Hospitals: Crowded out

Overcrowding in hospital emergency departments has become a yardstick for ongoing problems in the public health system. Despite many initiatives aimed at tackling the issue, overcrowding continues to worsen. That makes new research offering novel perspectives on the problem especially welcome.

Writing in this month's Irish Medical Journal, doctors from Beaumont Hospital in Dublin and researchers from Dublin City University suggest older patients are bearing the brunt of the overcrowding crisis in emergency departments. Patients aged 80 and over wait more than twice as long for admission to a hospital bed as those aged under 20, according to the research.

The comprehensive 10-year study of records at the emergency department of Beaumont found that, contrary to accepted wisdom, it was busy year round. The number of patients presenting to the emergency department was highest in summer. However, the number requiring admission remains relatively constant throughout the year. Waiting times for beds are significantly higher over the winter, which the authors say may be due to an older cohort of vulnerable patients presenting to the department at that time of year. These are significant findings, because many efforts to tackle waiting times have focused on winter initiatives. This could lead to inefficient use of resources.

The authors say alternative care systems need to be available for those patients who have completed their acute hospital stay but who are unable to be discharged to their own homes. And they postulate that patients with complex care needs are harder to find ward beds for because wards are concerned about beds being occupied by patients with complex discharge-planning needs.

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In conclusion they note their research “provides evidence that the ‘overcrowding crisis’ and other challenges associated with the provision of emergency care need to be carefully distinguished and tackled accordingly”. This valuable research has national relevance. It must urgently reform our approach to trolley waiting times andovercrowding.