The Emergency Department Taskforce Implementation Group has been overseeing initiatives to address ED performance and overcrowding. These initiatives include optimising discharges in advance of the weekends, strengthening the senior decision making presence at wards and in EDs, increased access to diagnostics and securing staff to open overflow areas.
During 2015, additional funding of €117 million was provided to the HSE to relieve ED overcrowding pressures. This funding has supported initiatives to expand hospital capacity with 364 additional beds opened or reopened, reduce the number of hospital attendances by expanding community intervention team services and increasing the availability of community hospitals, and support timely patient discharge from hospital by reducing the wait time for Fair Deal funding to no more than 4 weeks, providing additional transitional care places, public community beds and home care packages.
Since the beginning of 2016, the HSE has reported an increase of 6.9% in patient attendances in comparison with the same period last year. However, the total year to date number of patients waiting on trolleys at 8am each morning has shown a marginal increase of 1%.
This year, the HSE is focusing on a number of key activities to manage waiting lists more effectively, thereby improving patient waiting times. These include; ensuring that chronological scheduling is adhered to, putting in place validation procedures to ensure that patients are available for treatment, relocating high-volume low complexity surgeries to smaller hospitals; and designating an improvement lead for each hospital group.
With respect to possible underutilisation of surgical beds, the ED escalation framework states that reviews of elective admissions should be carried out by hospital management in consultation with the relevant consultant. It is only at Stage 3 of escalation that all admissions are to be carried out through the Emergency Department and that elective surgeries are cancelled.
Stage 3 requires that elective staff are redeployed to assist with patient flow through the ED. This can impact on staffing and bed capacity in surgical wards. Taking into account the immediate and short term predictable demand/capacity scenario, decisions on hospital admissions and bed management have to be taken with regard to the safe operating limits of the hospital as a whole and in the interests of patient care.
