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Just how unsafe are emergency departments in Irish hospitals?

Dr Muiris Houston: University Hospital Limerick has been a black spot for many years

The terrible details revealed at the inquest into Aoife Johnston’s death at University Hospital Limerick (UHL) on December 19th, 2022, shocked even the most seasoned of health service observers. She had presented at the hospital’s emergency department two days earlier, on the evening of December 17th, suffering from a suspected case of sepsis. She died two days later, following a delayed diagnosis and a complete failure to administer the life-saving treatment she had been prescribed. Those working in the ED at the time said it was “chaotic”, “like a war zone” and “not a safe environment”.

Dr Jim Gray – the on-call emergency medicine consultant that weekend – likened the department to an aeroplane, with passengers in every seat and blocking up the aisles. Patients were back-to-back on trolleys, with every conceivable space occupied. “It was a death trap,” Dr Gray said.

Here are some of the questions now being asked by a worried public:

If one of the State’s main EDs is a ‘death trap’, how worried should we be about the overall safety of our beleaguered public health system?

UHL has been a black spot for many years. Ever since the closure of acute facilities at Nenagh and Ennis hospitals, the bed-starved hospital has been the subject of several damning reports from the health watchdog Hiqa (Health Information and Quality Authority). Just last week Hiqa reported that significant risks to patient safety remain in the ED of UHL, despite some improvements.

But it is not the only hospital against whom red flags have been raised. University Hospital Kerry, University Hospital Galway and others have all featured negatively in Hiqa reports. A combination of poor infrastructure, a shortage of frontline health professionals and myopic and dysfunctional mismanagement have all played their part.

Delays to inpatient admission of more than five hours are associated with an increased risk of death. This indisputable metric shows that people are dying in Irish public hospitals because of delays spent in EDs.

How might I know if my local ED is safe or not?

Keep an eye on national Trolley Watch figures recorded daily by the Irish Nurses and Midwives Organisation (INMO). More than 11,000 patients were admitted to hospital without a bed in April, according to the INMO.

The top five most overcrowded hospitals were:

  • University Hospital Limerick – 1,971 patients
  • Galway University Hospital – 1,208 patients
  • Cork University Hospital – 1,096 patients
  • St Vincent’s University Hospital – 650 patients
  • Letterkenny University Hospital – 594 patients.

Can anything be done to remedy the situation?

A year ago, Hiqa issued a report following an unannounced inspection of Beaumont Hospital’s emergency department. The inspectors found that the emergency department of the hospital had a good overall level of compliance with the National Standards for Safer Better Healthcare. It had a full complement of nursing staff in the emergency department and had established greater access to consultants and senior decision-makers. It had good access to step-down facilities, which facilitated efficient patient flow from the hospital.

And in a key finding, Hiqa noted that “in recent years [Beaumont] had managed to move from a situation of persistent overcrowding in the emergency department to one where such crowding was well managed or not present”.

What a difference eight years can make. From one of the “bad boys” of the Irish hospital system in terms of trolley watch figures it was particularly striking to see the degree to which a hospital can turn around its performance.

UHL is my local hospital. What do I do if I need emergency care?

Do not attend UHL ED unless you absolutely have to. Go to your GP. If they suggest you need ED care, consider going to the nearest urgent care centre run by Laya or the VHI. Do not call an ambulance for relatively minor problems.

Ambulance cases have to go to UHL. If you are involved in a serious road traffic accident or you are experiencing an acute coronary event, there is no other option available.

mhouston@irishtimes.com

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