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Capacity the real issue with ED crisis

By Paul Mulholland - 02nd Sep 2022

Emergency Medicine

The Irish Association for Emergency Medicine (IAEM) has welcomed reports that Minister for Health Stephen Donnelly has approved recruitment of additional consultants in the specialty. 

According to a story in The Irish Times on 19 August, up to 50 new consultants are to be appointed to emergency departments (EDs) in the coming months to relieve the chronic problem of overcrowding. 

“Particularly important is the suggestion that further posts will be funded in the future, which will allow the national training scheme to train sufficient doctors to take up these posts,” outlined the IAEM’s statement. 

“Having fully trained specialists in emergency medicine looking after patients with emergency presentations will undoubtedly enhance the quality of care provided to these patients and ensure that the most ill and injured have access to consultant-level care more frequently than at present, and earlier in their clinical course where the greatest benefit is to be had.” 

However, the IAEM pointed out that the most significant problem affecting clinical care in EDs is the inability to provide timely access to a bed for patients who require hospital admission. It stated that overcrowded EDs and delays to hospital admission from the time of the decision to admit were independent predictors of excess 14- day mortality. 

“As welcome as this initiative may therefore be, the appointment of additional consultants in emergency medicine will not address this issue,” according to the Association. “It is imperative therefore that, in parallel, bed capacity is urgently created to improve the safety of patients in EDs.” 

Currently, the Irish acute health system has 2.7 beds per 1,000 of the population in comparison to the OECD average of 4.3 per 1,000. 

“The Association acknowledges that there has been the beginnings of an uplift in acute bed capacity over the past year, but is strongly of the view that far greater ambition and urgency is required if the very serious clinical risk is to be addressed.” 

In an interview with the Medical Independent, published on 25 August, Clinical Lead of the HSE National Clinical Programme for Emergency Medicine Dr Gerry McCarthy acknowledged the lack of capacity within the acute system. 

In reference to University Hospital Limerick’s ED, which has been the subject of a recent HIQA report, Dr McCarthy said the persistent issue of overcrowding “breaks my heart…. I wish it wasn’t there. It interferes with our daily work, we know that. The problem in Limerick is beds.” 

A previous editorial highlighted the concerning implications of the recent ESRI report, which outlined the significant staffing requirements in public hospitals between 2019 and 2035 as a result of demographic changes. 

The need to recruit additional health staff is essential, both now and into the future. However, unless the lack of capacity is acknowledged and adequately addressed, the problem of overcrowding and long waiting lists will continue. 

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