An independent report into the crisis in Accident and Emergency departments at the State's acute hospitals has pinpointed a lack of beds as the principal problem and has called for more powers to be given to bed managers.
The report has been welcomed by the Irish Nurses Organisation (INO) which has pledged to implement its recommendations. But the Irish Medical Organisation (IMO)criticied the report, rejecting the claim that consultants were contributing to overcrowding.
CAPITA Consulting was commissioned by the Health Service Employers Agency (HSEA) and nursing unions to undertake a comprehensive review of bed management in May 2002, following industrial action taken by nursing staff working in Accident and Emergency departments.
The report found that bed management is not practiced uniformly and the powers and supports for the role differed widely. "In some hospitals, the focus of the Bed Manager is strictly on placing patients in beds (or "bed finding"), while in others, the Bed Manager only deals with strategic issues such as finding and negotiating for long-term care beds, leaving all bed finding to hospital nursing administration," the report found.
The report identified a number of "critical elements for effective bed management" including the need for a single accountable manager with appropriate professional and administrative support and "explicit protocols to support" the treatment of patients from initial consultation through to discharge from care. It said the entire process should be put in the hands of the bed manager and their team.
The INO today said the report backs contentions they have been making for over a year. "The report makes many recommendations which are reasonable, practical and cost effective in the crisis management context within which the Irish acute hospitals are working. Many of these were already suggested in the INO's original submission and the consultants have added to them and enhanced upon them," INO deputy general secretary Mr David Hughes said.
The report identified "chronic shortages in acute care beds across the country [which] has led to ongoing occupancy rates of 85-100 per cent in almost all hospitals in the country".
It said spare capacity was necessary for A&E departments and the that shortages emerge at an average occupancy rate of about 85 per cent. "Occupancy rates greater than 90% are generally considered to be clinically risky for A&E patients", it said.
It also criticised the practice of consultants who retain the exclusive right to discharge patients as casuse of overcrowding.
It also claimed some consultants were keeping patients in A & E beds over the weekend so their own private patients would find a free bed on Monday.
The INO rejected the findings saying the focus should be on increasing the number of conultants and beds.
MO Director of Industrial Relations, Mr. Fintan Hourihan said: "Ireland currently has the lowest number of A&E Consultants in the European Union and hospitals are still suffering from the loss of 25 per cent of all acute beds since 1980 and the absence of rehabilitation facilities.
"Equally the increasing clinical workload, which has seen overall acute hospital activities rise by 17 per cent over the last five years, has caused further delays."
The CAPITA report also identified problems caused by patients who have been discharged but have nowhere to go for intermediate or long-term care. "This problem is especially acute in a number of Dublin hospitals, where as many as 20 per cent of acute care beds are occupied at all times by delayed discharge patients."
The report concluded by saying that employers and nursing unions should discuss the report with a view to agreeing an action plan.
Mr Hughes said the report was a "significant aid" but warned investment was needed to avert "the now annual accident and emergency crisis".
Meanwhile, industrial action involving the INO at the A&E Department of the Midlands Regional Hospital at Portlaoise has been deferred.
The dispute was caused by a ban on agency nursing which, the organsiation says, caused serious staff shortages.
The agreement guarantees a pool of temporary nurses to allow for shortfalls in staff, the filling of all vacancies and a further meeting between staff and nurse management chaired by a facilitator to agree rosters.