IN THE space of one week in late August, patient numbers in the emergency departments of two of the state’s flagship university hospitals reached a level where the units became unsafe for patients. The most recent occurrence of hospital overcrowding was noteworthy for two reasons: it occurred at a clinically quiet time of the year when elective surgery activity is low and pressure on in-patient beds is less; and it occurred at a period well removed from the winter months when demand for urgent hospital care is at its highest.
Earlier in the month, the Health Information and Quality Authority (Hiqa) undertook a surprise inspection of the emergency department of Tallaght hospital as part of an ongoing investigation into the unit. The hospital was immediately told it must stop placing patients, who are due to be admitted, on trolleys in corridors near the emergency department, as the practice poses an unacceptable and serious risk to patients. It also found that a patient with infectious tuberculosis was placed for over 72 hours in a room which was not an isolation room.
An indication of the likely national ramifications of the Tallaght inquiry are evident in its terms of reference which specifically state: “In the interests of wider service improvement, national recommendations may also be made where the Authority considers appropriate.” The report is expected to be finalised by the end of the year.
In its interim instruction to the board of Tallaght hospital, Hiqa touched on what is likely to become a contentious issue when it comes to making national recommendations: in the absence of an in-patient bed, are patients who require hospital admission in less danger when kept in the emergency department or when they are moved to additional beds set up in already full in-patient wards?
There is strong research evidence from Australia to show that hospital and emergency department overcrowding is associated with a 30 per cent increase in mortality for patients requiring emergency admission. This increase in mortality appears to be independent of patient age, season of the year or diagnosis. Commenting on the research findings, an editorial in the Medical Journal of Australia stated: “An overcrowded hospital should now be regarded as an unsafe hospital. Health care workers should not have to provide services in an environment that potentially jeopardises patient safety.”
The Irish Nurses and Midwives Organisation remains strongly opposed to placing additional beds in the corridors of wards when emergency departments become clogged. However this may, in the absence of additional wards being opened, be the least worst option when it comes to the safety of sick patients.
While we await a definitive recommendation from Hiqa, the premature overcrowding crisis of last month means there is a clear and continuing danger to people who require emergency admission to hospital. If unnecessary deaths are to be avoided in the weeks ahead, the Government must institute interim measures to shore up patient safety in our overstretched public hospital system.