A&Es ‘screaming out’ to be fixed as doctors warn one size fits all approach won't work

Doctors have warned that any attempt to impose a “one size fits all approach” to the crisis in hospital emergency departments will not work.

A&Es ‘screaming out’ to be fixed as doctors warn one size fits all approach won't work

The president of the Irish Medical Organisation, Dr Ray Walley, said any policy response must be flexible enough to deal with local issues and not be constrained by unworkable, nationally- imposed solutions.

He was responding to the system-wide escalation framework and procedures to tackle overcrowding unveiled by the emergency department taskforce implementation group.

Dr Walley said that, without necessary investment, it was not realistic to set a target of a nine-hour maximum waiting time for patients.

“Setting time limits might sound impressive, but it means nothing if additional beds are not made available for hospitals,” he said.

Dr Walley said a capacity deficit was the root cause of the emergency department crisis and it was “screaming out” to be addressed.

“The simple fact is there is overcrowding in the system which is manifesting itself in our EDs,” he said.

He said many hospitals and doctors were already implementing the new protocols but overcrowding would not end until the lost beds in the system had been replaced.

The system-wide escalation framework and procedures to tackle overcrowding in EDs has set targets of between zero and six for patients needing beds.

Three of the country’s busiest hospitals — Beaumont in Dublin, Galway University Hospital, and Our Lady of Lourdes, Drogheda, each have a trolley target of six.

Health Minister Leo Varadkar has said there should be no more than 70 admitted patients on trolleys on a given day and the HSE has set a target of 64.

Leo Varadkar
Leo Varadkar

There will be zero tolerance for having patients on trolleys for more than nine hours after a decision is made to admit them. If there have been persistent breaches of the the nine-hour waiting limit, hospitals will be punished with a budget deduction of €10,000.

The HSE director general, Tony O’Brien, told the joint committee on health and children last week that almost 40% of patients were waiting more than nine hours to get a hospital bed earlier this month.

The first of the four-step process to deal with overcrowding is triggered when 30% or more of the trolley bays are occupied by patients awaiting admission.

The Irish Nurses and Midwives Organisation object to the implementation of the full capacity protocol — putting trolleys up on wards.

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