Kathy Sheridan: Trolley crisis has to be kept in perspective

Some once-notorious hospitals have battered the problem into some degree of submission

Security and medical staff working in the emergency department of St James’s Hospital. Photograph: Alan Betson

Security and medical staff working in the emergency department of St James’s Hospital. Photograph: Alan Betson

 

Last year, my nominated watchword was “nuance”. It failed to take off, spectacularly. Sweeping statements, generalities and outright lies won the public discourse by a mile. This year, optimistically, I’m going with “perspective”.

So what is the perspective on the annual emergency department crisis? Having blearily ingested acres of coverage from the perspective of bed and a hacking cold, like much of the population, I saw only distress and despair.

But if the entire system is in meltdown, why does it take such a terrible toll on some hospitals but not others? Why was the Minister contradicted immediately upon asserting that flu was the problem ? If physical resources are the ongoing problem, why does the crisis blow up for no more than a few weeks every year? Why does the crisis happen at exactly the same time every year? Have there been absolutely no improvements at all?

There was a time when drunks got all the blame for emergency department anarchy. Or youths rambling in with football injuries. Or elderly people refusing to budge from the bed. This year, it seems to be all about GPs, overburdened by (feeless) under-6s or squandering the taxpayers’ investment on Australian beaches. Or perhaps it’s the flu and the startling fact that less than a third of healthcare workers get the vaccine. Or if it’s not flu now, it certainly will be in a few weeks’ time, apparently. By which time, we are warned, a big swathe of the health service will be out on strike. So many vested interests.

Legitimate question

A senior official quoted anonymously in this paper asked “how come the ‘crisis’ never hits on December 28th, 29th , 30th?” Or indeed on Christmas Eve, when, according to HSE figures, there were only eight patients on trolleys throughout the country. Those damned winter bugs know nothing about holidays, so the official asks a legitimate question, though lacking the courage to say precisely and out loud what he/she means by it.

Individual experience counts for little if an entire system is slowly collapsing over decades, but up to a year ago, it’s safe to say that members of this household would have chosen a quick death over a trip to any emergency department.

Then there was an unavoidable visit a year ago, on December 29th as it happens. En route to the Mater Hospital in the early morning, the thought of wading through a heaving ED intensified the gathering sense of doom.

Then we thought we were in the wrong place. There were just two people awaiting attention; a third was prostrate on a bench, sleeping off a big night out. Within 20 minutes, our patient was in a bed in the assessment unit, receiving first-class care.

Another emergency dash in November landed us in an emergency department we had been actively avoiding for years. It was on a Sunday at dawn so we had little choice and Beaumont Hospital had become our treatment centre and its ED the only route back in (a fact not fully understood by many who believe that insurance somehow enables patients to skip past the queues). That morning, there were all of three people waiting, plus a burping drunk.

Immediate care

Again, the attention, professionalism and care were immediate and sustained and our patient was in a bed in the assessment unit in minutes. As the day wore on and trolleys built up, he was moved to a side room, then to a ward in the main hospital, usually reserved for day patients if the name on it is any guide. Clearly, the hospital was under pressure. But from our perspective, ED Armageddon never materialised. By Sunday night, the big day ward – with about 20 beds – saw patients continue to come and go, calmly. That ward would be no one’s first choice for privacy, facilities or decor, but it did the job that night and for the rest of the week.

This is a side of the ED story that rarely makes it into the news. Some once-notorious centres have managed to batter the problem into some degree of submission. Beaumont – with a catchment area encompassing some of the largest concentrations of elderly people – had 54 patients on trolleys around this time last year, placing it top of the trolley leader board. Last Friday, at the height of the crisis, it was 22. Yes, 22 too many, but nothing like the scenes unfolding elsewhere.

Other important hospitals you will not have heard of in last week’s crisis-watch include St James’s – also located among high populations of elderly people and among the poorest communities – and Connolly in Blanchardstown.

Despite the senior official’s cynicism about crisis timing, this story encompasses countless acts of outstanding public service, not just by nurses and doctors, but also by many consultants and some much-derided hospital managers. This is perspective.

Next step: a great surge of leadership, courage and meaningful reform that honours both them and us.

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