The issues identified in the recent Report of the unannounced inspection of the Emergency Department at University Hospital, Limerick against the National Standards for Safer Better Healthcare generated significant furore and subsequently much ill-informed comment, both about the causes of and the solutions to these issues. Now that much of this has abated it is appropriate that the Association sets out its position on the issues raised. A number of points need to be made which would apply in the overwhelming majority of Irish hospitals.
- The current situation in UHL is unsafe, both for patients and staff alike – this situation is replicated countrywide. We know that attending a crowded Emergency Department (ED) and having a prolonged wait for hospital admission are both independent predictors of increased mortality for patients;
- UHL’s ED is relatively new and therefore its infrastructure is better than many other EDs across the country – access to basic facilities such as toilets and catering is far more challenging elsewhere in the country;
- The number of presentations to Ireland’s EDs is increasing at an alarming rate since the temporary drop during the early stages of the first COVID wave. EDs across the country are now seeing daily attendances that were unimaginable even 10 years ago;
- The percentage of patients attending EDs who ultimately require hospital admission, i.e. inpatient care, has not risen in step with the increase in attendances. This reflects our lived experience that patients are attending EDs because of difficulty accessing other services (primary care, community services, other hospital services etc). Staff in EDs are therefore working ever harder to address deficiencies elsewhere in the healthcare system which is not their role. While Emergency Medicine accepts that EDs are the safety net for patients, EDs should not be the safety net for failing medical services;
- EDs are attempting to deal with this onslaught in the face of significant medical, nursing and other staff shortages. While some of this is COVID-related, more and more staff are leaving as they feel they cannot continue to work in such an impossible and dangerous environment;
- The primary causes of ED crowding are due to factors outside the control of the ED. Ireland’s well-established shortage of acute hospital beds (a mere 2/3 of the OECD average) is the main factor as emphasised by HIQA in its report on UHL. This will not be addressed by reopening EDs that have been reconfigured into units providing appropriate and safe care for a select group of patients;
- Flow, both in hospitals and EDs, becomes impossible when hospital bed or ED occupancy levels exceed 85% (this 85% occupancy figure is true of many systems dependent on flow to function). The current dysfunctionality therefore promotes even greater levels of dysfunctionality and even greater risk.
While the Association welcomes the HIQA report and is very much of the view that were HIQA to look at other Irish EDs its findings would be very similar, it is very conscious that the Trojan work of ED medical and nursing staff in the ED in UHL is what is keeping an intolerable situation from being far worse for individual patients. The criticism of the situation that ED clinical staff find themselves in (and as HIQA has acknowledged this is due to circumstances outside of the control of the ED) should not be allowed to demoralise the very staff that are attempting to keep patients safe in such an unacceptable environment.