The Health Service Executive is to carry out a strategic review of the number of hospital emergency departments in Dublin.
HSE Director General Tony O’Brien said that when compared to other cities of similar size, Dublin appears to have a large number of emergency departments.
Speaking on RTÉ’s Today’s with Sean O’Rourke, he said a reduction in the number would have to be considered.
He said if there was a greater degree of specialisation there could be better outcomes for patients.
Mr O'Brien also said there may need to be a differentiation between elective care hospitals and emergency admission hospitals.
He said HIQA recommended a strategic review of the number of emergency departments in the capital following its review of the ED in Tallaght Hospital and the issues that arose there.
He said: "It’s not just about number, it's about the scale, the proportionality; whether we'd be better served by having some of our larger hospitals not seeking to deal with emergencies and others seeking to be more specialised in that area.”
Mr O’Brien said it was important to engage in a conversation about a different healthcare system, based on need and not income and means.
He said the HSE was initiating a review and nothing will be done precipitately and "what we’re engaging in is a review process, which will result in a plan, which will result in a careful period of implementation".
He said a truism about healthcare is that "everyone wants progress, but nobody wants change and you will never get progress without change".