Sir, – Liam Doran proposes five immediate steps to end the hospital trolley crisis ("We must expand public health system to tackle hospital trolley crisis", Opinion & Analysis, April 3rd). The first four steps recommend an increase in hospital beds and staff. The fifth recommends sustained investment in primary care.
On the same day we read in The Irish Times that €74 million is being earmarked to help solve the crisis ("Coalition requires modest health plan to meet targets", April 3rd). A total of €44 million is to support the Fair Deal process, and the remainder is to purchase bed space. As Mr Doran has pointed out, this is not enough.
I believe some important issues have not been addressed.
At present, emergency departments (EDs) are the only way to get patients admitted to hospital. EDs have furthermore unnecessarily become the primary triage station for minor illness or injuries.Herein lies the problem. Staff are required to tend to the whole spectrum of emergencies – major and minor – at the same time. This means huge resources are needed if “trolley waiting” is to be avoided.
A solution could be to separate the major from minor emergencies through an offsite triage centre. Minor illness or injuries – including uncomplicated fractures – would be dealt with here.
This would allow the EDs to be admission units which can only be accessed by those who are brought in by ambulance or who have been already triaged elsewhere, ie from the proposed triage centres or in primary care.
To do this, we need, as Mr Doran suggests, to increase primary care resources. This will enable GPs to return to being effective gatekeepers for our hospitals.
However, this will take some time to implement. In the interim, an extension of the €100 charge for attending to an ED without a GP’s letter should be extended to all. This would encourage people to seek first contact in primary care.
This system works very well in other countries, including those in Scandinavia.
In summary, if we reduce the number of attendees with minor illness or injuries to EDs by having them triaged elsewhere, there will be breathing room in the EDs and therefore less pressure on beds. The measures outlined would help provide a more efficient and cost-effective health service for our country. – Yours, etc,
Dr TRULS
CHRISTIANSEN,
Wicklow Town.