A temporary break in elective admissions might ease the crisis, writes Dr Muiris Houston, Medical Correspondent
It is no coincidence that the accident and emergency crisis has reached its height at this time of year. Significantly, the previous highest total for the number of patients lying on trolleys waiting for a hospital bed was reached 12 months ago.
While many factors contribute to the perennial logjam in hospital emergency departments, one key element that prevails in mid-winter is the high incidence of respiratory infection.
Although we have yet to see a significant rise in influenza this season, there are many other, more common respiratory viruses in circulation. Respiratory syncitial virus, in particular, causes a flu-like illness leading to the hospitalisation of vulnerable patients.
People without chronic heart and lung conditions can usually fight off these viruses without medical intervention. However, if you have chronic obstructive disease, a common smoking-related condition that causes shortness of breath, and you develop an acute respiratory infection, your symptoms usually worsen. Such patients can deteriorate rapidly, requiring urgent hospital admission for intravenous steroids, antibiotic treatment and chest physiotherapy.
A similar situation applies to those living with cardiac failure. This disease, which causes fluid to accumulate in the lungs and in the lower extremities, is usually controlled by water tablets and other cardiac medication. But once a respiratory infection takes hold, the pressure on the heart increases and it tips into more severe congestive heart failure. Again, the only solution is hospital admission.
Minister for Health Mary Harney and HSE chief executive Dr Brendan Drumm feel we have enough hospital beds. The medical and nursing unions disagree, saying we need 3,000 more to replace those lost in the 1980s and to compensate for population growth.
Another important factor is the relative under-development of our primary care sector. If more primary care teams were in place by this time next year (as promised in the Budget), some of those queuing for hospital beds could be managed at home.
A possible short-term solution is to temporarily cease elective admissions in certain hospitals. We already have evidence that such an approach would succeed. Over the Christmas and new year period, when elective activity shuts down, patients in A&E are admitted to hospital beds more rapidly and efficiently.