You realise what trouble we are in when policy advice is being given on whether it is best to look after patients on a trolley in A&E or on a trolley in a ward corridor. We seem to have got past the point where either of these situations are unacceptable and are now being seen as inevitable.
The advice last week from the College of Emergency Medicine is that this is the safest way of dealing with current capacity problems in some hospitals.
Maybe so but we have to careful that we are not setting up a system that will become the norm ie that every 20-bedded ward will now become 20 patients plus the one unfortunate on the trolley.
Apparently there is substantial evidence patients are harmed waiting in overcrowded emergency departments or ambulances but there is no evidence of harm to patients through waiting on wards. It may be of course that once a significant number of patients do end up on trolleys in ward corridors that we will establish that that causes harm too.
Ward corridors can be frantic and frightening places. Any patient parked in a corridor will get a ringside view of what is happening throughout the ward, much of which will appear alarming. Ringing phones, harassed staff, ringing buzzers, distressed relatives. It will all be on view and I can’t imagine it will be good for their health and recovery.
The college does specify that the patient stuck on the trolley must be “stable, orientated and not receiving active treatment or require monitoring”. However it won’t be long before that detail is lost and the trolley be treated like the 21st bed. The college may be giving useful advice — the worry is how it will be used.