The ERI came close to meltdown as 36 patients waited in the emergency department for up to 17 hours in the midst of an on-going beds crisis.
A medical director warned of the “many” safety risks to “patients and their families” as those arriving at the emergency department were forced to wait hours for admission with a search for spare hospital beds being instigated across south-east Scotland and Tayside.
Dr Andrew Flapan, Associate Medical Director and Consultant Cardiologist, described the flagship hospital as being “in extremis” last Friday in a memo sent to staff appealing for their help to find beds for the new admissions. He also warns of the knock-on effect on operations, saying “of course cancellation of major elective surgery is a serious risk for a site like the Royal”.
In the e-mail seen by the Evening News, medical teams are asked to look at “anything and everything” that can be done to improve the flow of patients out of the hospital to free up bed space.
Tom Waterson, branch chair of Unison at the ERI, said the type of “in extremis” e-mail request were sent out “at least twice a month” but the full extent of the “perilous” state of affairs had never been made public.
The memo lays bare the pressures on patient care at the country’s busiest emergency department and the continuing problem of so-called bed blocking when patients have to wait to be discharged due to problems organising care for them outside hospital.
Mr Waterson said: “That type of e-mail comes out at least twice a month – that’s how perilous the situation is at the Edinburgh Royal Infirmary.
“It’s because of the critical situation with delayed discharge and can be linked to the Liberton Hospital story you carried in the Evening News last week.
“Enough care is not being provided in the community at home and this is due to a failure of the home-care system in NHS Lothian.
“The e-mail is sent to emphasise to staff how serious the situation is and the requirement where possible to free up beds via discharge, either preferably to a patient’s home or a healthcare home facility. The situation doesn’t provide a very good level of care.
“The issue here is one for the local councils as the problem is out in the communities. It’s the councils that are not providing enough step-down facilities to move the patients on – which causes blockage at the front door of the hospital.”
The Evening News reported in November how senior NHS managers had warned that the ERI has been “functioning on the goodwill of staff” after inspectors found significant issues with bed blocking among older patients.
Scottish Labour health spokesman Anas Sarwar said: “This is an explosive e-mail that lays bare the shocking and unacceptable pressure that staff at the ERI are under.
“This is a full-blown crisis that could have a major impact on patient safety, and the SNP Health Secretary needs to urgently intervene and publicly reassure patients across Edinburgh that this situation has been resolved and can never happen again.
“It demonstrates the scale of the crisis facing our NHS, not just in Edinburgh but across Scotland. A decade of SNP mismanagement has created a staffing crisis in our NHS. Under the SNP our NHS staff are overworked and undervalued. Our hospitals simply do not have enough doctors and nurses.”
Since 2007, the national standard for A&E waiting times is that new and unplanned return attendances at an A&E service should be seen and then admitted, transferred or discharged within four hours.
Lyn McDonald, Site Director at the Royal Infirmary of Edinburgh, NHS Lothian, said: “On Thursday 20 April, the Royal Infirmary of Edinburgh Emergency Department had an extremely busy day, particularly in the late afternoon and early evening, after a busy Easter weekend.
“The number of attendances at the department were higher than average, which meant that the site admitted an additional 20 patients more than is normally predicted.
“This resulted in a number of patients in the Emergency Department waiting to be admitted.”
A Scottish Government spokesperson said: “Unnecessary long waits in A&E are not acceptable. The board have offered their assurance that they quickly recovered their A&E performance following higher than average attendances at the Royal Infirmary of Edinburgh last Thursday. Through the A&E Improvement Programme, we are working closely with hospitals to ensure processes and best practices are in place to minimise delays for patients. We have been supporting the RIE to roll out ‘Daily Dynamic Discharge’ across its wards, aimed at improving the timeliness and quality of patient care from arrival to discharge from the hospital.”
Miles Briggs, MSP said: “These A&E waiting times are totally unacceptable and another indication of the massive pressure on NHS services in Lothian which is clearly struggling to cope. The SNP government, which is consistently failing to meet its A&E targets, needs to get an urgent grip and support hardworking NHS staff locally. I will be tabling questions at Holyrood to put pressure on Ministers to act before this crisis worsens.”
‘It’s high time that the government took a really strong view of the NHS’
Margaret Watt, chair of the Scottish Patients Association, slammed the Scottish Government saying the situation in hospitals all over the country was “getting worse”.
She said: “It not only happens in Edinburgh, I’m sure this kind of thing has happened in Glasgow as well at the new Queen Elizabeth Hospital.
“It’s high time that the government took a really strong view of the NHS in Scotland because we’re not going anywhere.
“It’s just getting worse and worse – what are they going to do about it?
“The politicians are so busy fighting among themselves, they forget that we, the public, employ them to look after our needs and that is not what’s happening.
“The situation is now out of control and unless the Scottish Government do something about it – I don’t know what we are going to do with our patients. If they can’t handle it then I’m sorry – send the patients to the private sector which I don’t think is a good thing. But where are we going to put them? They need the surgery, they need their operations because some of the conditions are very serious.
“This type of situation is always putting patients’ lives at risk and it’s always covered up.
“They have to deal with it now instead of fighting among themselves in the parliament.
“Something must be done about our NHS to keep our patients safe.
“Patients deserve better for the money that we are paying the politicians. They have to go through a system before they can be registered or taken to a ward.
“If you’re going in by ambulance you have to sit in a queue.
“That’s because the administration can’t deal with things quick enough.
“The thing is – and this is the case at all big hospitals – you normally have to wait for somebody to vacate one of the emergency cubicles before you can be seen by a consultant and this can be very time consuming. After that the patient goes to a ward or a room and that’s only if one is free. If it’s not then they just have to lie there waiting.
“How do they know that some of these people are not having heart attacks or have just had a stroke while they’re lying there waiting to be seen?
“I know another referendum is important to the politicians at Holyrood but they need to start looking at the health service – because if they don’t we’re going to lose it.”