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Simple change to hospital management could save hundreds of lives - doctors

The Irish Association of Emergency Medicine believes changing the management of emergency departments could save hundreds of lives.

A RELATIVELY SIMPLE change to the management of Ireland’s hospital emergency departments could save the lives of around 350 people a year, an association of doctors has said.

The Irish Association of Emergency Medicine believes that adopting a ‘Full Capacity Protocol’ in Irish hospitals – where patients are moved from an emergency department to another ward as soon as they are admitted as an inpatient – is a relatively easy way of saving lives.

Currently, patients who visit an Emergency Department (ED), and who are then admitted to hospital, can often be left waiting in an ED for several hours – or even days.

The IAEM believes that by simply assigning patients to another hospital ward – even if it is not the one ideally suited to their condition – the chronic overcrowding in emergency departments can be relieved, potentially saving hundreds of lives.

Similar policies are already in place elsewhere in the world, IAEM president Fergal Hickey says, with a significant reduction in hospital mortality rates as a result.

“At the moment, there are between 30 and 50 patients on trolleys in some emergency departments in the country,” Hickey told

“What that means is that all of these hospital admissions are being kept in the emergency department. We know that’s unsafe.

There are well-constructed studies in Australia, where if you adapt the population to Ireland, you find that 350 to 360 patients are dying ever year, in Ireland, as a direct result of emergency department overcrowding.

That’s more than the numbers who die on the roads.

Under the Full Capacity Protocol system which the IAEM is now formally advocating, inpatients would be accommodated as extras in another ward, instead of being made wait in a crowded ED.

“If you have a 30-bed ward, it is safer to have 31 or 32 patients in that ward, rather than all of the hospital’s inpatients crowded into one area… it wouldn’t be such a burden on the emergency department, which has to be open 24 hours a day,” Hickey explains.

Emergency departments, he adds, are not equipped to act as both an emergency department and an inpatient ward.

Status quo

Under the current system, a patient presenting with pneumonia may be admitted to the hospital, but cannot be housed within the hospital until a space becomes available in a ward.

In the meantime, they may be left on a trolley, near the company of other patients – some of whom may have complaints which could place the original patient in greater danger.

The IAEM acknowledges that its proposed policy may not be popular with staff on other wards, who would have to share the burden of dealing with hospital overcrowding, but the policy was being put forward to prioritise patient welfare.

Asked if the policy would pose problems when patients were assigned to wards other than those specifically suited to their conditions, Hickey said this was already the case – with hospital conditions meaning beds were used up by whatever patients needed them.

Obviously there aren’t men in maternity wards, but you may regularly have surgical patients being treated in medical wards, and vice-versa… Though you should try to assign them to an appropriate ward, you should admit them as an extra wherever there is capacity.

Hickey insists that relatively little preparation work is needed to equip wards to cater for the new policy – and that Ireland simply “doesn’t have the political will or the management will to face up to it”.

“It’s not ideal, but it’s the safer solution,” he says. “”It just needs to have more frequently – at the end of the day, this is about the difference between making it and not making it.”

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