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Dr Chris Luke To improve care in emergency departments, we should do two simple things today

The former consultant in emergency medicine says the appointment of patient and staff carers could transform struggling ED care.

THERE CAN BE few people nowadays who are unaware of the miseries faced by patients and staff in our health service ‘frontline’ due to understaffing, lack of space, lengthy public waiting lists and dwindling access to general practitioners.

Indeed, it’s not unusual to hear someone describing their experience in a hospital emergency department (EDs) as absolutely ‘hellish’.

At the risk of seeming pedantic, I suggest a better word to describe this experience is ‘purgatorial’. Purgatory — to remind some readers — is a largely Roman Catholic concept of a place of temporary suffering, where souls are prepared for entry to Heaven.

So am I resorting to a religious rationale to explain the problem? Certainly not, but I am seeking an apt analogy for a new 21st-century ‘certainty’. In short, while many who are admitted to hospitals are satisfied with the inpatient care they eventually receive, huge numbers presenting to our EDs are now ‘required’ — not by religious but by political doctrine — to experience brutalising conditions before they reach the Nirvana of an inpatient ward, outpatient clinic or a (newly ‘heavenly’) home.

Sadly, ED overcrowding is not just deeply unpleasant, but it can occasionally be lethal. Every few months, the media report cases of apparently avoidable deaths (due to delays in seeing subtle signs of infection, stroke or bleeding amidst a crowd of distressed individuals), but such cases are just the tip of an iceberg. In early 2023, the Irish Times reported that almost 1,300 patients died over the preceding winter as a result of delays in hospital admission from Irish EDs.

How can we fix this?

As an emergency physician, I’ve spent decades trying to find solutions (‘fixes’) for the patient in front of me, as well as the many patients yet to attend the ED (1.3 million annually in Ireland), and I often feel that we provided better care in the past. Back in the 1980s, for instance, I worked in EDs in St James’s Hospital, Crumlin Hospital and Edinburgh which were routinely packed (although beds were more often available than they are now), but working in emergency medicine back then was incredibly exciting and rewarding.

Sadly, the conditions in ‘the trenches’ are now (often) intolerable. Older staff can be burned out from overwork and moral distress (the mismatch between professional aspiration and reality), new graduates avoid the work in droves, and patients report endless stories of frustration.

Just this week, on local radio, I heard a heartbreaking story of a young woman admitted by ambulance to a large hospital ED where she lay on a trolley for hours, without anybody ‘coming near her’. Her tears attracted the attention of another patient who ascertained that the young woman was not only distressed by her abdominal discomfort, but she was also ‘freezing’ and her feet were bare. Thankfully, as well as offering some kind words, the ‘neighbour’ was able to partially alleviate the young woman’s distress by giving her some fresh socks to wear, and getting hold of a nurse.

Now, as someone who’s spent years rushing around EDs, looking for chairs, sandwiches, socks, tea and water for patients (plus space to examine them with a modicum of dignity), as well as trying to oversee the medical care of a department’s entire cohort of cases, I’m not going to plead for any grand gestures (a million quid here or there, say). Instead, as a specialist in ‘quick fixes’, I simply offer two remedies that would help to reduce the misery that staff and patients in so many of our EDs must endure daily:

Fix No. 1: appoint a ‘Francis Brennan equivalent’ to every department. In other words, someone with expertise in hospitality, whose role is to ensure that every patient in every ED is made as comfortable as possible while waiting for medical assessment and treatment. This person would free up clinical staff from having to run around looking for the basics of human comfort: space, water, blankets, pillows, snacks, reading material as well as access to clean chairs, toilets and charging points for phones. And add warmth.

Fix No. 2: appoint a ‘staff carer’ in each ED whose role is to make sure that staff have hot food and drink available 24 hours a day, a tidy staff room, toilet and changing facilities, clean bed linen if overnight stays are required, and to facilitate staff vaccinations, identity badge provision, and other paperwork in situ in the ED (where staff absences are the least tolerable anywhere on a large hospital campus).

It almost beggars belief, but the reality in many of our EDs is that there can be as much suffering by staff as there is by patients and yet so much of this misery is avoidable. Once upon a time — back in the early 1980s — clean staff residences, bedrooms, staff rooms, kitchens and hot food (served by kindly hospital staff who knew your name) were all the norm. So too were a warm reassuring welcome, a comfortable chair and a little refreshment for every patient.

Sadly, in our recent obsessions with dollars, data collection and technology, we seem to have completely forgotten that the primary function of a hospital is not technological, commercial or even medical, it is to care for people.

Dr Chris Luke is an author, columnist and former consultant in emergency medicine.

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