Emergency departments under 'unprecedented strain' says report

The health service is under “unprecedented strain” as it struggles to cater to a “significantly higher” number of patients presenting to emergency departments than in previous years, according to the Health Information and Quality Authority.

Overcrowding in EDs continues to “compromise the dignity and respect of patients, and poses a risk to the health and safety of patients,” according to a HIQA report published today.

The health authority released the report of its monitoring programme against the national standards in seven emergency departments in 2022 which stated that it is not uncommon for them to find patients in emergency departments to wait “80-90 hours for an inpatient bed.”

In one extreme example, a patient was waiting over 116 hours or 4.8 days for admission to a bed at Limerick University Hospital.

The hospital emergency departments inspected were Cavan and Monaghan Hospital, Cork University Hospital, Limerick University Hospital, Mayo University Hospital and Sligo University Hospital, as well as in St Michael's Dún Laoghaire and St Vincent's University Hospital in Dublin.

It follows the ongoing controversy regarding the downgrading of Navan Hospital's emergency department. In recent weeks 17 consultants wrote to Minister for Health Stephen Donnelly warning that "patients may die" if plans to have ambulances bypass the Emergency Department (ED) in Navan instead bringing patients to Drogheda Hospital go ahead.

Protestors braved Arctic conditions outside Navan and Drogheda Hospitals on Monday to make their voices heard against HSE plans to freeze out emergency services at Our Lady's and heap even more pressure on the Lourdes.

Last month saw chaotic scenes of overcrowding at the ED in Drogheda. At one stage eleven ambulances were stuck outside the Drogheda hospital on a busy Saturday night - unable to drop patients off or respond to 999 calls.

The report has four key recommendations.

HIQA said there is an urgent need to build extra bed capacity in both acute and community beds.

It said there was a need to better anticipate and manage staff shortages.

HIQA has called for better leadership at local, regional and national level to deal with the problem.

It also wants improved monitoring of patient safety risks linked to overcrowding.

HIQA’s Director of Healthcare, Sean Egan said: "Findings from this new programme of inspections, continues to highlight that overcrowding in emergency departments compromises the dignity and respect of patients, and poses a risk to health and safety of patients. Improvements are needed to ensure that there is a balanced approach to the daily operational management of patient flow, capacity and appropriate staffing, which is clearly linked to patient safety and activity."

Sean Egan continued: "The Irish healthcare system remains challenged by bed capacity and workforce shortages, and access and capacity issues in primary care.

"Emergency department overcrowding and insufficient access to acute and primary services will continue to occur unless a system-wide approach is taken to address major structural concerns and respond to, rather than continuing to tolerate or normalise, this problem. Delivering care in overcrowded and understaffed environments poses a significant risk to the provision of safe, quality, person-centred care. It is for this reason that urgent efforts to progress whole system change to our health service must be progressed."

The Irish Nurses and Midwives Organisation said there were 638 admitted patients waiting for a hospital bed this morning.

It said the hospital worst affected was University Hospital Limerick with 75 patients, while there were 68 at Cork University Hospital, 51 at Letterkenny University Hospital and 47 at Tallaght University Hospital.

INMO General Secretary, Phil Ní Sheaghdha said:

“The report published by HIQA today compounds what the INMO has been consistently highlighting – our hospitals are under enormous pressure due to capacity issues and unsafe staffing.

“The report is particularly stark when it comes to safe staffing in our hospitals. According to HIQA, of the seven emergency departments they inspected, only one hospital was properly staffed. This is unacceptable. We know that many nurses are leaving emergency departments because of the conditions that they are faced with. This phenomenon cannot continue into 2023.

“Over 70% of the hospitals that HIQA inspected were over capacity. This is borne out in the INMO TrolleyWatch figures. Today alone over 638 patients were without a bed with many patients facing long waits before being admitted to a trolley. We know that excess time spent on a trolley or an inadequate bed has negative health implications for patients.

“We have sought an urgent meeting with the Minister for Health in the coming week to discuss how a more proactive approach can be taken to tackling the very serious challenges that exist in our emergency departments. Trade unions raised this issue as part of our engagements at the Labour Employer Economic Forum (LEEF). We are strongly of the view that emergency measures are now needed to prevent the unnecessary continuation of these inhumane and undignified conditions for patients and really unhealthy working conditions for nurses and midwives and other healthcare workers.”