Madam, - It has fallen to me to accompany an elderly relative to the Accident and Emergency department of the local hospital on a few occasions recently. To me as a doctor, this has been a fascinating experience, and I get lots of time to observe and to think.
On our most recent visit, I was once again struck by a fact which is already well known to most medical people: that the A&E crisis is not an A&E crisis at all, but rather a ward crisis. Every A&E department in this State would be more than capable of handling its workload if only it was let do so, and did not have to handle large numbers of people who should not be there in the first place.
People who should be attending their GP certainly slow the system down, but they are not the ones who end up on trolleys for hours and days. The real problems are the people who need admission but have no ward beds to go to. Improving A&E departments without increasing the number of beds on wards would be a bit like upgrading the railway line to a town which has no station.
There is a relatively simple solution to the problem, but it would involve going back to the way things used to be in the past. When I was an intern in Northern Ireland in the late 1980s, I don't think I stood in the hospital's A&E department more than a handful of times in the whole year. All admissions, you see, went straight to the ward. The GP phoned the intern to arrange the admission, and when the GP's letter said "Please admit", that was it, the hospital had to admit. While some hospital doctors may disagree, the fact remains that nobody is better placed to make a judgment on whether a patient actually needs to be admitted to hospital than an experienced GP in the community, indeed often in the patient's home. If all admissions went straight to the relevant ward then A&E could be left to get on with A&E work.
Some people may say that this system would just move the problem elsewhere. True, but there would be a number of very significant advantages. Medical, surgical, paediatric, geriatric admissions would all be going to separate areas of the hospital, so there would not be a large number waiting in any one area. Until the number of ward beds are increased, each ward on call would need to have an admission area where patients would be attended prior to actual admission to a bed, especially at night.
If some patients ended up spending hours or days awaiting a bed on a trolley in this admission area, well at least they would be in the part of the hospital best suited to addressing their individual needs, and could be included in consultants' ward rounds.
Just as important from the perspective of the patients and their families, they would also be far removed from the drunks and various other comedians who inhabit the A&E sub-world. - Yours, etc,
Dr JOSEPH QUINN, Ballybranagan, Kinvara, Co Galway.