Nurses must allow trolleys on wards
Published 11/01/2016 | 02:30
Nurses have historically voiced zero tolerance for moving any patient on a trolley from an overcrowded emergency department onto a ward.
The patient still lies on a trolley – but they are at less medical risk in the confines of the ward.
It is a screamingly obvious solution to some of the problems of congestion.
I believe the nurses are wrong in trying to frustrate it and there is a sense they are playing silly industrial relations games.
It should be part of any escalation procedures to alleviate the pressure when trolley traffic reaches a certain crisis.
Any attempts to obstruct it are akin to terrorists hiding themselves among unfortunate hostages.
Just like in bus disputes where passengers end up being kicked around, it is now the turn of the patient.
Doctors’ unions are also guilty of this when the occasion arises.
Irish nurses are relatively well paid compared to their counterparts in many EU countries.
And the number of nurses in Ireland’s health service is high when compared to other health systems.
We should not be shocked that patients are used in health disputes.
But patients die painfully, with added existential suffering, when we play that game in health.
Maybe it is time we examined where we have got it right in improving services and apply the same drive to the trolley crisis.
Smaller and inefficient – a polite way of saying unsafe – cancer services were closed and reconfigured into safer, more effective, larger units.
Within a remarkably short time, by Irish healthcare standards, our cancer outcomes now approximate the most effective first-world health systems for common cancers. Incredible.
How amazing that it took 15 years of unseemly haggling – and the sad death of patients such as Susie Long – to finally galvanise us to do the obvious.
The equivalent for the emergency department problems is blindingly obvious.
In the short term, immediately redistribute acutely unwell newly admitted patients on trolleys to wards.
In the intermediate term, close unsafe regional services where there are insufficient consultants to provide adequate 24-hour cover. This is small up-front pain.
We have to tackle the vested interests head on, as we did with cancer services.
We need to improve the basic running of hospitals by investing in more technology.
Incredibly, most care in hospitals is still recorded on bulky paper files.
In our so-called “smart economy” it is absolutely inexcusable that hospital clinical activities are not computerised and subject to real-time data analysis – itself the oxygen of all functioning modern health systems.
Also, we should not be relying on the nursing union to provide trolley counts of the numbers waiting for a bed daily.
We must amalgamate unsafe, smaller emergency departments and insist on full computerisation of clinical functions in hospitals.
Then we should take out three-quarters of junior hospital doctors, and recruit towards an additional 25pc of specialists and GPs.
Do the above and the system will start to sing.
Expand capacity on the community side by further accelerated development of the Fair Deal nursing homes scheme, encompassing packages to also subsidise care for people at home.
Then, instead of occupying a bed in a hospital ward, acute complex elderly patients could instead be cared for at home or in a nursing home, where most of them would prefer to be.
Dr Brendan O’Shea is a family doctor. He is Medical Director at K Doc, a GP co-operative in Kildare and West Wicklow, and is Assistant Adjuvant Professor in General Practice at Trinity College Dublin