospital Limerick said it “faces significant capacity issues” like many other hospitals countrywide, and uses the protocol when pressure “becomes more acute”.

“We regret that any patient has to face long waits in our emergency department during busy periods and any distress or inconvenience this causes for patients and their loved ones,” said a spokesman.

Asked about use of the protocol, the HSE said there is a “need for a significant shift in the provision of care to the community in addition to an increase in acute hospital capacity.

“Where any acute hospital continues to experience demand which exceeds their available capacity, the National Escalation Framework continues to provide a stepped and dynamic process to manage such pressures.”

Shauna Bowers

Shauna Bowers

Shauna Bowers is a reporter for The Irish Times