50 patients per week The death toll directly caused by lengthy delays in our A&Es
AT LEAST 50 people die unnecessarily every week due to overcrowding in hospital accident and emergency departments, according to new analysis.
The stark revelation comes as the Health Service Executive (HSE) is on course to miss all of its emergency care targets for the second half of 2023, the Irish Mail on Sunday can reveal.
In July this year, the HSE set out four ‘realistic and achievable in-year improvement targets to be achieved prior to year end’ in its Urgent and Emergency Care (UEC) Operational Plan 2023.
These were: no patient aged more than 75 years will wait more than 24 hours in emergency departments (EDs) nationally; there will be no more than 440 Delayed Transfer of Care (DTOC) patients per week; the average monthly trolley count at 8am will be no greater than 320; the average stay for those in hospital more than 14 days will not exceed 28 days. However, figures provided by the HSE yesterday show it is not on track to meet any of the targets, barring a dramatic turnaround over the Christmas weeks.
And numbers around current ED wait times equate to an excess mortality rate of at least 50 people per week, according to the co-author of a study on the link between lengthy ED waits and premature death, published in the British Medical Journal (BMJ) two years ago.
The average emergency department wait time in each of the last four weeks for patients who were admitted to hospital was 12.29 hours for the week ending December 10, 12 hours for the week ending December 3, and 9.9 hours and 10.7 hours respectively for the preceding two weeks.
The number of admitted patients was similar in each of those four weeks, ranging from 7,259 to 7,587. The BMJ study, which analysed more than five million patients in the NHS over two years, found ED wait times of six to eight hours led to one extra death per 82 patients across all age groups.
One of its authors, Stephen Black, a UK based data scientist from Belfast with extensive experience analysing NHS and HSE emergency rooms, said that number narrows to one in 72 people when patients wait eight to 12 hours.
Examining the numbers for the week ending November 26, when 7,403 people waited an average of 9.9 hours, he told the MoS: ‘When your waits are averaging around 10 hours, it’s fairly safe to say that half those people will probably be waiting more than that. That gives us a crude basis to apply some of
our estimates about mortality.’
Using a conservative estimate, Mr Black divided the number of admitted patients by two, in order to discount those who would have waited less than the average. He then divided that number by 72 – since the study found one death per 72 people – which comes to more than 51 people.
He said the true number is likely to be higher, as many patients probably waited more than 12 hours before getting a hospital bed.
‘We think the mortality rate keeps going up, the longer the wait,’ he said. ‘We didn’t have a vast number of 12 hours or more waiters in the original study, so we didn’t do the calculation. We just expect it to be worse than the eight to 12 hour group. So for conservatism in the estimate, we apply the eight to 12 hour number to all the waits, even if we know a lot of them will be longer than 12 hours. But it seems reasonable that it’s not good to overestimate deaths.’
Responding to the figures, the leader of the country’s ED consultants, Professor Conor Deasy, said the Irish Association for Emergency Medicine (IAEM) has ‘been emphasising for years now that we must get patients out of emergency departments in six hours to appropriate beds’. He told the MoS: ‘The problem is there is a shortage of beds to get these patients into and while there has been a commitment to delivering 1,500 beds in the acute sector, we haven’t seen that come to pass.’
Prof Deasy, director of unscheduled care at Cork University Hospital and professor of emergency medicine at University College Cork, also said the HSE recruitment freeze is ‘hitting hard at the moment’.
Prof Deasy said ‘We are now in a situation where the [recruitment] embargoes are affecting quality of care, safety of care, delivery of care, and these embargoes need to be lifted so that we can get on with the care that we need to provide to our society and our citizens.’
Anthony Staines, professor of health systems at DCU and a member of the Independent Scientific Advocacy Group, said: ‘People spend significant time in hospital and they also get sent into hospital more because, while in other countries there are resources in the community to mind frail people when they’re sick, there aren’t here.
‘You access those resources by going into hospital and the only way into hospital is through the emergency department. So you’re stuck [in] every direction.’
A HSE spokeswoman acknowledged long ED wait times are ‘extremely difficult for patients and their families’ and pointed to a number of actions to improve patient experience
‘This includes additional funding for GP Out of Hours services, increasing services work over seven days, additional funding to allow hospitals access extra community beds so patients who are clinically fit can be discharged, availability of private hospital beds to allow hospitals transfer suitable patients, and more private ambulance availability so hospitals can quickly transfer patients who are ready for discharge to a community facility or home, as appropriate,’ she said.
‘Mortality rate keeps going up, the longer we wait’