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Escalations move ‘must include consultants’

21 Jan 2016

Liam Doran, INMO

The Irish Association for Emergency Medicine (IAEM) hopes that last week’s agreement between the Irish Nurses and Midwives Organisation (INMO) and the HSE will ensure that “consistent, effective escalation policies” are in place around the country, allowing hospitals to respond in a more timely fashion to emergency department (ED) overcrowding.

The Association has welcomed the requirement, brokered at the Workplace Relations Commission (WRC), for there to be both Hospital Group and individual hospital oversight to ensure the consistent and appropriate implementation of such escalation plans. However, such mechanisms must avail of the expertise of consultants in emergency medicine in each hospital. “We welcome the commitment of the WRC to assess compliance with these commitments with this caveat in mind,” the IAEM noted.

From a patient safety perspective, the IAEM said it was “entirely inappropriate” that EDs were expected to function simultaneously as an ED and as an acute ward for admitted inpatients.

“The burden of each hospital’s admitted inpatient workload must be shared between the ED and hospital wards rather than the current approach whereby patients are lodged in crowded EDs while much of the rest of the hospital continues to function, oblivious to the patient safety risks faced by these patients,” the consultants group added.

The INMO said the deferral of planned industrial action scheduled for January 14 and January 26 was to allow ED nurses to consider and ballot on revised proposals produced by the WRC on January 11. The revised proposals expand upon the earlier measures produced in mid-December and focus on confidence-building and implementation measures, as well as managing clinical risk, and regular senior management engagement. The proposals will be put to a ballot of members following information meetings over the next number of weeks.

“It is now imperative that the HSE, at national level, and at senior level within all Hospital Groups, immediately commits to fully operate the revised proposals,” INMO General Secretary Liam Doran said.

The expanded proposals explicitly provide for senior management weekly meetings, with INMO Emergency Department Representatives, to monitor implementation of the agreement and, in particular, the revised escalation policy to avoid ED overcrowding.

There are also to be enhanced health/safety and risk management/mitigation measures, which “clearly acknowledge that Emergency Department overcrowding leads to an unsafe work environment which must be addressed and mitigated”, the INMO said.

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times