‘Third world’ waits two years after Task Force

Two years after the Emergency Department Task Force report, patients in Emergency Departments (EDs) face ‘third world’ waits of up to 28 hours to be admitted to a hospital ward, despite the HSE’s national target being a maximum of six hours, new figures show.

Transitions from EDs to acute wards again represent a growing crisis for the Executive. In June, ED patients faced waits of 28 hours in Beaumont, 22 hours in Loughlinstown and 21 hours in both Blanchardstown and Naas, figures seen by Irish Medical Times show.

“These are third world standards. The figures are unacceptable. No patient should be detained in an ED beyond the time of decision to admit them into hospital,” said Mr Fergal Hickey, President of the Irish Association for Emergency Medicine.

The Dublin hospitals suffer particularly from delayed discharges. However there are also problems in Galway, where the average time spent in the ED before admission to a ward, was 17 hours in both May and June.

Difficulties arise when patients who need to be in a nursing home remain in acute hospital beds, as there is nowhere to put them.

The knock-on effect of this is that ED cubicles and patient-care spaces are taken up with patients who should be on the wards. The next group of ED patients cannot thus be seen.

The paediatric EDs in Dublin have recently been deluged with patients with swine flu. Adult EDs are also getting increasing numbers of patients.

The HSE’s Winter Plan for 2009/2010 states the Executive will focus on making “integrated discharge planning a feature of the management and care of all hospital patients.”

A pilot project at five sites aims to improve patient flow from EDs to wards. “We intend to ‘board out’ where possible the patients who are finished their treatment,” the HSE plan states. Many hospitals use a variety of methods to downplay the real extent of the ED overcrowding problem and the true position may even be worse that the figures suggest, Mr Hickey believes.

“For example, in some hospitals if you come into the ED with palpitations and a decision is made to put you on cardiac telemetry, you are regarded as having left the ED, even though you are physically there,” Mr Hickey said.

The Emergency Department Task Force Report was published two years ago, and a menu of options which it contained remain to be implemented. The HSE at Board level has acknowledged that the situation is getting worse. – Irish Medical Times