A&E overcrowding at maximum despite extra beds

The Emergency Department at Galway University Hospital has been on Code Red or Black – the highest status in its new escalation policy – continuously for five weeks due to overcrowding.

On Tuesday, there were 36 people waiting on trolleys when the hospital issued a warning about excessive delays, urging people to stay away unless “in the case of real emergencies”. That was down to 32 by Wednesday morning and up from 25 on Monday.

The unrelenting pressure on the ED continues despite the opening of 17 new beds last month to accommodate more patients, with a further thirteen due to come on stream before the end of this month on the site of the old Physiotherapy and Social Work Department.

However the extra capacity has done very little to alleviate the lengthy waiting times for patients, insisted Clare Treacy, Irish Nurses and Midwives Organisation (INMO) industrial relations officer for the Galway region.

And it follows a national agreement with the INMO to implement an escalation process when 30% of patients are waiting more than nine hours on a trolley in the ED, which sets out specific steps to be followed to try and speed up the flow of patients. These include cancelling elective patients, arranging more step down beds in the community, organising transport for the discharge of patients and rushing diagnostic tests.

The hospital said it was procuring convalescence beds “on a daily basis” from private nursing homes and working closely with all the hospitals in the Saolta group to ensure that capacity on all sites is maximised.

“We’ve been meeting with management at UHG every week since just before Christmas and they’ve been in full escalation – either Code Red or Code Black – since January 6, apart from the one or two days that they have dropped back to Code Orange or Green,” Clare stated.

“There’s no escalation policy going to deescalate the situation in Galway in my view – only building a new Emergency Department and adequately staffing it.”

Yesterday management brought in private ambulances to move patients fit for discharge. However a promise to hire more staff has stalled as nurses spurn the chronic conditions at UHG for the less stressful atmosphere and better pay of private hospitals.

“I believe local managers are doing as good as they can do – they are having meetings, they are trying to improve the flow of patients through the hospital but there just aren’t enough beds, the ED is still small and way understaffed,” stressed Clare.

Ten ED nurses left the unit last year.

Health Minister Leo Varadkar stated that the new ED will go to design and planning stage after a cost benefit analysis is done by the end of March on a revised proposal submitted by the hospital management after their original plan was deemed overly ambitious. A further 75 beds are expected to open by the end of the year after various departments have been moved and other units built in a complex game of infrastructural chess on the highly developed Newcastle site.

In the meantime, planned surgeries are continuing to be postponed.

Almost 7,000 surgeries were cancelled at Galway’s two public hospitals in the past two years – that’s on average nine elective surgeries at UHG and Merlin Park every day of 2014 and 2015. Saolta, the group which runs Galway’s three public hospitals, was fined over a million euro for failing to adequately clear lengthy waiting lists across all disciplines for the final five months of last year.

However the practice of imposing fines is due to be reviewed for this year.