The publication by the Health Information & Quality Authority (HIQA) of reports following the unannounced inspections of the Emergency Departments of Beaumont Hospital, Dublin and University Hospital, Waterford in April 2023 reveal significant progress in both hospitals’ management of crowding in their Emergency Departments (EDs). The reports published on 5th September make clear the factors that have brought about such improvements and clearly show that where individual hospital managements adopt a more aggressive, zero tolerance approach to the holding of admitted inpatients on trolleys in the ED, substantial progress can be made. Such a level of management commitment adds significantly to the shop-floor work done by Consultants and other senior decision makers in EM to improve service provision which is noted in both reports.
The report on UHW shows that a significant uplift in hospital bed capacity (an additional 72 beds since 2019) combined with proactive approaches both within the ED but also, and vitally, within hospital management have led to a situation that there was no patient on a trolley awaiting a bed at the time of the inspection. This has had the effect of removing a major clinical risk for both patients and staff and allows the proper functioning of the ED, without it having to function both as an inpatient ward as well as its primary function as an ED where the most acutely ill and injured patients in the community will be brought. A better, safer experience for patients can be expected which should be the target of all those working in healthcare.
While the report on Beaumont showed substantial improvement, there remained a number of patients on trolleys waiting for admission, although none had reached the 24 hour mark which is such an unacceptable feature of Irish Healthcare currently. The Beaumont report points to actions taken to avoid ED attendance and measures to improve the efficient discharge of patients who no longer need acute hospital care. Many will remember when Beaumont had a particularly poor reputation and allowed its ED be a warehouse for admitted inpatients. Thankfully, with changes in Hospital Group management this is no longer regarded as acceptable.
In the light of these more positive findings in recent hospital inspections, it is time the appropriate bed capacity was created nationally and individual hospital managements became much more focussed on eradicating the phenomenon of patients waiting for hospital admission on trolleys within the ED. The recent target set by the HSE in its Urgent and Emergency Care Operational Plan July 2023 of suggesting that having up to 320 patients on trolleys at 08.00hrs is in some way acceptable is the equivalent to the Road Safety Authority accepting that 150 deaths on Irish roads is acceptable just because that is better than 200 deaths! This aspiration to such mediocrity is not acceptable to patients nor is it acceptable to the medical and nursing staff working in Irish EDs.