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Press Release No end in sight to ED Crowding

Although Emergency Department (ED) crowding with admitted inpatients (trolley patients) has been with us for well over a decade, January 2017 has seen new and shameful records as those responsible for our Health Service continue to fail to address the underlying issues, particularly our well-documented shortage of acute hospital beds. Ireland has 2.8 acute hospital beds per 1,000 of the population whereas the OECD average is 4.3. Ireland’s acute hospitals not infrequently run at bed occupancy rates of 100% whereas the accepted optimum rate is 85%. It is no surprise therefore that patients wait exceptionally long periods for provision of a hospital bed once the decision has been made that inpatient care is required. It must be appreciated that those on trolleys are patients who have had their emergency care provided by ED medical and nursing staff but need continuing hospital care. They typically represent an older patient group; often with significant pre-existing medical conditions who require ongoing hospital care and whose needs cannot currently be met outside the acute hospital setting

Much public commentary on this issue is ill-informed, populist and commonly well wide of the mark. It is regularly suggested that the problem is due to ‘drunks’, ‘patients with minor complaints’ or is caused by inappropriate attenders when quite frankly it isn’t. The reality is that EDs send home most of the patients they see after assessment and treatment and the patients on trolleys represent that minority of patients who cannot be sent home as they require hospital admission. The problem of a shortage of acute hospital beds will not be addressed by better primary care provision or additional community facilities, irrespective of how much this is needed in its own right

The current reluctance of HSE spokespersons and Government Ministers to publicly identify the real problem i.e. the extent of the shortage of capacity does everyone a disservice. Unless the issue is identified and definitively addressed there can be no solution to the current crowding and patients will continue to die as a direct result of this shortage of hospital beds

Previous bed capacity reviews have showed a shortage of acute beds and also, specifically, critical care beds. The latest, much vaunted but long-delayed bed capacity review the Minister has committed to is likely to confirm the worsening of the bed capacity shortage. However unless the shortfall is actually addressed by commissioning new facilities then none of the bluster and spin will result in real progress. Given that the process is likely to identify the shortfall as being approximately 2,000 beds of varying kinds, a comprehensive capital investment programme will need to be drawn up at the earliest opportunity and ring-fenced funding provided so as to stop further of our citizens having poor medical outcomes and a greater likelihood of dying

The Association notes the improvement in the number of delayed discharges with this number currently standing at approximately 435, which is perhaps the only success of the HSE Winter Initiative to date. It is important that further steps are taken to bring and keep this figure below 200. The policy of spreading the excess inpatient load by lodging additional admitted patients on hospital wards also needs to be implemented more comprehensively so as to ensure that the available hospital capacity, limited as it may be, is maximised. This temporary solution should not be seen as anything more than a sticking plaster while additional bed capacity is developed

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