Emergency department overcrowding 'getting worse, not better' 

A shortage of hospital beds means patients will continue to be left on trolleys.

Overcrowding in emergency departments has not been solved by additional HSE funding as a shortage of hospital beds means patients will continue to be left on trolleys.

Dr Fergal Hickey, Irish Association of Emergency Medicine spokesman, was responding to an Irish Examiner report that 27,129 people left emergency departments (EDs) between July and September before completing treatment.

“It’s a symptom of a bigger problem, and that problem is getting worse in spite of so-called ‘winter plans’ and other plans that have really not delivered anything,” Dr Hickey said.

“What have they delivered? The problems are getting worse, not better.” 

An investment of €350m in February was followed by a HSE winter plan of €169m with further commitments for next year.

669 patients on trolleys

Despite the investment, the Irish Nurses and Midwives' Association counted 669 patients waiting on trolleys in recent days.

“The only way we can judge the winter plan is on whether things are getting worse, better, or staying the same. The reality is they are getting worse,” he said. “So maybe things would have got even worse but for the investment.” 

He pointed out the funding does not directly target EDs.

“The issue here is that the disease is elsewhere but the symptoms are felt in the ED. We don’t have enough acute beds so people wait for extraordinary periods of time to get admitted to a bed once the decision is made that they require admission,” he said.

“Over-75s are particularly affected by that.” 

Dr Hickey said the 27,000 people may have left at different stages of their journey through the ED, including patients who are assessed by nurses and told they do not need to see a doctor.

Others have an X-ray which reveals they do not need hospital care, and some may have low-risk illnesses which are better treated elsewhere or can be treated the next day instead of that night.

“Having said all of that, the reason this number is increasing is because of the pressures on emergency departments,” he said.

“It will continue to increase as long as the pressures on emergency departments continues to increase.” 

Admissions

Dr Hickey was dismissive of commentary linking unnecessary ED visits to the trolley situation.

“The people on trolleys are people we have decided need hospital admission, they need their appendix out, hip fracture fixed, stroke treated,” he said. “The people who don’t need to be there, we send home. They do not contribute to people being on trolleys.” 

He welcomed plans to recruit more consultants and nurses, but said without up to 2,500 additional beds, “it will not solve what is essentially a capacity problem.” 

HSE chief clinical officer Damien McCallion said the focus is on offering alternatives to people who don’t need hospitals, supporting hospitals, and moving patients out of hospitals when they are recovered.

However, he told the Irish Examiner he expects this to take some time before the effects are felt. “The first one takes time to bed in, over 2,000 staff are gone into the ‘enhanced community care’ programmes and that will take time to bed in.”