Improving timeliness of care in Ireland’s emergency departments

Background 

The National Emergency Medicine Programme in Ireland in 2012 recommended that a six-hour limit to the time patients spend in an Emergency Department (ED) from ED arrival to admission to a ward, trans-fer or discharge home should be achieved 95% of the time. This research was performed to establish what Consultants in Emergency Medicine in Ireland felt was required to consistently achieve the delivery of emergency medical care within a six-hour limit. 

Methods

This prospective qualitative research involved a questionnaire based on Asplin et al’s conceptual model of Emergency Department crowding and a review of the literature as to proposed causes and solutions to crowding. 

Results

Long waiting lists for diagnostic tests and outpatient appointments are leading to patients being referred to ED. It was proposed to increase access to diagnostics and outpatient appointments and to facilitate appropriate direct referrals to specialist services. Solutions proposed to address throughput challenges were increasing staffing levels in the ED, improving patient flow and extending the hours of access to diagnostics and imaging. 

Discussion

Inadequate hospital capacity was noted as the major cause of ED crowding and an urgent need for an increase in hospital bed numbers was identified.