It was imperative to eliminate crowding in EDs in the interest of patient safety and for the successful implementation of the new Emergency Medicine Model of Care, according to the National Clinical Programme for Emergency Medicine (EMP).
The Health Service Executive (HSE) and the Royal College of Surgeons in Ireland (RCSI) jointly launched the National Model of Care 2025, which they said was the most significant update to Ireland’s strategy for delivering urgent and emergency care in more than a decade.
The MOC defined crowding in EDs as the accumulation of patients who had finished their ED episode of care and were awaiting transfer to an inpatient bed after the decision to admit. “If a patient requires an overnight admission, they are always best served by being admitted to the appropriate ward as early as possible in their journey. Boarding of inpatients in EDs and Acute Floor units, which are not designed or staffed for inpatient care, results in poorer care at greater expense”.
It says the central role of maintaining patient flow throughout the system has become increasingly recognised, as has the harm associated with keeping patients on ED trolleys for prolonged periods (Jones et al., 2022
The new MOC is aimed at ensuring that emergency care evolves in line with the needs of patients and the principles of Sláintecare. It reflects significant healthcare reforms, population growth and lessons learned from the COVID-19 pandemic. It also emphasises the importance of patient participation in shaping services, ensuring that care is designed around the people who access it.
The MOC builds on the original framework published in 2012, which was developed by the RCSI National Clinical Programme for Emergency Medicine and HSE, following patient engagement and consultation with emergency medicine teams around Ireland.
It highlights a shift towards more proactive and patient-centred approaches to urgent and emergency care and emphasises the importance of “right care, right place, right time” through four key pillars – organisation of care, patient pathways, infrastructure, and quality improvement.
It also calls for stronger pre-hospital and community-based services so that patients can access care in the most appropriate setting, while also developing specialised services tailored to paediatric and older patients.
The document describes how multidisciplinary teams will play a greater role in delivering care, supported by expanded advanced practice roles and sustainable workforce planning and the importance of data-driven tools and digital innovation in to improving patient flow, guiding decision-making and supporting value-based care.
It recommends all future Consultant posts in Emergency Medicine should be allocated to a hub ED with sessional commitments to supporting units, with consideration given to sub specialisation within EM, particularly in the areas of Paediatric EM, Geriatric EM and pre-hospital EM critical care.
It says the ED must be reserved for same-day emergency presentations. “GPs working in EDs benefit patients whose presentations would be better served by a GP than an EM clinician. EMP recommends the streaming of appropriate patients directly from triage and from the community to AMAUs, ASAUs, PAUs and Mental Health Assessment Units.
“Since 2012, the population has grown by 15% (from 4.45 million to approximately 5.25 million in 2024). The greatest percentage increase is among those >70 years, with the number of those >85 years increasing by 25% since 2016 (CSO, 2023). This population increase has several effects, many of which place fresh demands on the Urgent and Emergency Care (UEC) system. The significant increase in the population of older adults and net inward migration is happening at a time when there is a widely acknowledged national shortage of General Practitioners (GPs). In 2022, only one GP practice in five was in a position to take new General Medical Services (GMS) Scheme patients, and only one in four was able to take new private patients (ICGP, 2022).
“The public health restrictions, changes in clinical practice, rapidly changing clinical guidelines and many other aspects of the COVID-19 pandemic combined to make it an unanticipated and immediate challenge to the delivery of healthcare, both for COVID-19-related conditions and for ‘business as usual’ in terms of the healthcare needs of the general population. Some benefits that have arisen from the adjustments in community and hospital care include the increased use of virtual consultation in the delivery of healthcare. However, some patients presenting to EDs report that they find the widespread use of virtual consultation less satisfactory than in-person consultation. This may be a further driver of increases in ED attendances.
Speaking at the launch, Minister for Health Jennifer Carroll MacNeill said, “This Model of Care is a comprehensive and welcome step forward to our shared objective of improving the quality, safety and accessibility of our emergency care services. At its heart, this is about dignity, safety and trust.
“We are not simply launching a document – we are reaffirming our commitment to every person who attends an emergency department or injury unit, day or night. I want to sincerely thank the clinicians, nurses, healthcare professionals and patients who contributed to this model. Your unwavering commitment to excellence and best practice has brought us to this moment.
“As Minister for Health, one of my priorities is ensuring that people can access the support they need when they need it. I look forward to continuing the strong collaboration with the Emergency Medicine Programme as we work together to deliver better outcomes for all.”
Dr. Colm Henry, Chief Clinical Officer, HSE said, “This Model of Care represents a significant step forward for emergency care in Ireland. It reflects both the challenges and opportunities of today’s healthcare landscape, from demographic change to digital transformation, and ensures our services are equipped to deliver safe, high-quality, and patient-centred care that prioritises patient safety now and into the future.”
Professor Deborah McNamara, RCSI President, said, “The launch of this Model of Care sets out a vision for more integrated, equitable and sustainable emergency care across Ireland. Putting patient care at the centre, it will support the development of a resilient, sustainable and patient-focused emergency care system. It was written by frontline clinicians, nurses and healthcare professionals who gave their time and expertise on a goodwill basis on top of their demanding roles. Their insight is what makes this document practical, credible and achievable.
