Overcrowding in hospital emergency departments 'not inevitable', says Hiqa

Hiqa found despite improvements in some hospitals, that the environment in 80% of emergency departments inspected did not respect “the dignity, privacy and autonomy of patients using the service”.

Overcrowding in hospital emergency departments compromises the dignity and respect of patients but it is not inevitable as some hospitals avoid this, the Health Information and Quality Authority (Hiqa) has said.

Despite the difficult conditions, patients praise the care healthcare staff offer, an overview report by the health watchdog states.

They found despite improvements in some hospitals, that the environment in 80% of emergency departments inspected did not respect “the dignity, privacy and autonomy of patients using the service”.

Hiqa has called for action in four areas which could reduce levels of overcrowding in Irish hospitals.

These include more beds and staff to increase capacity in hospitals and in the community services which are connected to them. This would help to address the rising demand caused by a higher number of patients.

Hiqa has called for a “responsive leadership approach” to health care, focused on these issues.

Focusing on staffing, they called for more effective workforce planning.

Systems such as those for managing care of sepsis and transfer of care between hospitals and other facilities should be expanded and built on to improve patients’ experiences.

This report builds on early observations and findings in Hiqa inspections of emergency departments around the country.

“Many emergency departments inspected in 2022 and 2023 were over capacity on the day of inspection, with intended emergency department capacity occupied by admitted patients awaiting an inpatient bed,” the report states.

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This is referring to the ongoing crisis whereby patients are deemed sick enough to be admitted to hospital, but the hospital is full so they remain on trolleys in the emergency department instead.

The report highlights a number of reasons for these pressures.

The first is simply a rising number of people in need of emergency care, with some hospitals saying the shortage of GPs is adding to this as patients cannot get help early.

Other hospitals pointed to a shortage of community services which could include homecare or nursing home beds. This leads to a delay in transferring patients out of hospital once their care is finished.

In the hospitals, Hiqa also identified staff shortages as linked to the problem. At four sites, they found “significant shortfalls in medical and nursing staff”.

They found hospitals relying on agency staff, with full-time staff regularly doing overtime or being re-deployed out of their specialist area to help elsewhere.

At four sites, Hiqa found “significant shortfalls in medical and nursing staff”. File photo: Sam Boal / © RollingNews.ie

“The unfilled shifts impacted the quality and safety of care provided to patients in emergency departments,” inspectors warned.

Hiqa also highlighted University Hospital Waterford and Beaumont Hospital in Dublin as having “good overall levels of compliance with the National Standards for Safer Better Healthcare”.

UHW regularly records zero patients waiting on trolleys, according to a separate daily tally by the Irish Nurses and Midwives Organisation.

“Beaumont Hospital and University Hospital Waterford had managed to move from a situation of persistent overcrowding in the emergency departments to one where such crowding was well managed or not present,” the report states.

The full Overview Report Monitoring and Regulation of Healthcare Services 2021 – 2023 can be read on the Hiqa website.