Consultant shortage puts patients at risk

THE care of some patients may be at risk because of a serious shortage of A&E consultants, the Irish Association of Emergency Medicine (IAEM) has warned.

“Ideally, every patient that comes to an emergency department should be seen by a consultant, but we are a long way from that,” said Dr James Binchy, a consultant in emergency medicine.

The IAEM published a position paper yesterday calling for a major boost in staffing and resources in hospital A&Es. Everyone should have optimum standards of emergency care, the association insisted.

The IAEM wants the number of emergency medicine consultants in the country’s major acute hospitals to be more than doubled from three to eight, stressing that this was the minimum level of staffing required.

“We are starting from a very low base and we need to accelerate quickly towards a safe base,” Dr Binchy said.

“The care of some patients may be put at risk because of inadequacies in the service.”

The IAEM pointed out the clinical effectiveness of emergency departments had also been limited in recent years by overcrowding caused by a shortage of patient beds.

Dr Binchy said emergency departments in the United States with around 40,000 attendances per year had 30 emergency medicine consultants and every case is discussed with a consultant. That was the gold standard, he said.

Currently, there are 48 emergency medicine consultants and 35 hospitals with emergency departments in Ireland, which were attended by 1.2 million people last year. While the major acute hospitals have around three emergency medicine consultants, many hospitals have either a single full-time consultant or sessions covered by one or more consultants, based in emergency departments elsewhere.

The association said smaller A&E units, with less than 20,000 total attendances per year, should have a minimum of four emergency medicine consultants; medium units with between 20,000 and 40,000 attendances should have at least eight, as should those with over 40,000 attendances.

The association said it accepted that rationalisation of existing A&E units would be required to move to a 12 hour, seven day a week model but stressed that such rationalisation must have defined minimum staffing.

The IAEM also said a 24-hour consultant-based service would require massive expansion in consultant numbers, unrealistic even in the medium term.

“What we wanted to do in publishing this document is state what is the minimum acceptable staffing level for running a high quality emergency service in 2006,” said Dr Binchy.