IAEM welcomes the greater urgency in addressing ED crowding
The Irish Association for Emergency Medicine welcomes the recent Ministerial directive requiring the HSE and its individual hospitals to intensify efforts to reduce the number of admitted hospital inpatients languishing on trolleys in Ireland’s Emergency Departments (EDs). The subsequent instruction from the HSE’s Director General requires specified actions to take place; mandates specific reporting arrangements and ultimately may lead to fines being imposed on hospitals which fail to comply with the directive. The Association recognises that the application of financial penalties to hospitals that do not have sufficient resources to meet their conflicting demands is a blunt instrument and may be ineffective; however the move is an imperative for hospitals to act where previously they may not have. It also equalises the perceived bias in favour of scheduled care indicated previously by the introduction of fines for hospitals not meeting scheduled care targets.
The moves outlined by the Minister are a clear step in the right direction. However to accept that it is legitimate that 236 patients remain on hospital trolleys is both medically and ethically wrong. This is analogous to the Road Safety Authority determining an acceptable number of road deaths or An Garda Síochana deeming a certain number of murders to be acceptable.
The only acceptable figure is zero. This was acknowledged as long ago as March 2006, when then Minister for Health & Children, Mary Harney TD, committed the government to a zero tolerance approach. It is hugely disappointing that a decade later the unacceptable seems to be acceptable.
We repeat: ED crowding is a proven cause of poorer medical outcomes and death for patients. All measures to eradicate it are welcome but this step needs to be seen to be just an important single step on a longer journey rather than the final destination.