Emergency relief
The Emergency Department Taskforce’s report sets out how to reduce A&E overcrowding.
Emergency departments have become increasingly overcrowded, with rising numbers of patients being classified as delayed discharges and non-urgent procedures being postponed. Overcrowding in acute services stems from other parts of the Health Service becoming stretched. The latest figures show that more than 3,500 patients spent more than 24 hours in emergency departments during January.
Health Minister Leo Varadkar last month published the Emergency Department Taskforce Report which aims to optimise existing hospital and community capacity and improve internal capability and processes. It also focuses on the improvement of leadership, governance, planning and oversight.
The number of delayed discharges have fallen from an average monthly peak of 867 in 2009 but still remained high at 728 at the end of January 2015. In most hospitals, more than 15 per cent of beds are blocked on an ongoing basis. The report sets a target to limit the number of delayed discharges to 500 in 2015, ensuring that delayed discharges do not take up more than 10 per cent of a hospital’s available beds.
Hospitals need to set a daily target based on the average number of admissions by day of the week, thus avoiding queuing. Discharge times should align with times of maximum bed demand for new patients. A whole hospital system approach is required, to include waiting areas for discharged patients. Cross-team discharging has proven to be effective in getting patients out of hospital within seven days and should be extended across all hospitals.
The length of stay for patients in hospital needs to be reduced by improving processes. The taskforce wants to increase admissions on the day of surgery by 10 per cent to meet a national overall target of 70 per cent in 2015, in order to reduce the number of overnight stays.
The report stresses the need for strong clinical and managerial leadership that prioritises unscheduled care. Access to senior clinical decision-making is critical to tackling admission and discharge problems. Some hospitals rely heavily on agency consultants and doctors and Ireland has 2.7 doctors per 1,000 people (whilst the European average is 3.4). Additional investment should be used to recruit more consultants and other professionals. Chronic disease management also needs to be improved with current measures being assessed and the coverage of clinical nurse specialists being increased.
Additional funding has been announced to implement the report, including €44 million to be allocated to the Nursing Homes Support Scheme which will provide an additional 1,600 places and reduce waiting times. Standardised care pathways for frail elderly can avoid admissions, reduce length of stay and prevent readmission.
€30 million will be invested in extra temporary transitional care beds until June, these will in future be replaced by sustainable, more cost-effective beds. Up to 250 community care beds would also be made available; approximately 60 of these are already open.
Varadkar stressed the need not just for additional investment but for the reform of processes and practices. He commented that the plan would have a noticeable and measurable impact on trollies, overcrowding and delayed discharges. “It will not, however, resolve all problems in all sites,” he added, “that is not solely a matter of resources and is very much linked to process, management, efficiency and patient flow.”
