Sir, – Dr Truls Christiansen (April 8th) believes that the removal of patients with "minor" illness and injury will make a significant difference. However, the current crisis is entirely one of admitted hospital in-patients, ie patients who require hospital admission but for whom there isn't a hospital bed. Dr Christiansen feels that EDs should just become admission units and points to the Scandinavian experience. Yet Scandinavian countries are moving towards the Anglo-American model that is in use in Ireland. In this model, EDs are seen as places where patients with the whole spectrum of disease are assessed and decisions made as to whether admission is necessary. This gets the greatest use out of emergency medicine training, which is focused on assessment of undifferentiated patients, particularly those with a need for time-critical interventions. As to the notion that all patients presenting to an ED should be obliged to attend a GP first, perhaps Dr Christiansen might explain how this will help with time-critical conditions, such as stroke or heart attacks needing urgent reperfusion, or an ischaemic limb, to name but a few?
If the admitted in-patients were no longer warehoused in Ireland’s EDs, emergency medicine would be well capable of dealing with the workload that comes its way. – Yours, etc,
Dr FERGAL HICKEY,
Consultant in Emergency
Medicine,
Sligo Regional Hospital.