Madam, - I read with interest Prof Brendan Drumm's article "Cumbersome procedures must go in A&E" (Opinion & Analysis, April 6th). I was struck by the statement that "the majority of attendances at accident and emergency departments are between 5pm and 1am. We need emergency consultants and diagnostic personnel working during these hours when their expert decision-making skills are most needed."
These few words reveal many things: Prof Drumm is not aware of the correct statistics for Irish A&E departments, which show that 75 per cent of attendances are between 8am and 8pm. Quite where he got his figure from I do not know, but I can only assume that it was from one of his "value for money" support team.
He considers emergency medicine consultants to be "experts", which is nice to know. Oddly, the Irish Association for Emergency Medicine, which represents all emergency medicine consultants in this State, has been unable to get any response from him to three separate written requests for a formal meeting to discuss and advise on what the Tánaiste now calls a "national crisis". Now that he considers us "experts", I can only assume that his spokesperson, who recently classified our letters as "irrelevant", simply mixed us up with somebody else.
May I request that Prof Drumm clarify his ambiguous reference to "diagnostic personnel"? I would have expected that this term would include all those whose skills can facilitate the diagnosis and treatment of patients attending A&E departments with acute illness and injury - i.e., radiographers, laboratory staff and, of course, the consultants in all related medical and surgical specialities. I am sure Prof Drumm would agree there should be consistency in service delivery in hospitals and thus, if it is deemed necessary to have formal arrangements for emergency medicine "experts" to be in their departments looking after sick patients in the wee hours, then it is only right that all the other "experts" in medicine and surgery, who are responsible for the continuing care of these patients in hospital, should be there as well.
My main gripe with Prof Drumm's article is that his underlying message, yet again, is that one of the main reasons A&E departments are overcrowded is because of inadequacies in the service provided by A&E staff. His frequent pronouncements on how A&Es do and should work and their relationship to overcrowding are, in the main, factually incorrect and are simply not supported by research studies on what is an international problem. Quite why he and the Tánaiste have not read these papers or accepted their contents is not at all clear. Might I suggest that, for the Minister, it may have something to do with electioneering and that popular Irish pastime of consultant-bashing?
The firm and consistent view of all those who fully understand overcrowding is that the fundamental problem is lack of capacity in hospitals: sick patients who need ongoing care cannot get into a bed. It could not be any simpler. Despite Prof Drumm's assertions, it has nothing to do with issues such as inappropriate attendances at A&E by patients with primary care problems. No primary care initiatives, such as GP co-operatives or stand-alone minor injury units, have ever resulted in any significant reduction in overcrowding in A&E departments, in Ireland or anywhere else.
The lack of capacity in hospitals arises from a combination of too few acute hospital beds, inappropriate occupation of beds by patients who have finished their acute hospital treatment, and an element of inefficient use of beds. These factors, when added to bed occupancy rates of 98 to 100 per cent and a failure correctly to balance elective and emergency work, result in a dysfunctional service, which fails in its duty to deliver quality care and is a danger to the health and well-being of both patients and staff.
Until Prof Drumm and his team understand and accept these facts and develop their corrective strategies around the realities of this problem, the future for emergency medicine in Ireland will remain bleak. - Yours, etc,
AIDAN GLEESON, Consultant in Emergency Medicine, Beaumont Hospital, Dublin 9.