Emergency departments and capacity

Sir, – Although Paul Cullen points to the extraordinary delays that patients attending emergency departments who require hospital admission are forced to endure and correctly points out the risk to patients of prolonged trolley waits, he then claims that there is a clear "model" in St Luke's Hospital, Kilkenny, which would address the problem ("Health service implicated in chronic problem of access", Analysis, May 11th).

He notes that in Kilkenny patients “are admitted or discharged in under three hours”, although it is obvious that the two groups are incomparable.

Those that endure long waits for hospital admission are deemed sick enough to require hospital admission, whereas those that can be discharged within three hours clearly don’t.

He goes on to suggest that providing “five or six routes into St Luke’s for sick people” in some way solves the problem. One doesn’t have to be a specialist in emergency care to recognise that if the hospital capacity, ie the number of beds is fixed, then irrespective of how many additional doors are created, the capacity of the hospital is not improved.


Patients wait on trolleys for hospital admission because there is no bed into which to admit them. This is a capacity problem which has been long recognised.

Unfortunately, recognition of this problem has not prompted the necessary major increase in capacity which would allow patients who require hospital admission to be admitted in a timely fashion and substantially reduce the burden faced by the country’s emergency departments. – Yours, etc,



Irish Association for

Emergency Medicine,

Consultant in

Emergency Medicine,

Sligo University Hospital,