Scheme for quicker transfers to EDs 'making situation worse'

A new scheme for quicker transfers from ambulances to emergency departments (ED) has led to more patients waiting in corridors and chairs, according to a leading consultant.

The Release To Rescue initiative was brought in last month by the Department of Health (DoH) to ensure a maximum two-hour wait for patients stuck outside EDs in ambulances.

The Royal College of Emergency Medicine (RCEM) told Stormont's Health Committee the move had started off well, but had ultimately made the problem worse and led to further overcrowding.

The DoH say that since the scheme was implemented, the average handover time has reduced by 30 minutes.

Dr Michael Perry told MLAs that more than half of clinical leads in Northern Ireland's EDs had reported over-crowding following the introduction of the scheme.

"We did have concerns about Release To Rescue when it was first published and we felt it would make over-crowding worse," said Perry.

He added: "Yes, there has been an improvement in (patients being) off-loaded... but the patients waiting to go to the wards haven't changed - it's reconfiguration within departments.

"It's more patients being put onto chairs, onto corridors. It's not really tackled what we think is the fundamental problem, which is the back door (flow out of hospitals)."

The DoH have said that the health minister acknowledges that "more work needs to be done to improve patient flow" in hospitals, including increasing social care capacity.

However, a departmental statement said, there are "no quick fixes" and the matter will need "long-term investment".

It said pressures faced are "not just about the numbers of patients attending EDs but also about the acuity of patient conditions".

Last month, the RCEM described the state of NI's EDs as "utterly horrifying", with the number of patients waiting more than 12 hours for treatment the worst on record.

It also said 1,032 excess deaths of patients last year could be attributed to long waits for hospital admission.

Dr Sara McGurk from the RCEM said while it welcomed moves to ensure quicker ambulance handover times, the scheme had not been working.

"We wanted to give it a few weeks to get a real idea. In the first few weeks, there was a concerted effort to make sure we could get flow and that there was space in the hospital," she said.

"We are overcrowded, we are still trying to offload ambulances in [EDs], to try and meet those targets. But we also have our waiting room doors, we have people coming in the front door, and we are solely focusing on the ambulance target at the moment, and there needs to be more balance.

"We have other patients coming into the department, so the overcrowding has not got any better and we now see these ambulances that are coming in and making the situation worse."

Following the committee, Independent Health and Care Providers (IHCP) chief executive Pauline Shepherd said pressures in social care were contributing to hospital overcrowding.

"When medically fit patients cannot leave hospital because appropriate homecare packages or care home beds are unavailable, hospital beds remain blocked and pressure builds throughout the entire health system," she said.

"Social care can no longer be viewed separately from hospital performance or patient safety."