Hospitals are to be fined €10,000 each time they breach a new directive aimed at cutting overcrowding in emergency departments.
The money deducted will be reallocated to the hospitals that demonstrate the best performance in keeping trolley numbers low, according to the directive signed by Minister for Health Leo Varadkar and HSE director general Tony O'Brien.
In a letter to the heads of six hospital groups, both men offer a “carrot and stick” approach by promising that fully compliant hospitals will have any fines imposed as a result of long waiting lists for inpatient and day-case work waived between now and the start of March 2016.
The increased focus on cutting trolley numbers has forced some hospitals to cancel planned appointments and procedures, leading to lengthening waiting lists for scheduled care and consequent imposition of fines.
The new directive makes it compulsory for hospitals to take specific steps to tackle extreme overcrowding by implementing an escalation plan.
Once overcrowding has reached a specific critical level, or any patient is waiting longer than nine hours in the emergency department, the hospital will be obliged to take steps such as cancelling elective work, discharging patients earlier in the day or putting on additional ward rounds.
Putting extra beds on the wards – a policy opposed by the Irish Nurses and Midwives Organisation – must be invoked "as a final step", according to the directive. "Putting extra beds on wards is a necessary part of escalation however all other required escalation steps must be undertaken prior to this."
TrolleyGar
The number of trolleys required to trigger the escalation plan in a hospital is determined by the TrolleyGar count carried out by the HSE three times a day. The TrolleyGar figure is often slightly lower than the Trolley Watch figure counted by the INMO daily, which is generally accepted as the measure of emergency department overcrowding.
Trolley numbers this year have been at record levels, but a slight improvement has been recorded in recent weeks.
Mr Varadkar said the most recent trolley counts showed there were fewer people on trolleys this month, compared with November 2014.
On weekdays, the number of patients on trolleys tended to peak at about 300, falling to 150 by the evening.
“While not acceptable, this is a far cry from the 500-600 we witnessed in January,” he said.
Mr Varadkar said the situation had eased because of a number of measures, including more staff and more beds in hospitals, nursing homes, and community facilities.
“Nonetheless, there are still far too many people waiting too long in our emergency departments, so further measures now need to be taken to escalate this response to ensure that the progress is sustained.”
