Why we still have a beds crisis

A leading consultant has said four years after Health Minister Mary Harney declared emergency department overcrowding to be a national emergency, "nothing had changed" and the problem has worsened.

ED trolley wait figures have now for the first time reached 500. In 2006, when they were just below this level, Mary Harney declared the A&E situation a national emergency.

However, Dr Niall O'Connor of the Irish Association for Emergency Medicine said this appears to have made little or no difference.

"Nothing has changed. The Minister declared it a national emergency in 2006 but the situation is now the same if not worse, and yet she does not seem to consider it a problem," Dr O'Connor told irishhealth.com

He said there were a number of factors involved in the current crisis, some of which were seasonal, and some of which were organisational and structural issues which remained to be addressed.

Dr O'Connor said hospitals needed to be better at predicting and planning to some degree for the number of admissions they might have at given time. "You would swear winter was an epidemic that just came upon us every year without notice."

He said the numbers attending EDs would tend to increase this year in any case. However, there had also been a lot of fractures due to the bad weather and some of these patients had not yet been discharged. There had also been an outbreak of the winter vomiting bug, in addition to the normal winter illnesses.

Dr O'Connor, who is emergency medicine consultant at Our Lady of Lourdes Hospital in Drogheda, also identified organisational and structural issues that needed to be tackled in hospitals.

Hospitals needed to work smarter in terms of their use of beds. He said there was a need for more medical assessment units and short-stay beds, which can lead to a more rapid turnaround of patients.

Dr O'Connor said these facilities mean that patients can be investigated and discharged as appropriate more rapidly. However, the success of these beds depended on the level of easy access to x-rays and other tests round-the-clock.

He said the delayed discharge issue also needed to be dealt with through providing more alternative community accommodation for those who had completed their acute care but wre forced to remain in hospital beds.

Dr O'Connor pointed out that not all hospitals had easy access to this type of accommodation locally, and those that did tended to have shorter ED waits.

He said the "full capacity protocol" measures, whereby as an emergency measure patients awaiting admission in EDs are accommodated on wards, had a role to play when there was pressure on beds.

"People whose emergency department portion of their care is completed and who remain in the ED tend to have higher mortality, illness rates and lengths of stay."

The Irish Nurses and Midwives Organisation, however, recently objected to this protocol in Limerick Regional Hospital, saying such overcrowding had negative consequences.

Dr O'Connor said there was also a need for better discharge planning in hospitals, whereby there is a targeted length of stay, and barriers to discharge are identified in advance, such as possible lack of home help for an elderly incapacitated patient.

Another factor, he said, was the need to tackle the length of time people had to wait for an outpatient appointment, as their conditions often deteriorate when they are on waiting lists.

Dr O'Connor said many patients could be treated on an outpatient basis but were often admitted as an inpatient instead.

Referring to bed closures, he said there was no point in cutting beds if you are not going to change how the hospital works.

"Clearly, if you close 30 beds and take 1,000 bed days out of the system, and continue to work in the very same way, that hospital is going to continue to have issues with overcrowding."

Dr O'Connor said since the national emergency was declared in 2006, the population had got older and there was increased demand on hospitals.

See also:'Beds crisis reaches breaking point'

[Posted: Wed 20/01/2010]