Curious reversal of fortunes for 'trolley blackspot' hospitals
Two of the country's busiest hospitals, which used to be at opposite ends of the winter trolley count, have experienced a change in fortunes.
Beaumont Hospital in Dublin was for years labelled an A&E "blackspot" and regularly had the highest number of patients on trolleys every morning.
St Luke's Hospital in Kilkenny has been held up as a model of good process and was seen as a shining example.
However, so far this winter it is Beaumont which is keeping the ED chaos under some control, while St Luke's has been at breaking point.
The contrast has led to questions about how lessons can be learned, as the hospital service faces record winter pressures.
Dr Peadar Gilligan, emergency consultant at Beaumont Hospital, said the improvement has been due to various factors, including a "whole hospital approach".
"What was formerly a discharge and transit lounge is now being used to accommodate patients," he said.
"Beds which were closed are now open."
The hospital is strict about calling on the full capacity protocol, which means that once the emergency department reaches a certain level of overcrowding patients are moved to wards.
The patients are still on trolleys but it frees up space.
It also means that a decision is made to cancel planned surgeries, a move which impacts on patients on waiting lists due to be admitted for operations.
"When you don't have enough capacity you have to make those decisions," Dr Gilligan said.
More surgery is being done on a day-case basis and the hospital has benefited from extra access to community beds for patients ready for discharge.
Radiologists work extended hours for access to diagnostics and a patient who needs to see a specialist is no longer confined to the on-call doctor.
Dr Gilligan stressed the conditions faced by patients remain sub-standard, with an urgent need for extra beds.
Commenting on the difficulties faced by St Luke's Hospital, clinical director Dr Garry Courtney said it still has efficient processes in place but they are undermined by factors such as a lack of nurses.
It means that 38 beds are closed.
"We hope nurses we have recruited will be here before the end of the month and then we can open the beds," he said.