Emergency Medicine

The aim of the Emergency Medicine Programme (EMP) is to improve the safety and quality of patient care in emergency departments (EDs) and injury units (IU) to reduce waiting times for patients and keep care as close to home as possible.

The EMP is led by a multidisciplinary working group that includes consultants in emergency medicine, emergency nurses, representatives of pre-hospital care and the therapy professions. It is supported by the Irish Committee for Emergency Medicine Training, the Irish Association for Emergency Medicine, the Office of the Nursing and Midwifery Services Director, the HSCP Office (Health and Social Care Professions) and Clinical Design and Innovation of the HSE.

  • National Clinical Lead: Dr Gerry McCarthy
  • National Programme Managers: Mary Flynn and Breda Naddy
  • National Nurse Lead: Fiona McDaid
  • National Administrator and Project Support: Sinead Reilly

National Working Group

  • Dr Gerry McCarthy, Consultant in Emergency Medicine, Cork University Hospital, National Clinical Lead
  • Mary Flynn, National Programme Manager, National Emergency Medicine Programme
  • Fiona McDaid, Clinical Nurse Manager 3, Emergency Department, Naas General Hospital, National Nurse Lead
  • Breda Naddy, National Programme Manager, National Emergency Medicine Programme
  • Sinead Reilly, National Administrator and Project Support, National Emergency Medicine Programme
  • Dr Fergal Hickey, Consultant in Emergency Medicine, Sligo University Hospital
  • Dr Carol Blackburn, Consultant in Emergency Medicine, Children's Health Ireland (CHI) at Crumlin
  • Dr Anna Moore, Consultant in Emergency Medicine, Midland Regional Hospital Tullamore
  • Dr Rosa McNamara, Emergency Medicine Consultant, St Vincent’s Hospital
  • Dr Jeffery Mulcaire, Spr Emergency Medicine, Cork University Hospital
  • Rosie Quinn, Physiotherapist, Our Lady of Lourdes Hospital, Drogheda (Therapy Professionals Representative)
  • Michelle Barlow, Advanced Nurse Practitioner, Midland Regional Hospital Tullamore
  • Anne Scanlon, Clinical Skills Facilitator, University Hospital Limerick
  • Dr Conor Deasy, Consultant in Emergency Medicine, Cork University Hospital, President of IAEM (Irish Association for Emergency Medicine).

The team can be contacted at emp@rcsi.ie or you can follow our progress on Twitter. 

EMEWS training

National Clinical Guideline 18: The Emergency Medicine Early Warning System (EMEWS) is recommended for use in EDs when patients are waiting longer for review by a treating clinician than is recommended based on their Manchester Triage System (MTS) category. Based on international experience, if patient flow into and through the hospital were more optimal, there would be little need to introduce a schedule of on-going monitoring. It is the responsibility of the hospital's CEO/GM to optimise patient flow and ensure timely and appropriate action is taken to eliminate/minimise ED crowding. An EMEWS e-learning module is available to all clinical staff on HSELanD.

Emergency Department Activity and Profile (EDAP)

This project that was developed by the EMP, OpenApp and the Health Intelligence Unit (HIU). The purpose of EDAP is to provide 'close to real-time' data that is clinically and managerially relevant. It uses the Business Information Unit (BIU) PET data to describe the activity of the department, allowing for the input of ED profile/resources information as well as 'daily events' data to put context on that activity. Some information on patient profiles within an ED's catchment area is also available. This allows users to understand the performance of their own ED in the context of the resources available including staff, infrastructure, access to diagnostics.

Activity Based Funding (ABF)

ABF is part of the ABF implementation plan 2021-2023 and Sláintecare Implementation Strategy to broaden the scope of ABF to include EDs.

ABF provides funding in line with the activity that EDs undertake. Much work has been done in recent years to move away from block funding and annual budgeting of health services towards multiannual budgeting and ABF.

Activity within EDs is currently block funded and there is not sufficiently consistent or appropriate activity data nationally to classify ED care ABF at present.

Since 2016, the Healthcare Pricing Office has been working with the Emergency Medicine Programme to determine an approach to classify ED activity as a building block for ABF. Following an international review, it was agreed that Ireland will adopt the Australian Urgency Related Group (URG) classification system developed by the Australian Independent Hospital Pricing Authority for ED activity, the project in the ED at Midland Regional Hospital Tullamore ran from September until March 2022. The purpose of the pilot was to:

  • Investigate the feasibility of assigning diagnoses from the ED Short List by Emergency Medicine Clinicians to all ED attendances
  • Assess the usability of the Integrated Patient Management System (IPMS) for the recording of diagnosis codes
  • Compare URGs and PET fields to confirm feasibility of using PET data for ABF & Investigate if pilot data can be grouped to URGs

Expansion of the pilot to other sites is currently underway.

Better Data Better Planning (BDBP)

The BDBP is an observational study to assess appropriateness of attendances at five EDs nationally.

It aimes to develop a profile of ED attendees from across rural and urban EDs to examine appropriate and avoidable ED attendees by:

  • Profiling the types of patients who attended 5 EDs over a 24 hour period.
  • To develop a consensus between providers across healthcare settings about the necessity, appropriateness of those attendances.
  • To explore reasons for ED attendance from the perspective of the patient.

This was a multi-centre, cross-sectional study and recruitment occurred at a selection of urban and rural EDs in Ireland throughout 2020 (UHL, UHK, SJH, SVUH, MRHT). At each site all adults presenting over a 24-hour census period were eligible. Clinical data was collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED. Data from electronic healthcare records was compiled in patient summary files which were assessed for measures of appropriateness by an academic general practitioner and emergency medicine consultant. In cases where consensus was not reached charts were assessed by an Independent Review Panel. At each site all files were autonomously assessed by local GP-EMC panels. Semi-structured interviews were conducted with 46 adult patients who attended the ED during the study by participating in an interview 7-10 days following their ED visit to capture their in-depth experiences of attending the ED during the pandemic. All interviews were conducted by telephone by a research nurse

OPTIMEND

In a randomised controlled trial in the University Hospital Limerick, a research team looked at the impact of early assessment and intervention by a dedicated health and social care professional team (HSCP).

353 people, who were over 65 years, were included in the study and randomly assigned to either receive care from the HSCP team or the usual ED care. The HSCP team included one senior physiotherapist, one senior occupational therapist and one senior medical social worker.

Participants who didn’t receive the HSCP care were three times more likely to be admitted to hospital (56% versus 19.3%).

Participants who received care from the HSCP team spent approximately 50% less time in the ED than patients who received the usual ED care (control group). 30 days after the visit, there were no differences in terms of ED or hospital re-presentation, healthcare utilisation or quality of life.

The study found that early assessment and intervention by a dedicated ED-based HSCP team significantly improves overall health for lower acuity older adults, reduces conversion rates and, by reducing PET and inpatient length of stay for those admitted, results in significant cost savings whilst improving patient outcomes. Accounting for cost savings as a consequence of contact with HSCP team, the average incremental saving in the total cost, compared to Treatment As Usual, is -€6,128 (95% CI: -€9,217 to -€3,038, p<0.0001).

Dedicated HSCP teams are in existence in some EDs around the country. Early intervention in the patient journey will maximise the impact of these teams and strengthen health systems resilience.

Where dedicated HSCP teams do not exist in an ED, this reform will benefit the patient experience as well as ensure safe admission avoidance.