The Irish Association for Emergency Medicine questions the commitment of the government and the HSE to addressing the scandal of ED crowding as yet more new trolley records are set. Recent confirmation that a record 57,674 admitted hospital in-patients were accommodated on trolleys for the first seven months of 2017 and, within this number, 5,880 patients over the age of 75 were forced to endure trolley waits of over 24 hours is a major cause for concern.
“Not alone does it confirm a further worsening of the already unacceptable situation; it also confirms that the commitment given in the 2017 HSE Service Plan that no patient over the age of 75 would be forced to wait more than 24 hours on a trolley has, like so many other targets, been ignored.
“When speaking about numbers as large as these it is easy to forget that these figures represent individual patients. Sadly, there is incontrovertible evidence that the practice of warehousing patients on trolleys for extended periods of time risks death or worse medical outcomes for individual patients. In this regard two facts are worth restating,” says the organisation.
Based on well-constructed and unquestioned Australian studies, between 300 and 350 patients are dying every year as a direct result of ED crowding in Ireland’s hospitals. These are patients who would not otherwise have died.
Countless others have medical outcomes that are worse than they should have as a direct result of this scandal;
For a patient over the age of 75 years there is clear evidence that detention on a trolley for more than 12 hours results in longer lengths of stay, a greater number of medical complications and a lesser likelihood of being able to return to an independent existence. The fact that 5,880 such patients have been forced to wait over twice this period of time and countless others have waited for more than 12 hours is potentially catastrophic for these individual patients.
The usual official responses of ministerial “disappointment” and HSE claims that the problem is being prioritised but “can’t be resolved overnight” fails to recognise that the responsibility for addressing this issue rests squarely with the Department of Health and the HSE who have failed to address the underlying problem, namely the lack of capacity i.e. acute hospital beds. Given that this problem has been going on for the best part of two decades and as long ago as March 2006 was categorised as a ‘national emergency’, the notion that further time needs to be given for these problems to be addressed is self-serving and, frankly, indefensible.
In the light of the latest unacceptable figures and the inevitable negative impact on so many patients, the Association is yet again forced to ask how many more patients will be allowed to die or suffer poor medical outcomes before those politically and managerially responsible for the provision of healthcare in Ireland finally stop talking about doing something and finally do something to address the underlying issues.