Tackling the A&E logjam

With the number of patients waiting on trolleys in accident and emergency (A&E) departments reaching record numbers this …

With the number of patients waiting on trolleys in accident and emergency (A&E) departments reaching record numbers this month, it is clear that the overcrowding crisis in hospitals continues unchecked. Notwithstanding disagreement between the Irish Nurses' Organisation and the Health Service Executive (HSE) on actual numbers, it appears that the 10 point plan for A&E, announced by the Tánaiste 17 months ago, has been slow to bring about change.

Under the plan, almost 550 long-stay patients, who had been occupying acute hospital beds even though their treatment had finished, have been discharged to other facilities and to their homes. And some 590 people are now in intermediate care following the provision of additional step-down facilities. But extra resources in Dublin hospitals have been slow to materialise: planned medical assessment units in Tallaght, St Vincent's and Beaumont hospitals are not yet in place.

The Dublin Coroner's Court heard recently of horrific conditions in the emergency department of Dublin's Mater Hospital. Describing the case of a 74-year-old woman who died of a brain haemorrhage while on a trolley in the nurses' station, Dr Eamonn Brazil, a consultant in emergency medicine at the hospital, said that staff were forced to treat patients in chairs and on the floor and that four of his staff occasionally had to share one trolley when trying to assess a patient.

Such conditions pose unacceptable dangers to patients, staff and family members. The risk of cross infection from patients presenting with infectious diseases is high; the likelihood of MRSA transmission is increased; and the risk of workplace injury for hospital staff is multiplied. But it is the patients who are most at risk. It is simply not possible to provide adequate monitoring or safe treatment in such deplorable conditions.

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The HSE has responded to the latest rise in accident and emergency waiting numbers by establishing a dedicated team to tackle the specific issues affecting hospitals which are performing less well. It plans to introduce performance targets for individual units.

Seasonal factors, such as the winter vomiting virus and flu-like illnesses, are contributing to the pressure on hospital emergency departments. But the very seasonality of these factors means that it should be possible to anticipate them. The Department of Health and the HSE must put in place a strategic reserve of staff and beds so as to be able to respond to these annual pressures by temporarily opening up additional inpatient beds. Where waiting numbers exceed a certain target in each hospital, elective admissions to that hospital must cease temporarily until the logjam in A&E has been relieved.

Temporary initiatives such as these can be introduced quickly and with modest cost to the Exchequer. By implementing them, both the Minister for Health and the HSE can demonstrate a willingness to take short-term action on the A&E crisis to complement medium and long-term plans already in place.