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Hospital breakdown: 9,206 elderly people forced to wait over 24 hours in Emergency Departments

The HSE’s Service Plan for 2017 set a target that anyone aged 75 years and over entering an ED would be discharged or admitted within 24 hours.

Image: VILevi via Shutterstock

MORE THAN 9,200 people aged 75 and over have been kept waiting over 24 hours in Emergency Departments – despite the government setting a target to abolish such ‘trolley time’.

The HSE’s Service Plan for 2017 set a target that anyone aged 75 years and over would be discharged or admitted within 24 hours of registering at Emergency Departments.

That target, which has been criticised for not being ambitious enough, has been widely missed.

Earlier this month, TheJournal.ie highlighted how Ireland’s Emergency Departments are the most inefficient in Europe.

While Ireland ranked 21st out of 35 EU countries for overall health service and outcomes – the country had the longest waiting times recorded by patients in Emergency Departments when compared to every other country. 

Data supplied by the HSE now shows that up until 2 November of this year, 9,206 people aged 75 and over have been left waiting over a day to be examined and/or treated.

In response to this failure to reach its target, a HSE spokesperson said, “In respect of September 2017, 12,020 persons aged 75 years and older presented to our Emergency Departments (EDs). This represents an increase of ED attendances by this cohort of 5.7% when compared to September 2016. Of this 12,020 attendances, 781 or 6.5% experienced Patient Experience Times (PET) greater than 24hrs.”

Hospital Breakdown

A breakdown of offending hospitals shows that University Hospital Limerick had the highest number of patients aged over 75 waiting more than 24 hours (1,453), followed by the Mater Misericordiae University Hospital in Dublin (1,225) and Galway University Hospital with 1,100.

Emergency Departments Source: HSE

For a larger image of the above table, click here

The HSE released the figures as part of a response to a parliamentary question asked by Fianna Fáil’s Billy Kelleher.

As the party’s spokesperson on health, he commented, “It’s not acceptable that so many older and more vulnerable people should have to endure such long waits in Emergency Departments.

International research suggests that there is an increase in adverse outcomes for patients who have been in an ED for more than four to six hours. Long waiting times should be an exception and not the norm.

Director of Industrial Relations with the INMO Tony Fitzpatrick told TheJournal.ie that patients who are seen in the Emergency Department and sent to a ward simply can’t get a bed and are left waiting on trolleys.

“A lot of hospitals are at 100% capacity – we need to be at 85% to be able to function.”

Fitzpatrick added that in a nightclub a bouncer has a clicker and when the place is full, nobody else can get in but Emergency Departments don’t work like that and the ambulances and cars keep coming.

Our members are telling us that corridors, doorways and even fire safety exits are blocked with trolleys. People are literally head-to-toe on corridors.

“Ambulance staff regularly run out of trolleys and then there can be a queue of ambulances waiting for trolleys before they can remove a patient. That’s an ongoing feature.”

Fitzpatrick also noted that some hospitals have improved Emergency Departments by pro-active management engaging with frontline staff and identifying the bottlenecks and managing that.

This was something the Department of Health also pointed to in a statement when questioned about the missed target, “As of end of September 2017, HSE data shows that 93.5% of patients 75 years or over presenting in an ED have a decision to admit or discharge within 24 hours.

“Within this overall national figure, there are some sites already meeting this target with Mayo University Hospital showing 100% compliance and St. Luke’s Kilkenny and Letterkenny University Hospital at 99.8% compliance.”

Fitzpatrick added, “Every week 150-170 beds are closed due to staffing shortages, there’s not enough staff and the recruitment and retention of nursing staff is a huge issue.”

Nursing staffing levels have fallen by more than 3,000 since 2007.

The Minister for Health has committed to increasing the nursing workforce by adding 1,209 additional permanent nursing posts this year, but as this website recently highlighted, just 13 extra nurses have been added into the system.

That’s just over 1% of what was promised and leaves 1,196 nursing positions to be filled.

Weak target 

In 2012, a Health Information and Quality Authority (Hiqa) report recommended that the total patient time spent in an emergency department should be less than six hours.

The current 24-hour target is aimed solely at those aged over 75 so it’s far from ambitious.

Our neighbours in the UK aim for all patients to be seen and dealt with within four hours – that’s 20 hours less than our failed target and it includes everybody – not just the most vulnerable.

Chairman and co-founder of the Irish Patients’ Association Stephen McMahon told TheJournal.ie of the 500,000 people admitted to wards from the Emergency Department in the UK last month – only 53 patients had to wait more than 12 hours.

The situation here is just not acceptable, I’m very concerned that this level of elderly people are waiting so long to be moved to an appropriate ward.

Kelleher said, “The very idea that keeping an older person, or indeed any person, on a trolley in an Emergency Department for 23 hours is acceptable is simply insulting to the dignity of our citizens.”

The most recent figures from Euro Health Consumer Index (EHCI) measured waiting times based on patient feedback in Emergency Departments across Europe.

The below chart shows the median time that people waited, anything below 1.0 being less than an hour and anything above 3.0 being over three hours.

Patients in almost half of the 35 countries surveyed said they were seen within two hours, Ireland was the worst with a waiting time of at least three hours for 50% of patients.

It should also be noted that there was no upper limit in the survey so we don’t know how long over three hours these people were left waiting.

Waiting Times Source: Euro Health Consumer Index 2016

For a larger image, click here

The HSE has argued that this report is based on patient feedback rather than what data it can provide, but the EHCI said that it had decided to only score Ireland specifically on patient feedback for 2016 rather than accept Irish official waiting time statistics as it had doubts about their validity.

Back in 2006, the then-Health Minister Mary Harney declared a national emergency when there were 55,720 people on trolleys for the entire year. In the first 10 months of this year there has been 82,459 people on trolleys.

Yesterday, there were 298 people waiting on chairs and trolleys – and November is not yet peak flu season.

Kelleher added, “It’s going to get worse this winter, and I seriously doubt that Minister Harris has the wherewithal to deal with this crisis.”

Read: ‘Detrimental and harmful’: There were over 80,000 people on hospital trolleys so far this year>

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