Emergency departments (EDs) nationwide are currently working under “intolerable pressure” and this is posing a major risk to both patients and staff, doctors have warned.

According to the Irish Association for Emergency Medicine (IAEM), in recent months, the pressure on EDs “has increased beyond levels that had

been generally agreed as unsustainable during the ‘all hands on deck’ emergency pandemic response”.

“Increasing numbers of patients seeking ED care, including a significant number who have unsuccessfully sought a GP assessment before resorting to ED attendance; hundreds of patients awaiting admission on trolleys and chairs every day; the very contagious nature of the current Covid-19 variant, which has seriously depleted staffing in all areas but particularly EDs; and increases in deficits in other parts of the healthcare system have combined to produce a perfect storm,” the IAEM said.

It pointed to a recent UK study published in Emergency Medicine Journal, which found that a five-hour wait to be admitted to a hospital bed results in one additional death for every 82 such patients. This death rate increases if patients are left waiting even longer. (This study can be viewed here.)

These findings should “ring major alarm bells”, the IAEM said. It noted that the congestion experienced in ED clinical spaces, where patients can be left waiting hours or even days to be admitted, “appears to be regarded as normal by those who have political or managerial responsibility for the delivery of healthcare”.

Furthermore, there is “no convincing evidence” that those in charge recognise the threat to life and the urgent need to address this major public health crisis.

“Reports from those delivering care in Irish EDs indicate that the ‘new norm’ currently is that the ratio of patients awaiting an appropriate space to allow the necessary requirements of a proper history and examination in some degree of privacy, to the number of such spaces available, is in the range of 4:1 to 10:1 at various times of the day. This is far worse than has been seen previously,” the association pointed out.

It claimed that the large scale move to remote/virtual consultations by GPs, to replace face-to-face consultations, appears to have been a big driver of the increase in ED attendees.

As many of these patients are triaged as less urgent for emergency intervention, this can lead to particularly long waits. In some cases, patients have waited a full day or more for assessment and treatment “that is inferior in most non-emergency cases to that which they would have received in a face-to-face consultation with their GP”.

“Such long waits has led to a surge in patient complaints, the resolution of which requires the time-consuming input of senior clinical staff,” the IAEM noted.

It emphasised the danger to patients of the current situation, but also very significant risks to medical and nursing staff “who are now exhausted from being on the frontline”.

“Nobody working in Irish emergency medicine is at all surprised at the attrition and burnout that has resulted from this situation or the fact that staff of all disciplines and all grades are opting to leave emergency medicine and nursing.

“Inevitably, this will make the care of future patients more challenging as a significant amount of clinical experience and expertise will be lost,” it stated.

The association said that it has advocated strongly to ensure patients are seen in appropriate facilities by an appropriate multidisciplinary team. However, it added that this is not currently being achieved, and is unlikely to be in the future, “unless those who are responsible for service provision at national level belatedly recognise the worsening clinical risk and finally begin to address the underlying structural problems which have allowed this problem to persist and worsen over the past 25 years”.