Hospital emergency departments are a pivotal part of our health service; providers of acute care to critically ill people. They are also an important gateway between primary and secondary care.
The most recent Health Information and Quality Authority (Hiqa) report to examine quality of care has identified unsafe and overcrowded conditions in the emergency department at University Hospital Limerick (UHL). Some of the findings echo a similar 2012 report into conditions at Dublin's Tallaght hospital.
Inspectors identified some 37 patients on trolleys in the emergency department (ED) at one point during their UHL assessment. “Several ill patients were cared for on trolleys in the communal areas and corridors of the ED as there were no patient treatment bays available. Ill patients were placed close together,” they noted. Labeling the unit as not fit for purpose, Hiqa said conditions there increased the risk of healthcare associated infections, impeded access to patients for care and observation, and severely reduced patients’ privacy and dignity.
Public unease about safety in hospital EDs will not have been soothed by last week’s statement from the Irish Association of Emergency Medicine. It warned of a possible “staffing meltdown” next month when junior doctors finish their current contracts, predicting most EDs will be short of their normal complement of junior staff. A lack of resident medical registrar cover at night in hospitals has also been highlighted; the combined impact of staffing shortages will be to place patients at greater risk of avoidable adverse outcomes.
Another factor that hampers the care of patients in EDs is the inordinate delay experienced by ambulance crews when they arrive at acute hospitals. It has emerged that ambulances spent more than 8,000 hours delayed at hospital emergency departments waiting to hand over patients during one month this year. As a result crews waited longer than the Health Service Executive’s target of 20 minutes to hand over patients, retrieve their trolleys and return to responding to calls.
That similar problems to the ones identified in the Tallaght hospital inquiry have been unearthed in Limerick some 2 years later is disheartening. It provides solid evidence to back the assertion of recently departed Hiqa chief executive, Dr Tracey Cooper, that the health service lacks accountability and fails to learn from its mistakes. Her assertion that there are no consequences for lapses in patient care, even when they recur on a repeated basis, demands immediate action.
Notwithstanding the initial success of efforts instigated by Health Minister, James Reilly, to shorten waiting times in EDs, the continuing parlous state of patient safety in these units is indicative of a deeper malaise in the health service. Our health system is in urgent need of resuscitation.