‘Safer’ to move patients on trolleys from A&E to wards

PATIENT safety is compromised when too many patients are kept on trolleys in emergency departments according to a consultant in emergency medicine at the Midwest Regional Hospital in Limerick.

Dr Cathal O’Donnell was reacting to the Irish Nurses Organisation (INO) decision to ballot members for strike action in protest at a Health Service Executive (HSE) directive to move patients on trolleys out of the ED onto in-patient wards. The directive was issued to reduce overcrowding.

Nurses claim the decision to place additional patients on wards increases their workload without increasing the staff complement, leading to delays in discharging and access to beds for patients.

However Dr O’Donnell said the patients moved out of the ED had already been assessed and admitted and that he and his colleagues around the country “regard it as unfair that we have to look after the equivalent of two wards” in addition to dealing with “heart-attack, stroke and road traffic accident victims”.

“We feel it (moving extra patients onto wards) is the only safe thing to do to protect the patient. It is not ideal but it is better and more humane than keeping them corralled in the ED,” Dr O’Donnell said.

Dr O’Donnell said a study in Canberra, Australia, had found that where a similar policy was implemented, 13 deaths had been prevented in an ED that treats 34,000 patients annually. The Midwest Regional Hospital ED treats 57,000.

A statement from the Irish Association of Emergency Medicine supported the HSE directive warning that keeping patients in the ED after they had been treated “results in increased mortality and morbidity”.

“By contrast, the practice of lodging one or two additional patients on inpatient wards has been shown to be safe,” the statement said.

The INO blamed crowding in the ED on poor access to diagnostics, the absence of a multi-disciplinary team approach to discharge planning, and bed closures at the Midwest Regional Hospital (15 beds); St Johns’ Hospital (10 beds) and up to 60 acute beds taken out of Ennis and Nenagh Hospitals since October 2009.

“This has had a serious impact on capacity at the Midwest Regional Hospital Limerick and led to 29 patients awaiting beds in the Emergency Department on Tuesday morning, December 1,” the INO said.

Separately, the ED at the Midlands Regional Hospital in Tullamore is back on call. It had stopped accepting patients from the ambulance service due to overcrowding.