Sir, – The report of the coroner's inquest held following the death of a 79-year-old man who had spent 10 hours on a hospital trolley in the emergency department of Cork University Hospital cannot go without comment ("Man (79) died of heart attack after 10 hours on hospital trolley" , November 3rd).
I have no doubt that the in-patient medical team members involved in this man’s care and who gave evidence at the inquest did the best they could for the deceased under the circumstances.
Any suggestion, however, that the care received by an in-patient on a trolley in an emergency department is as good as the care that can be delivered in a specialist in-patient ward is simply not so. While emergency departments are very good at dealing with the healthcare needs of those patients who attend hospital acutely, they cannot function simultaneously as an emergency department and an in-patient ward.
Over the last decade clear evidence has emerged that patients who remain on trolleys for extended periods of time suffer greater mortality and poorer medical outcomes as a direct result. To claim that 10 hours on a hospital trolley is acceptable, just because the current HSE “target time” for a patient under 80 to get to a hospital bed is 24 hours, is unacceptable.
It should also be remembered that the then-minister for health Dr James Reilly accepted the targets in the Emergency Medicine Programme National Report in June 2012 that 95 per cent of patients would be seen and either admitted or discharged within six hours of arrival and 100 per cent of patients within nine hours. The loosening of these targets is not acceptable, has caused harm to patients and will lead to further patient harm.
What all of those medical and nursing staff who work in emergency departments agree (and I suspect our in-patient colleagues would also agree) is that those who are responsible for loosening these targets, and those in management roles who continue to allow even these unambitious targets be regularly breached, should be giving evidence, rather than those frontline staff unfortunate enough to have to care for patients in such an inappropriate and dysfunctional environment.
Equally, those who have failed to provide sufficient in-patient beds for the needs of patients should be held to account for their decisions, not doctors and nurses. –Yours, etc,
Dr FERGAL HICKEY,
Consultant in
Emergency Medicine,
Sligo University Hospital.