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A RELATIVELY SIMPLE change to the management of Ireland’s hospital emergency departments could save the lives of around 350 people a year, an association of doctors has said.
The Irish Association of Emergency Medicine believes that adopting a ‘Full Capacity Protocol’ in Irish hospitals – where patients are moved from an emergency department to another ward as soon as they are admitted as an inpatient – is a relatively easy way of saving lives.
Currently, patients who visit an Emergency Department (ED), and who are then admitted to hospital, can often be left waiting in an ED for several hours – or even days.
The IAEM believes that by simply assigning patients to another hospital ward – even if it is not the one ideally suited to their condition – the chronic overcrowding in emergency departments can be relieved, potentially saving hundreds of lives.
Similar policies are already in place elsewhere in the world, IAEM president Fergal Hickey says, with a significant reduction in hospital mortality rates as a result.
“At the moment, there are between 30 and 50 patients on trolleys in some emergency departments in the country,” Hickey told TheJournal.ie.
“What that means is that all of these hospital admissions are being kept in the emergency department. We know that’s unsafe.
There are well-constructed studies in Australia, where if you adapt the population to Ireland, you find that 350 to 360 patients are dying ever year, in Ireland, as a direct result of emergency department overcrowding.That’s more than the numbers who die on the roads.
Under the Full Capacity Protocol system which the IAEM is now formally advocating, inpatients would be accommodated as extras in another ward, instead of being made wait in a crowded ED.
“If you have a 30-bed ward, it is safer to have 31 or 32 patients in that ward, rather than all of the hospital’s inpatients crowded into one area… it wouldn’t be such a burden on the emergency department, which has to be open 24 hours a day,” Hickey explains.
Emergency departments, he adds, are not equipped to act as both an emergency department and an inpatient ward.
Under the current system, a patient presenting with pneumonia may be admitted to the hospital, but cannot be housed within the hospital until a space becomes available in a ward.
In the meantime, they may be left on a trolley, near the company of other patients – some of whom may have complaints which could place the original patient in greater danger.
The IAEM acknowledges that its proposed policy may not be popular with staff on other wards, who would have to share the burden of dealing with hospital overcrowding, but the policy was being put forward to prioritise patient welfare.
Asked if the policy would pose problems when patients were assigned to wards other than those specifically suited to their conditions, Hickey said this was already the case – with hospital conditions meaning beds were used up by whatever patients needed them.
Obviously there aren’t men in maternity wards, but you may regularly have surgical patients being treated in medical wards, and vice-versa… Though you should try to assign them to an appropriate ward, you should admit them as an extra wherever there is capacity.
Hickey insists that relatively little preparation work is needed to equip wards to cater for the new policy – and that Ireland simply “doesn’t have the political will or the management will to face up to it”.
“It’s not ideal, but it’s the safer solution,” he says. “”It just needs to have more frequently – at the end of the day, this is about the difference between making it and not making it.”
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The hospital’s should be implementing discharge policies that actually work and not making up stupid short term solutions like this. It’s not fair on any patient to be sitting on a trolley down in ED or to be sitting in a temporary bed placed behind a door. It’s also not fair on ED staff or ward staff to have to deal with extra pressures like this as the job is already hard enough as it is!!
There are so many “bed blockers” in the hospitals, if these were dealt with properly the bed situation wouldn’t be as bad as it is and that is just one solution. In the hopsital that I work in there’s about 80 out of approx. 650 beds taken up by people awaiting long term care alone, never mind those waiting for home care packages to be put in place, for convalesence places, rehab places, the list just goes on and on…it’s a joke and it”s completely unfair on the staff and patients alike!!
As a nurse I worked in Oz in the unlikely event of putting an extra bed on a ward all emergency facilities available including O2 & handwashing not behind a door as happens here.
Problem is that we have long stay patients who cannot go to nursing homes because Fair Deal money has run out. There is no place to discharge dependent patients to. No step down beds. Therefore system clogs up. We need to get Fair Deal back on track. It won’t fix everything but will help!
It’s all good saying that it would fix the problem if we put an extra 1 or 2 patients on each ward but where exactly are these 1 or 2 patients supposed to go?! Currently they’re being placed in a bed behind the doors of wards with no access to oxygen or suction equipment and absolutely no privacy. There’s already been an incident where a patient was scalded with hot tea as the door they were placed behind was opened quickly and hit into them sending their tea flying. Nevermind the extra pressure it puts on the already understaffed nurses. It’s easy to say ah sure it’s only 1 or 2 extra patients but if they’re very sick patients a nurse can spend most of their day with them and the rest of their patients get neglected. Ridiculous short term solution.
What about the lack of privacy for the forty extra patients bedded in the ED? They’re in halls, and certainly not near oxygen or power outlets. And there’s a huge amount of pressure being put on (already understaffed) nurses in the ED, who already deal with a lot of social problems that ward-based nurses don’t see.
Plus, seeing patients in the halls on the wards puts a lot more pressure on teams of doctors and nurses to discharge patients and turn over beds quicker than the “out-of-sight, out-of-mind” practice of having them all lodged in the ED!
Aisling – I obviously can’t speak for IAEM to address your latter point (the incident where a patient was scalded), but when I spoke to its president he did specifically acknowledge that oxygen and suction equipment would be needed. He seemed quite clear, however, that this was a relatively routine matter and that it would be a far lesser one-off hassle than the ongoing management of an overcrowded ED.
I just wanted to put that out there – I didn’t include references to it in the article because I thought it was beyond the scope of a general interest news piece, but it WAS something that was addressed/considered by the proponents.
i am sick of being put in a ‘virtual ward’ near the laundry room.
i am not a well woman, which seems to evade the notice or care of the staff.
to be put beside someone with menigitis is wrong, and also to be examined near a male relative of a stranger is also very wrong.
i could write a book on being sick in holy ireland. and i am still trying to shake a hospital acquired bug, MRSA.
DR JAMES REILLY NEEDS TO OPEN ROSCOMMON A & E NOW OR LOT OF PEOPLE WILL DIE FOR THE VERY HARD TOUGH WINTER AHEAD OF US ALL A & E IN GALWAY YESTERDAY WAS LIKE A WAR ZONE AND IF PEOPLE SAW IT YESTERDAY YOU WOULD BE ALL SHOCKED HEALTH AND SAFETY WOULD BE VERY SHOCKED TV CAMERAS NEED TO GET IN THERE FAST TODAY TO SEE IT FOR REAL 34 PEOPLE ON TROLLYS AND THE AE DOORS BLOCKED PEOPLE COULD NOT GET IN AT ALL A LOT OF STUFF NOT SAID WHATS GOING ON AT ALL OPEN ROSCOMMON A & E NOW OREILLY AND KENNY FAST PEOPLE WILL DIE O YES PEOPLE IN THERE 70S ON TROLLYS NOW GOING IN TO THERE 4 TH DAY ON TROLLYS
Stop writing in capitals. It’s moronic and makes you come across as a 5 year old child.
True sentiment but hard reading.
It seems to me if we’re going to implement this then we need some major infrastructure improvements in most hospitals, the ED’s don’t have sufficient facilities for the numbers of patients we’re now seeing on trollies, O2 and suction to say the least. On the wards many rooms are designed for 4 beds but now have up to 8 with suction and O2 lines trailing all over the place, extension sockets are commonplace. Lets say you do put 1 or 2 extra beds into one of these rooms, you now have 9 or 10 patients in a room originally designed to hold 4. Pray no patient in that room has an arrest. If an arrest does take place, how is the team supposed to get to that patient? There comes a point when we have to say just what is safe, how many beds is it safe to have in a room, how many nurses do you safely need and none of this .5 crap and when things are no longer safe at some stage we have to say NO. Taking a stand saves lives too.
The suggestion is surely that the patients be placed in the EMPTY beds in existing wards, not that they shove additional trolleys in there? Being admitted from A&E is the problem being identified here, or am I misreading?
How flippen Irish that provision of cups of tea has higher priority than oxygen.
@Jane 10 years ago you may have seen empty beds on wards but this stopped happening a long time ago, there simply are no empty beds these days. When a patient is discharged by their doctor they are often asked to vacate their bed straight away and wait in a day room as the bed will be needed by one of the many patients on trollies in the ED. What you’re laughing at has happened in some hospitals, they have started to shove trollies from the ED into wards in order to juggle figures, got 60 patients on trollies in ED, media on your back, hmmm? Shove 25 trollies into the wards and hey presto! You have 35 trollies in the ED, no problem there.
ER consultants are rarely in actual emergency departments in this country so they are the last people who should know what to do. All these guys do is triage the patients.
Hmmm… that’s a blanket generalisation. It depends on which emergency department you are in. I have worked as an NCHD in Sligo, which gave superb senior support and supervision. Consultants were actively involved in providing service, not just doing the consultant led thing.
I think that’s a very unfair statement, ED consultants work extremely hard and while they may have commitments other than the purely clinical, they spend most of their time on the floor in the ED. And it’s a nurse who triages the patients.
Would seem like a logical solution to our problem except that that is what is supposed to be already happening. Like re writing the text book. It used to happen years ago but somewhere somehow the way was lost. Seems to have all gone arseways with the arrival of "bed managers" more like mismanages.
Identifying a potential discharges through a comprehensive discharge policy is paramount to this and in this matter drs do all this discharging
Drs letter, prescription etc however in Ireland you have entourage drs rounds where by you can see unto 5-15 drs doing rounds it wud be more appropriate to delegate a proportion of these drs to assessment/ discharge duties early morning have letters prepared/ scripts filled and discharge advice given should there be difficulty in any of these tasks then refer up the line. Plus they need to be schooled as to the effects of delayed discharges it is their duty also to aim for a reasonable discharge turnaround. It all builds to more effective use of beds. For example say a patient is requiring an test that may not influence their management but conclude a working diagnosis but can’t get the test for say 48hrs plus as may be pushed down the priority list why can’t there be a provision within the hospital that said patient through can be discharged through a well thought out medical discharge plan in the short term and return as a semi-priority in different setting as opposed to thi inpatient setting opd setting.
Next: surgeons need to stop bringing in their patients days in advance of their surgery for tests set up a proper pre assessment clinc as is done in some hospitals.
Also patients could be referred back promptly to hospitals closer to there home etc a simple refer back policy is also needed this does not happen enough. Especially in critical care.
It’s well known that any unit in Ireland cannot run at. 100% occupancy in current climate so to imply that sending in an extra 1-2 will help the patients is ridiculous it’s simple maths if u have more coming in to a unit of space than is leaving u don’t look at how to further utilise the space u look at how you can free space
Look at history overcrowding kills look at football stadiums, over crowded vehicles.
Simply put over capacity of any unit of space makes for a very dangerous environment
And the suggestion that it put drs under pressure to discharge patients is is juvenile and poorly thought through
Unfortunately I think more management planning needs to ve introduced into curriculums at all levels cause good drs and nurses don’t always make for good person/environment managers
Plus if a unit says for example it has reduced it’s number of beds say from twenty five to twenty due to staffing then bloody remove them five beds as drs ,management only see an empty beds with none of the implications on resources it may be cruel at the face of it but long term it will give a truer picture of the state of the Hse. Producing more patients that produce 100% occupancy or more require staff doing extra work extra hrs results in extra stress and boom so the sickness and absenteeism
Begins and all you have to do is look at national and local figures on this.
Please look at the staff ratio to patients now and b4 the embargo/ cutbacks
Tell us that current levels of staffing are sustainable/safe and do it independently
With no bias cause a dr can say it can be done a manager can say it can be done ( facts and figures can be manipulated ti suit statistics and outcomes that is a well known fact)but you ask a patient, a nurse a Physio, an occupational therapist how this is reasonable to put the extra occupancy on already restricted space and resources you will soon see a more realistic picture on the state of our hospitals.
I’m not saying we are not working to our potential we are in most cases but we have to be multidisciplinary in our approach, realistic to our resources, safe in our environment patients and staff alike.
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