Doctors want patients transferred to wards as emergency units reach limit

DOCTORS HAVE called for new arrangements to be introduced that would allow management in hospitals automatically move additional patients on to wards once emergency department overcrowding had reached certain levels.

Emergency medicine consultant at Dublin’s Beaumont Hospital Dr Peadar Gilligan said while there had been agreement at HSE level on the use of such “full-capacity protocols”, it had been left to local decision-making as to when it would be enacted.

He said the process should be standardised and patients moved from emergency departments to hospital wards once certain criteria were reached.

Dr Gilligan, who was speaking at the annual conference of the Irish Medical Organisation (IMO) in Killarney yesterday, said historically there had been resistance from the Irish Nurses and Midwives Organisation to such initiatives on the basis it would created difficulties for the majority of their members who did not work in emergency departments.

Such a “full-capacity protocol” had been implemented about three times in the last year or so at Beaumont. However, there were often 30 emergency department patients who had been deemed appropriate for admission but who had waited there for 12 or sometimes up to 20 hours before getting a bed.

“The difficulty that creates is that we do not have trolleys available for new arrivals. We do not have trolleys to decant patients on to, so ambulances are held up at the emergency department, so if they are called there is no ambulance available. That is a particular problem in north Dublin.”

He said the Department of Health had not been forceful enough in identifying to hospitals the fact that the implementation of the full-capacity protocol had to happen in certain circumstances. It had also not been forceful enough in identifying what those circumstances might be.

Within each emergency department, he added, if certain criteria were reached, moving additional patients to wards should be enacted straight away rather than giving rise to yet another series of meetings and discussions giving rise to further delays.

Dr Gilligan said the sort of criteria that should be considered would include that no ambulance should be delayed at an emergency department pending the availability of trolleys, there should never be a situation where the time to the delivery of care for critical patients was compromised because there was no trolley and there should always be capacity within the resuscitation area of an emergency department.

Meanwhile the conference also heard concerns yesterday that the recession was contributing to a worsening of health inequalities.

Institute of Public Health director Owen Metcalfe said the difference in life expectancy between men born in the most deprived areas and women born in the least deprived areas was almost 10 years.

Union president Dr Paul McKeown said the incidence of stroke and coronary heart disease was twice as high in the most deprived areas. The union has meanwhile called for the appointment of a minister for public health to encourage health promotion.