Sir, – We read with interest your article on hospital crowding and its effect on emergency department function ("Older patients 'bear brunt' of A&E overcrowding crisis", News, September 13th).
To be sure, the quoted researchers are entirely correct. This is not a seasonal issue and is directly attributable to the inability to transfer admitted patients in the emergency department to a hospital ward.
Emergency crowding is a direct function of hospital crowding. It rarely occurs when a hospital functions at 85 per cent bed occupancy rates, is likely at 90 per cent and is a given at greater than 95 per cent bed occupancy.
It has nothing to do with the winter flu season and is a daily reality for emergency physicians and nurses. It is, indeed, the sick elderly who bear the brunt of the burden associated with crowding.
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What is not stated in the article is the toll of such crowding. There is incontrovertible international evidence that those who wait on trolleys in the emergency department suffer. They are robbed of dignity, their basic human and medical needs are not satisfactorily met as they line up in brightly lit and noisy hallways with no privacy and no toilet facilities. Those who wait on trolleys for admission are at risk of harm from medical error, delayed therapy and increased risk of complications, including death. Trolley waits are associated with system gridlock and inability to off-load ambulances, inability to transfer critically ill patients from rural communities and increased costs to the healthcare system.
To mitigate crowding, one needs to consider the American model of overcapacity protocols. To solve it, a government must improve access to hospital ward beds.– Yours, etc,
ALAN DRUMMOND, MD,
International Federation
of Emergency Medicine,
Melbourne,
Australia.