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More beds on wards will be ‘a last resort’

02 Dec 2015

As a “last resort”, extra beds will be put on wards to solve the excessive crowding problem in our emergency departments (EDs), a new acute hospitals trolley protocol has mandated.

Hospitals that do not comply with the new protocol for acute hospitals will be subject to penalties with “budget deductions” of €10,000 for each nine-hour trolley wait breach event. Breaches will be determined by the Special Delivery Unit (SDU).

A full escalation response will now be mandatory, as long as any patient is delayed on a trolley in the ED for more than nine hours. The protocol requires hospitals to implement their escalation plan whenever their ED experiences crowding.

It makes it compulsory for each acute hospital to take specific steps to address crowding, such as extra ward rounds if trolley figures reach ‘red’ status as set out on the daily reports from the SDU. It also requires each hospital to take steps if any patient is left on a trolley for more than nine hours, the recommended maximum waiting time. Significantly, the Directive removes the discretion of individual hospitals to implement their escalation plan.

Individual escalation plans require additional ward rounds, postponement of non-urgent elective procedures and full cooperation with Social Care and Primary Care services in discharging patients.

Working closely with Community Intervention Teams to provide antibiotics and other basic care in a patient’s home or care facility, rather than a hospital, is also required, as is active engagement with the national ambulance service to assist in effective turnaround times and provision of inter-hospital transfers to manage group wide capacity.

The Directive requires that each hospital regards ED congestion as a key issue for the whole hospital, and for primary and community care services. If ED congestion occurs, all hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care.

The HSE and the Minister for Health have signed an ED Congestion Escalation Directive “to ensure that progress made to date on overcrowding is sustained and deepened”. The Director General of the HSE Tony O’Brien, the Director of Acute Hospital Services Liam Woods and Minister for Health Dr Leo Varadkar have signed a Protocol to “build on the small but significant progress made in recent weeks to address Emergency Department overcrowding”.

This follows a small improvement in trolley numbers in the past week, compared with the same period last year. The number of people on trolleys was lower for November 2015 than November 2014, said the Minister for Health.

This represented a “marked improvement” from the summer when the situation was between 20 and 40 per cent worse than summer 2014, added Dr Varadkar.

“On any given weekday, the number of patients on trolleys peaks around 300, falling to 150 by the evening. While still not good enough, this is a far cry from the 500 to 600 we witnessed in January,” said Minister Varadkar.

“The situation has eased due to the measures taken to date, including increased staffing, more beds in hospitals, nursing homes and community facilities, more home helps and home care packages to facilitate discharge, and more community intervention teams, day hospital capacity and acute medical assessment units, to allow people to avoid having to go to the Emergency Department at all.”

Attendances are down about 1 per cent this year.

Pictured above is Liam Woods, Director of Acute Hospital Services, HSE

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times