The risk of avoidable death in A&E departments is high, writes DrMuiris Houston, Medical Correspondent.
The latest crisis in the hospital service, involving the inability of Beaumont Hospital's accident and emergency department to cope with the pressure of acutely ill patients over the weekend, is very likely a final warning of an avoidable catastrophe in the hospital system.
According to a statement from Beaumont, the pressure on its A&E department was well above the seasonal average during last week. As a result, a backlog of approximately 40 patients built up, all needing a hospital bed in order to receive necessary treatment.
Despite taking preventive measures such as reopening closed beds and bringing in additional agency nurses, the hospital found itself in trouble on Saturday night.
At 11.30 p.m. it sought to divert all incoming ambulances to its sister northside hospital, the Mater. However, 30 minutes later the Mater, too, needed "protection" from ambulance admissions, which are the source of 25 per cent of any teaching hospital's daily workload.
On Sunday at lunchtime Beaumont again sought relief from ambulance pressure for a two-hour period. Significantly, within 75 minutes of this request the Mater could no longer cope, and so Beaumont did not receive the full period of respite it needed.
The weekend's events represent an incremental worsening in an increasingly fraught situation. While people may have become somewhat tired of hearing about the problems of A&E departments in the capital, the situation is moving inexorably from one of inconvenience, discomfort and unnecessary patient suffering to one where people's lives are at risk.
The reason is simple. A typical A&E department can just about cope with 20 people waiting for admission. When the numbers rise to 30 and beyond, people with life-threatening illness will find themselves sitting in chairs, their trolleys having been commandeered to allow the latest severely ill patients to be assessed and stabilised.
With a wait of three to five days for a bed now routine, such a patient may have to spend a considerable time slumped in a chair. While there, it is impossible to carry out the normal observations of blood pressure, pulse and temperature which are basic measurements by which healthcare professionals assess whether the patient is stabilising.
Unfortunately, the individual's condition may worsen. Without access to routine electronic monitoring, it may take vital minutes for a nurse or doctor to notice that he has begun to bleed, lost consciousness or stopped breathing.
When alerted, the A&E staff will immediately respond, transfer him back to a trolley and begin resuscitation. And while it is possible that they will be successful, the likelihood of a patient unavoidably dying in a situation such as this arises in direct proportion to the overcrowding of the emergency unit.
The Irish Times has been reliably informed of several such scenarios occurring in Dublin A&E units over the past number of months.The death of Róisín Ruddle in Crumlin children's hospital some weeks ago when planned cardiac surgery was abruptly postponed is the subject of an inquiry, the results of which have yet to be made public.
However, what is beyond dispute is that the two-year-old's death was avoidable. The risk of avoidable death of an adult in an A&E department while waiting for a hospital bed in one of Dublin's five teaching hospitals is now extremely high.
There are, at most, about two months left in which to avoid certain catastrophe. Once October comes, the seasonal pressure on hospitals will begin to intensify. As our winter approaches, and infectious illness attacks those with heart and lung disease, the number of people requiring urgent hospital treatment will rise.
Last weekend's events in which Beaumont was unable to go off call without tipping the Mater into a crisis will become a daily occurrence.
Based purely on mathematical considerations the likelihood of avoidable death simply becomes a matter of when.
The best the plethora of recent reports on how to reform the health system can do is to bring about change in three years. But this crisis needs a short-term solution. And that solution is relatively simple.
The National Health Strategy has stated that we need 3,000 extra hospital beds. Of the present Dublin bed stock, 200 have been closed since May and approximately 350 are occupied by older people who no longer require urgent medical treatment but who cannot function independently in the community and have nowhere to go.
With the number of acutely ill people needing urgent hospital admission reasonably predictable, the solution to the crisis is to tackle the bottleneck by opening up closed hospital beds.
Those appalled at the cost of the health service and who have been calling for the fiscal rectitude that has led to recent bed closures might wish to reflect on a simple economic fact. Achieving cost reductions in three years' time requires short-term transient funding to allow the system cope until structural change is complete. And the type of acute care represented by A&E departments does not distinguish between public and private patients.
The possession of private health insurance offers choice when it comes to planned surgery; it offers no such choice when it comes to the acute onset of a heart attack or the emergency treatment of a severe asthma attack.
Unfortunately, it is our parents, grandparents and friends who are lying in A&E units for days on end. They are vulnerable people who are not receiving healthcare to a minimum safe standard at present.
And let there be no doubt - an avoidable death in a hospital casualty department is now an absolute certainty in the absence of immediate remedial action.