Dr. Máirín Ryan:

We did a review of international best practice and looked at a range of countries that had some similarities with ourselves in terms of healthcare delivery. We looked at the UK, Australia, Canada, New Zealand and some European countries. On the standards required for a hospital that supports an emergency department, what is very clear is that you do not consider just the emergency department. It needs to be integrated with a hospital. Mr. Egan mentioned the services that need to be available. You need to have critical care, anaesthetics, medicine, surgery, cardiology, intervention, radiology, other radiology services, lab services and mental health support. It is really about having an emergency department that is going to be capable of treating the sickest patients or providing what we call undifferentiated care, that is, in respect of patients who arrive and you do not know what their diagnosis is but you need the wide range of services to provide them with safe and effective care. To do that, you need to have that emergency department sited in a hospital that has all of the specialties I mentioned and that is also able to maintain a safe roster for those services. For example, with anaesthetics, the model of care at the moment is two plus two. Therefore, 24-7, with three shifts over every 24 hours, you have two consultant anaesthetists and two supporting doctors. It is about standing up a very big service behind an emergency department in order that you can guarantee that the patients who are seen in that emergency department receive a safe service.

One of the other things that is really important about it is that it is patient-centred care. It is about focusing on ensuring that it is about the patient as opposed to being maybe about the efficiencies, although the efficiencies are obviously really crucial as well, and then having dedicated services around paediatrics and older persons as well to meet specific requirements. That is the overview of international standards.