Emergency Department Congestion Escalation Directive signed by Health Minister

Date Published : November 29th, 2015    Published By : admin

The Director General of the HSE Tony O’Brien, the Director of Acute Hospital Services Liam Woods and Minister for Health Leo Varadkar have signed a Protocol to build on the small but significant progress made in recent weeks to address Emergency Department overcrowding.

This Protocol for acute hospitals requires them to implement their Escalation Plan whenever their Emergency Department experiences overcrowding. Hospitals which do not comply will be subject to penalties with the resources re-allocated. It follows a small improvement in trolley numbers in the past week, compared with the same period last year. The Directive is designed to ensure that as much further progress is made in the weeks and months ahead in terms of managing ED overcrowding.

Overcrowded A&E Pic independent
Overcrowded Hospital A&E Unit: (Pic: Irish Independent)

Speaking on Friday, Minister Varadkar said: “The most recent numbers from the INMO and SDU indicate that the number of people on trollies is lower for November 2015 than November 2014. This represents a marked improvement from the summer when the situation was between 20% and 40% worse than summer 2014.
“On any given weekday, the number of patients on trollies peaks around 300, falling to 150 by the evening. While still not good enough, this is a far cry from the 500-600 we witnessed in January. The situation has eased due to the measures taken to date including increased staffing, more beds in hospitals, nursing homes and community facilities, more home helps and home care packages to facilitate discharge, and more community intervention teams, day hospital capacity and acute medical assessment units, to allow people to avoid having to go to the Emergency Department at all. Attendances are down about 1% this year. Nonetheless, there are still far too many people waiting too long in our Emergency Departments, so further measures now need to be taken to escalate this response to ensure that the progress is sustained.

“Today I signed a directive jointly with Tony O’Brien and Liam Woods, setting out the measures that hospitals must take when overcrowding occurs. It is our expectation that this can help to secure in December some of the progress made so far as even more beds will open.”

Leo Varadkar Portlaoise Hospital A&E Ambulance
Minister Leo Varadkar. (Pic: Irish Examiner)

The Plan makes it compulsory for each acute hospital to take specific steps to address overcrowding such as extra ward rounds if trolley figures reach ‘red’ status as set out on the daily reports from the SDU. It also requires each hospital to take steps if any patient is left on a trolley for more than nine hours, the recommended maximum waiting time.

Significantly, the Directive removes the discretion of individual hospitals to implement their Escalation Plan.

The Directive is being issued on foot of discussions between the Director General of the HSE and the Minister for Health on how best to address ED congestion with all of the available resources, both within and outside acute hospitals.

Individual escalation plans require the following steps to be taken:

·        Additional ward rounds;
·        Postpone non-urgent elective procedures;
·        Full cooperation with Social Care and Primary Care services in discharging patients;
·        Working closely with Community Intervention Teams to provide Antibiotics and other basic care in a patient’s home or care facility, rather than a hospital;
·        The national ambulance service must be engaged with actively to assist in effective turnaround times and provision of inter hospital transfers to manage group wide capacity;
·        As a last resort, extra beds will be put on wards.

A&E Ambulances Pic Independent
(Pic: Irish Independent)

The Directive requires that each hospital regards ED congestion as a key issue for the whole hospital, and for primary and community care services. If ED congestion occurs, all hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care.

The signing of the Directive follows the allocation of €117 million of additional funding specifically to address ED overcrowding, the ongoing recruitment of frontline staff, and the phased re-opening of 420 beds under the Winter Initiative.

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