A news article from Irish Nursing and Midwives organisation is highly critical of placing extra trollys in wards when A&E's are full.
Also see - Escalation Of Antrim A&E led to Fire Escapes Being Blocked With Trolleys
This practice was widely used in Antrim area Hospital post the Rutter & Hinds review in 2012, with Mary Hinds from that review now taking charge of the health trust can the public be fully satisfied that improvements will be made within the trust.
The decision by management at the Mid-Western Regional Hospital in Limerick to place multiple trolleys on medical wards in recent weeks, as a response to accident and emergency department overcrowding, was described by Dave Hughes, Irish Nurses and Midwives Organisation deputy general secretary, as "abandonment by HSE management at local and national level, of patients and staff both in emergency departments and medical wards".
“It is legitimate for emergency department staff to seek support and assistance throughout their hospitals when EDs reach capacity and are overcrowded. The practice of putting trolleys on wards, however, simply imposes further risks, pain and discomfort on patients and nurses and ignores the fact that the only real relief for such overcrowding is the re-opening of closed beds or accelerated discharge of patients.”
Mr Hughes, is the union side joint chair of the National Accident and Emergency Forum. He said the Forum, which is currently engaged in a series of meetings recognising the severity of the demand arising from the critical set of conditions now facing emergency departments, is attempting to agree a special 'Acute Escalation Plan' which would involve all stakeholders playing their part.
He said it was simply unacceptable for hospital management to dump the problem onto nurse managers and nursing staff who do not have the power to discharge patients. The consequences of this, he added, were overcrowded wards that deprive patients of dignity and respect and impose a number of serious risks and dangers to the health of patients.
Overcrowding, in recent years in the busiest acute hospital emergency departments has unfortunately become a regular feature but recent events have only served to exacerbate an already difficult situation.
The combination of the worst weather conditions experienced in Ireland in more than 40 years, the unprecedented public finance crisis currently experienced by government, the legacy of delayed discharge of patients and the emerging shortage of medical doctors, in this winter period, will inevitably lead to impossible conditions in some of the emergency departments unless significant additional conditions are now initiated by all, according to Mr Hughes.
He said the Forum, which involves representatives of medical and nursing staff along with management, had seriously reviewed escalation plans within Ireland and abroad.
The most successful examples are those hospitals that focus on reducing potential admissions by promoting out-patient activity, hospital transfers etc. These hospitals also work on increasing patient discharge through additional ward rounds or securing essential investigations in addition to providing certain treatments in an alternative setting outside of the acute hospital sector.
“The key to successful escalation policies in the face of such demand is that the agreed actions at each level hold an incentive which prevents any hospitals moving to the next level while at the same time maximising patients safety and minimising clinical risk," said Mr Hughes.
According to Mr Hughes, the actions of these hospitals are generally based on a graduated response ultimately leading to a red alert status which is considered a serious crisis.
"All actions, therefore, should be taken to prevent a hospital reaching a red alert status and additionally aimed at securing and maintaining stability within daytime hours so that an escalation is not triggered overnight when actions to address the escalation are restricted” he said.
Mr Hughes said that the Accident and Emergency Forum were on the verge of agreeing a hospital wide response to emergency department over crowding but whether that can be agreed will largely depend on whether all stakeholders will sign up to the escalation policies. He stressed that the success of this process would depend on the level of trust between management, nursing staff and medical staff.
“The behaviour in the Mid Western Regional Hospital in Limerick in recent weeks has severely undermined the very serious attempt being made at the Accident and Emergency Forum and has now placed the entire response in jeopardy," said Mr Hughes.
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