‘State of emergency’ the new A&E normal
‘Unacceptable’ overcrowding as crisis levels continually breached, making...
A LEADING A&E consultant says continuing high levels of overcrowding in emergency departments across the country will lead to ‘preventable deaths’ and ‘poor medical outcomes’.
Dr Fergal Hickey, the president of the Irish Association of Emergency Medicine, spoke out as the Government’s previous benchmark for a ‘national emergency’ around trolley numbers continued to be breached this week – almost six weeks on from the record high of early January.
The Sligo University Hospitalbased consultant described the numbers as ‘completely and utterly unacceptable’ and said the backlog will result in unnecessary fatalities. Dr Hickey told the Irish Mail on Sunday that: ‘500 may be less than 930… but it’s still completely and utterly unacceptable and it will contribute to a certain number of preventable deaths and a certain number of poor medical outcomes.’
The number of people waiting for hospital beds after visiting A&E exceeded 500 twice this week and stands at an average of 477 so far in February, according to the Irish Nurses and Midwives Organisation (INMO).
It comes months after the HSE’s Winter Plan for 2022/23 declared its intention ‘that no more than 236 patients will remain on trolleys awaiting admission on any given day’, and almost 17 years after former Health Minister Mary Harney declared 495 people on trolleys
to be a ‘national emergency’. While the INMO’s daily tot up includes those on trolleys and those waiting elsewhere in hospitals for a proper bed, the HSE only counts those on trolleys. However, their figure still far exceeded 236 on all but one weekday this year. Dr Hickey added: ‘The HSE will suggest that things aren’t too bad, but really 500 is 500 too many.
‘If you were the Road Safety Authority, you would never ever say that it’s acceptable to have 100 deaths on the road. The only acceptable figure is zero and it’s equally true that the only acceptable figure for trolleys is zero.’
Dr Hickey, who is Senior Emergency Medicine Consultant in Sligo University Hospital, said the situation in emergency rooms has improved, compared to the beginning of January when a record 931 were counted on trolleys. But he said this was thanks to a tapering off of flu, RSV and Covid infections and ‘not due to anything the HSE or the Department of Health has done.’ He pointed to research that lengthy waiting times for a hospital bed leads to excess deaths – a study previously detailed in the MoS showed that a wait-time of between eight and 12 hours leads to an average of one extra death per every 72 patients.
The experienced A&E consultant believes bed capacity is a bigger problem than a shortage of doctors, saying it ‘doesn’t matter if you appoint 500,000 additional consultants or roster them 24/7, 365 days a year, you will not solve a capacity problem with additional presence’.
A lack of community care infrastructure and the restricted working hours of those in that field is ‘the other big piece of this that they really need to sort out’, according to Dr Hickey.
‘The overwhelming majority of people who end up on trolleys are the over-75s, and therefore they represent what’s on the wards. But if you’re trying to send somebody home from a ward on a Saturday or Sunday, where they need home help, they need a discharge coordinator, they may need community services organised for them… it’s impossible at the weekend because these people work a nine-to-five office hours roster and they don’t exist at the weekends, they don’t exist on bank holidays.
‘So if Christmas falls the wrong way around, you could have a weekend followed by two bank holidays, which means you have four days in a row where you have no access to these services.’
Dr Hickey, who has worked in Sligo hospital since 1995, said he was ‘not defending consultants in general — there are some of them that are a waste of space, as there are in every profession’.
But he insisted: ‘It’s not the rostering of those that makes a difference; it’s having the infrastructure to allow them to do the job.’
He said a lack of resources like ambulances and home-help regularly leads to patients being kept in hospital for longer than necessary.
‘There’s nobody to manage all the infrastructure. The GP services disappear for the weekend to be replaced by an underlying service – they have no interest in day-today care of people, that’s not their job. So the whole thing falls apart for the want of the community infrastructure to allow people to make early decisions, and seven days a week, 365 days a year decisions.’
The HSE did not respond to a request for comment.
‘It will contribute to a number of deaths’
‘The only acceptable number is zero’