Hospitals warned against using medical trainees to assess ED patients

RCPI says it may withdraw accreditation from sites where junior doctors see triaged patients from ED

Hospitals have been warned not to let medical trainee doctors assess patients in emergency departments (EDs), amid claims some hospitals are using the practice to massage trolley numbers.

In a number of hospitals, patients coming to EDs are being evaluated by trainees without first undergoing review or “workup” by ED doctors, according to the Royal College of Physicians of Ireland (RCPI).

While acknowledging the practice may have started during the Covid pandemic, the RCPI’s Institute of Medicine has told clinical directors to ensure it is not happening in their hospitals.

Hospitals where medical senior house officers (SHOs) are still seeing triaged patients from ED are at risk of having their status as a training site for doctors removed, a letter from the RCPI states, adding that the college will soon review sites to ensure compliance.


An RCPI spokeswoman said the letter clarified that doctors in training work with patients who have been triaged for admission to hospital. “They do not assess patients for admission in the ED.”

“Internal medicine training is focused on inpatient care and follow up and not on the initial assessment of unselected patients referred to the emergency department.”

Tramore GP Austin Byrne pointed out that once patients are referred to medical staff they no longer count as ED trolley cases, despite having had no medical care or assessment by a doctor up to that point.

Normally, Dr Byrne said, medical SHOs workup patients who have been seen in the ED, had preliminary investigations and are deemed stable.

“These patients have been seen by the ED doctors, under supervision of senior decision makers and are safe to hand across for further workup,” Dr Byrne said.

He warned of “considerable” risk where patients were “bounced straight from arriving into ED” without being seen by experienced medical staff or having a preliminary workup performed.

The letter suggests that in some hospitals the ED journey “takes but the blink of an eye”, Dr Byrne said.

“What they seem to imply is that a patient arriving to the waiting room chair can now be ‘triaged’ to the eventual hospital destination felt most likely to suit their eventual needs and magically take up residence in a virtual place that lies outside of the ED but not yet within the physical reality of a hospital bed or any form of medical assessment.”

There are currently 560 doctors on the Basic Specialty Training programme working in accredited hospitals around the country, according to the RCPI.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times