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Thursday 18 September 2014

Emergency units threatened by patient safety crisis

Fears for patients as our hospitals struggle to hire €1,000-a-day medics

Published 10/06/2014 | 02:30

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Dr James Gray: says there is a medical manpower crisis
Dr James Gray: says there is a medical manpower crisis

OVERCROWDED hospital emergency departments are facing a growing patient safety crisis as experienced agency doctors, earning €1,000 a day, are becoming increasingly difficult to hire.

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Many struggling hospitals have not been able to attract enough junior doctors to join their staff and are heavily reliant on expensive agency medics to fill roster gaps and maintain services.

However, increasing numbers of these agency doctors, known as locums, are now joining the ranks of doctors who are leaving Ireland for better pay, conditions and training abroad.

The latest threat comes in the wake of a damning report on Limerick's emergency unit – branded unfit for purpose – and figures showing some ambulances can be held up outside these units for between three to 14 hours because no trolleys are free in the A&E.

A letter, seen by the Irish Independent, revealed how Tallaght Hospital in Dublin was reprimanded by watchdog, the Health Information and Quality Authority (HIQA), for its failure to have a senior doctor on duty overnight in its emergency department in March.

It is understood that the emergency department – which was at the centre of a major separate HIQA probe into overcrowding in recent years – had booked an agency doctor but he did not turn up, leaving it in the care of lower grade staff who would not have the skills to cope with complex patients.

The letter from HIQA inspector manager Susan Cliffe to hospital chief David Slevin said she had learned that that there was no senior doctor in the emergency department, which is one of the largest A&Es in the country, between midnight and 6.30am on March 14 when 24 patients were on trolleys.

Other hospitals which are relying heavily on agency doctors include the Mater, Naas, Limerick, Galway and Letterkenny. And doctors insist that some hospitals are "playing down" the problem.

Dr Mark Doyle, of the Irish Association for Emergency Medicine, warned next month's changeover of junior doctors, who are on six-month training stints, could leave some departments facing "meltdown" if not enough are recruited. He called for urgency from the HSE to avert the worsening shortages.

In her letter to Tallaght Hospital, Ms Cliffe warned that "this raises potential concerns about the quality and safety of care to patients attending the emergency department".

She demanded details of the arrangements in place to ensure patients are seen by a senior doctor at all times.

Asked if patient safety was at risk, Dr James Gray, a consultant in emergency medicine at Tallaght, told the Irish Independent: "It is definitely unsafe and poses a grave and unacceptable risk to patients if there is no senior decision maker in a major emergency department on a 24/7 basis.

"I am delighted HIQA have shone a spotlight on this. The rosters are heavily reliant on locums to keep the department staffed both on a continuing basis and to cover sudden unexpected gaps. There are four consultants in the adult emergency department contracted to work in the hospital, mainly daytime, and then be on-call for out-of-hours and weekends.

"Being on-call means being available for telephone advice and to come in for emergencies on a case-by-case basis. Asking consultants on onerous on-call rosters to come in and work a full night shift, on top of a day shift, and then be on duty the next day is like asking a pilot to fly a plane during the day and then fly again that same night and then again the next day without proper rest.

Recruitment

"The HSE needs to wake up now and create the conditions favourable to retaining and recruiting doctors. There is a national medical manpower crisis," he warned.

"Expensive locums filling the void make no fiscal sense and no one in the HSE seems to be joining up the dots. HSE overseas recruitment drives to date have not been successful. Poor working conditions including emergency department and hospital overcrowding, lack of career progression, uncompetitive salaries are all factors."

A spokesman for Tallaght Hospital said it had five junior vacancies in its adult emergency department and another two in the children's unit which had to be filled by agency doctors. He insisted there was a national shortage of junior doctors and the hospital had an ongoing recruitment campaign under way nationally and internationally.

Irish Independent

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