Concerns for Emergency Departments during St Patrick’s Day

As festivities resume for the first time in two years, emergency departments are likely to face increased pressure, at a time when they are already overwhelmed and encouraging the public only to visit as a last resort

As Ireland prepares to celebrate its first St Patrick’s Day since 2020, healthcare professionals have expressed concern that a surge in emergency department admissions could put extreme pressure on the health service.

St Patrick’s Day is rife with excessive alcohol consumption and anti-social behaviour. The result is an increase in people presenting to Emergency Departments across the country, particularly in major cities. Prior to the Covid-19 pandemic, INMO leadership were on record saying that nurses ‘dread’ working on the occasion, due to the difficult conditions.

At present, the HSE is still asking members of the public to consider all care options before attending hospital Emergency Departments noting that there are a range of care pathways available to patients who do not need emergency care, including Pharmacists, GPs, GP Out-of-Hours Services and Minor Injury Units.

As of this morning, 457 admitted patients are waiting for hospital beds, according to the INMO’s Trolley Watch. Meanwhile, 370 patients are waiting in the Emergency Department, while 87 are in wards elsewhere in the hospital.

Hovering on the brink
Speaking with IMT, Dr Mohammad Hamza, Emergency Medicine SpR, said that heading into any big holiday or major event in Ireland is an uneasy time for ED staff – as it represents an added pressure on a system that seems always to be hovering at the brink.

“We’ve been expected to keep this unsustainable balancing act going through years of perennial crises, where the ED disproportionately absorbs much of the risk in the system,” he explains. “We’ve seen this in recent weeks where record levels of hospital attendance have led to record levels of overcrowding.”

Hamza says that boarding of inpatients in the ED causes mortality to increase, including that of discharged patients.

Such measures should always have been unconscionable, he adds. “But in a reality where Covid-19 is still a significant risk, overfilling the department and compromising our infection control obligations poses an even greater risk to not only those vulnerable patients we serve, but also to the staff looking after them.”

A danger to patients and hospital staff
Both staff and patients are at risk from such conditions. ED staff have among the highest rates of burnout, and subsequently attrition in the health service. A 2021 study found that the Covid-19 pandemic was increasing mental health difficulties and exhaustion among frontline healthcare workers, with 74% of respondents, citing burnout.

“This is an incredibly resilient workforce, but the elastic can only stretch so far. As the RCEM president stated this week, ‘the burden of responsibility can no longer be placed on burned-out and overwhelmed staff who are struggling to manage this crisis’,” said Hamza. “We need to share this burden around, which means we need adequate beds for our acute hospitals, adequate community services and step-down beds, adequate access to outpatient services and diagnostics for our primary care colleagues.”

Responding to IMT’s requests for comment on the pressure St Patrick’s Day may pose for Irish hospitals, a spokesperson for the HSE said that Emergency Departments continue to be extremely busy with high numbers of patients attending, many of whom present with complex needs requiring admission.

“The HSE regrets that patients may experience long wait times in our Emergency Departments.

However, as always, Emergency Departments will prioritise the sickest patients and most urgent cases for treatment and care,” said the spokesperson.

“In line with the HSE Winter Plan, a number of measures are being taken to manage high emergency attendances, in order to de-escalate and assist with patient flow. This includes continuing to use Private Hospitals and other private diagnostic facilities to support access for patients.”

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