Best way to commemorate 1916 is to deal with the hospital trolley crisis

Three times now in the year preceding the centenary celebrations of 1916, the Health Service Executive has presided over cases of acutely unwell centenarians being left on hospital trolleys for over 24 hours. There were further reports of psychiatric patients facing a similar fate this week.

It is deplorable to hear Government politicians queuing up to suggest ways to commemorate 1916 while it presides over a healthcare system that exposes the nation’s children of the 1916 heroes to organised institutional abuse.

If we are to believe the Proclamation’s assertion that all citizens are sovereign, then these centenarians should be hailed as our High Kings and afforded the dignity and grace that the State lavishes on foreign visiting dignitaries.

Patients on trolleys have no monitoring, no access to sanitation, no privacy and no confidentiality, and are exposed to constant light and noise.

Denying anyone sleep for 24 hours is a form of torture in many regimes.

The HSE condones, accepts and designs a system to force this degradation on its most vulnerable citizens in their time of need. What (I urge the Government to ask) would the brave men and women of 1916 make of the treatment their children are exposed to by the Republic they dreamed of?

Instead of buying buildings in Moore Street, the Government should extend the most basic of human rights to our elderly citizens.

In recent times we've heard excuses that the emergency departments (EDs) in Limerick, Beaumont and Tallaght were busy with a surge of sick elderly people. Isn't this what an ED is for?

Absolute failure

The standard HSE response that building new EDs will fix the problem is a declaration of an absolute failure to grasp the root of the overcrowding issue.

Hospitals need more acute ward beds, not bigger EDs in which to house even more trolleys.

The HSE’s tolerance and, indeed, normalisation of a situation that forces our most vulnerable citizens to lie on a trolley for days reveals a corporate culture incapable of solving the issue.

We also, unfortunately, have a healthcare “watchdog” with no teeth.

Despite the damning report into patient safety in overcrowded EDs published by the Health Information and Quality Authority (Hiqa) in 2012, very few of its 76 recommendations have been implemented.

Why? Hiqa has no power of sanction against those whose failures of corporate governance is leading to a serious institutional risk to patients’ lives.

The Irish Association of Emergency Medicine has calculated that 350 people die every year as a direct result of ED overcrowding.

Critically unwell patients wait longer for lifesaving interventions, medical error increases, vital observations are not done and infectious diseases are passed between patients.

Overcrowding is as dangerous as operating with dirty hands.

Corporate manslaughter

Almost a death a day is caused by overcrowding. Shouldn’t this constitute corporate manslaughter?

Would we react differently if a bus company or an airline killed a passenger a day?

Ebola didn’t kill a single Irish person yet a national emergency plan was formulated without delay. And rightly so, but why do Irish people tolerate with resigned acceptance a “disease” that kills 350 a year and is preventable.

Hospital crowding won’t be solved overnight, but in the short term the HSE must protect the critical care units of each hospital (ie, intensive care units, coronary care units, emergency operating theatres, maternity delivery rooms and the emergency department) to avoid patient deaths.

These areas have an entry flow of critically unwell patients whose care should not be compromised because of an exit block in less acute parts of hospitals.

The Irish Times ran an excellent article recently by an emergency medicine physician setting out a prescription to cure emergency department overcrowding.

Busy EDs

Personally I feel the one and only therapy needed is an absolute ban on keeping patients who have been admitted to hospital in busy EDs. Once a patient has received their emergency care they should be safely moved into the hospital to allow other (over one million a year) acutely unwell patients rapid access to the emergency department.

Moving admitted patients from EDs to wards – in excess of the wards’ normal capacity – has been shown internationally to improve the efficiency of acute bed-usage as it places the service pressure where the solutions must be found and, most importantly, it allows emergency departments to deliver safe emergency care. Jean O’Sullivan, is a consultant in emergency medicine