Hospital overcrowding: 1,800 patients waited 24 hours or more on trolleys last week

More than 1,800 patients attending hospital emergency departments (EDs) last week had to wait 24 hours or longer due to “unprecedented” overcrowding, according to the Health Service Executive.

A total of 1,887 patients had to wait more than 24 hours, out of total attendances of 27,000, officials said. Last year, 67,000 patients waited at least a day in their ED before being admitted.

HSE interim chief executive officer Stephen Mulvany said one every one of these cases was “of concern” and the objective was to get wait-times “down to zero”.

Health staff have been told to make themselves available for weekend work over the next two or three weeks to help relieve overcrowding

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An increased onsite presence by senior clinical decision-makers is planned for the rest of this month, Mr Mulvany said. Support staff are also being asked to make themselves available for the period.

The directive is a short-term response that is not sustainable in the longer term, given the structures in place in the health service, he said.

Protocols have been changed to allow non-emergency department doctors assess patients in the ED where there is a significant risk due to delays, he told a media briefing on Thursday.

Nursing homes

The HSE is also investigating whether nursing homes that recently closed could be re-opened in order to provide more opportunities for discharging patients.

A “significant and sustained” increase in flu levels is likely to continue over the next three or four weeks, Dr John Cuddihy, director of the Health Protection Surveillance Centre warned. As a result, the flu season may continue until April.

Last week saw a record number of attendances at emergency department by over-75s, Mr Mulvany said, as demand on services reached “unprecedented” levels. The number of over-75s admitted to a bed was also a record.

The HSE’s modelling of current trends is matching or exceeding its most pessimistic forecasts, he added.

Describing the situation as “very concerning” he said it was getting “urgent and sustained attention” at all levels of the HSE.

The current flu season has not yet peaked, and levels of Covid and RSV remain significant, he said.

For the next 10 to 12 weeks, the HSE’s aim is to support its staff, work to protect patient safety and to minimise the impacts on patients, he said. Short-term measures being taken include additional GP clinic slots, greater use of private sector beds and diagnostics.

The average wait time for people attending emergency departments was 8.3 hours last week and for admitted patients, 13.8 hours, the briefing heard.

“We accept it’s not good enough, it’s not what we want,” Mr Mulvany said. “We ask patients to accept our apologies, seek to make them as comfortable as possible while they are waiting.”

Private capacity

Currently, the HSE has access to 145 private beds, about 10 per cent of its capacity, but talks are continuing with the sector to increase this number.

In the long term, the HSE boss said, greater investment in capacity is needed.

He said there are considerable variations in wait times in different hospitals that cannot readily be explained by variations in demand against available capacity. This pointed to the need for significant systemic improvements in process, clinical pathways and integrated working.

Attendances at EDs were up 15 per cent last week compared to the same period in 2019; admissions were up 6 per cent.

Dr Cuddihy said this year’s flu season is difficult to predict. However, in the past the flu season has lasted 11 weeks in average, but the length of the season can vary up to 20 weeks “which would take us up to April or May”.

While RSV rates have dropped, there can be a double peak with this virus after children return to school, he warned.

Twelve people died of invasive strep A infections last year, including four children, he said. There were 100 cases, including 34 in children, similar to pre-Covid years.

The massive surge in Covid cases in China is not expected to impact the epidemiological situation in the EU, Dr Cuddihy also said. “The variants circulating in China are already circulating in the EU, and as such are not challenging for the immune response of its citizens. In addition, EU citizens have relatively high immunity and vaccination levels.”

Pressure

Meanwhile, pressure on emergency departments continued to ease on Thursday but the number of people stranded on trolleys remained far in excess of the same time last year, according to new data.

With frustration continuing to mount at conditions across the healthcare system, the Irish Nurses’ and Midwives’ Organisation (INMO) reported 639 patients left on trolleys in EDs or elsewhere on Thursday morning.

That had fallen from the record high of 931 on Tuesday, and from 838 on Wednesday, the second-highest day on record.

However, despite apparent progress, Thursday’s figure remained 66 per cent above the corresponding day in January last year and comes amid warnings this week from Minister for Health Stephen Donnelly that the overcrowding situation was likely to worsen.

“They are all people, all individual stories, all somebody’s relative,” Prof Alan Irvine of the Irish Hospital Consultants’ Association (IHCA) told RTÉ News at One on Thursday.

[ ‘I sat in a chair for 57 hours with my coat as a pillow’: Pensioner calls for public inquiry into trolley crisis after hospital trip ]

“We are a wealthy European country, we should not have these conditions. It’s maddening really, it’s enraging.”

Of those waiting on trolleys on Thursday morning, 473 were in EDs and 166 elsewhere in wards. In Dublin’s three principal children’s hospitals, 10 patients were on trolleys.

The worst affected were Cork University Hospital (56), Letterkenny University Hospital (51), University Hospital Galway (49) and University Hospital Limerick (49).

However, there were no patients on trolleys in the Midlands Regional Hospitals in Portlaoise and Tullamore, Our Lady’s Hospital in Navan or at University Hospital Waterford.

Creaking system

The crisis in capacity follows what has been described as a perfect storm in respiratory and viral illness, and has antagonised an already creaking hospital system.

As health officials scramble to alleviate the strain, tensions have arisen between senior hospital consultants and Mr Donnelly who publicly appealed to them to work weekends in a bid to improve conditions.

[ Doctors and Donnelly clash over call for senior medics to work weekends to ease overcrowding crisis ]

“My members have a real difficulty in this because they are working every weekend, every bank holiday,” Prof Irvine said.

“People do not want to be flogged for doing stuff that they are already doing… that just more of that is going to fix an inherent structural capacity defect.”

He said there were hundreds of patients who were medically fit for discharge but who had no step-down facilities to go to within the community.