There were 838 patients admitted to hospitals left waiting for a bed on trolleys in emergency departments or wards on Wednesday morning, according to the Irish Nurses and Midwives Organisation (INMO).
The number is lower than the record 931 patients left on trolleys on Tuesday, which was the highest ever figure recorded by the INMO.
However, the 838 patients waiting for beds on Wednesday is the second highest figure recorded by the union’s trolleycount.
It comes as the health service has been battling a surge in cases of flu, respiratory syncytial virus (RSV) and Covid-19, putting major pressure on emergency departments (EDs) across the country.
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Commenting on the issue, Minister for Health Stephen Donnelly said it is clear that “overcrowding increases patient risks”.
Patients waiting on trolleys was something that had been seen for many years, and “more beds, more community resources” were needed, he said.
The Health Service Executive (HSE) recently secured 185 extra private hospital beds to help address overcrowding, Mr Donnelly said.
The Minister told RTÉ News at One that research had shown 2,400 extra acute beds were required, 1,000 of which had been provided, but it was “likely” that number would need to be higher.
The long-term goal was to come up with solutions other than increasing hospital capacity, such as providing more care in the community, he said.
Mr Donnelly said Prof Breda Smyth, chief medical officer, “would not be minded to introducing mandatory mask wearing”, but that the current advice was to wear face masks in crowded settings and on public transport.
There were 652 patients waiting on trolleys in EDs and 186 waiting for beds on wards, according to the INMO.
Overcrowding was highest in University Hospital Limerick where 76 patients were waiting on trolleys or chairs, followed by 65 in Sligo University Hospital and 62 patients waiting in Cork University Hospital.
In Dublin, St Vincent’s University Hospital had the highest number waiting on trolleys at 45 patients.
Phil Ní Sheaghdha, INMO general secretary, said hospital overcrowding was an “out and out crisis” and needed an “extraordinary” response from Government and the HSE.
“We again repeat our call for the current approach of telling people just to avoid hospitals to cease. The focus should be on providing supplemented emergency supports until the end of February,” Ms Ní Sheaghdha said.
Patients were being treated in “most undignified conditions”, the union leader said.
Nurses on the frontline were having to apologise to patients and families “because of the chaotic conditions”.
The INMO reiterated its call for a pause of all non-urgent hospital activity and the reintroduction of mandatory face mask wearing for a period of time.
“Nurses and other healthcare staff cannot continue to weather this storm without adequate support and protection from their employer, it will add to the increasing intention to leave of staff which is exactly what this health service does not need,” Ms Ní Sheaghdha said.
The HSE’s own TrolleyGAR count, which does not include patients waiting on wards for beds, said 619 were on trolleys in EDs on Wednesday.
Meanwhile, emergency medicine consultant Dr Peadar Gilligan warned it was not safe to treat hospital EDs like they had “rubber walls”.
Dr Gilligan, a consultant in Beaumont Hospital, said all hospitals needed to move to full capacity protocol, which would see more patients waiting in or near wards rather than EDs.
“It is safer to move one or two patients to a ward rather than treat the emergency department like it has rubber walls,” he told RTÉ Radio’s Morning Ireland.
Rather than housing patients in the ED who need to be on a ward, those patients would be moved to ward areas “where they may well be in a bed or a trolley awaiting further care, but that is a safer environment”, Dr Gilligan said.
The situation in Beaumont Hospital was “particularly challenging” at present, he said. There were 34 patients currently in the ED who had been assessed and deemed appropriate for admission, but there was no hospital bed for them.
“Essentially that means that 100 per cent of the capacity of the ED is occupied by patients who are waiting for a hospital bed,” Dr Gilligan explained.
“Some of those patients are sitting on chairs around our nurses station, some are on trolleys in the assessment area – essentially our available capacity is hugely constrained.”
Dr Gilligan said patient lives were “definitely” at greater risk in the current conditions.
Overcrowding in EDs meant delays in diagnosing heart attacks and strokes and delivering antibiotics, the consultant said.
“Definitely there are clinical consequences to our failure to develop the capacity that the system clearly needs. Lives are definitely at risk. The reality is we don’t have the beds in the system that we need.”
Dr Gilligan said the solution was to develop more capacity, and 5,000 acute hospital beds were needed.
Taoiseach Leo Varadkar said the length of time people were waiting on trolleys was “unacceptable”.
“But the Government and the HSE are doing everything possible to improve the situation,” he told RTE’s Six One News on Wednesday. “We have 1,000 more beds than we had only three years ago.”
Primary care
Meanwhile, a leading GP has said that the Government should invest more resources in primary care as a means of reducing the numbers attending hospital emergency departments.
Medical Director of the Irish College of General Practitioners, Dr Diarmuid Quinlan, said that the current crisis in the hospital emergency department system reflects the fact that the primary care sector is no longer able to cater for all those patients seeking acute treatment.
The result is that many, who are unable to obtain GP appointments, are instead going to emergency departments in hospitals such as Cork University Hospital, where over 18,000 patients ended upon trolleys in 2022, rather than going to their GP for conditions that are treatable at primary care level.
Dr Quinlan, who is one of eight doctors in a GP practice in Glanmire on the outskirts of Cork city, said the lack of capacity within the primary sector was identified just last month by the OECD in its Economic Survey on Ireland 2022 which devotes almost 50 pages to the health service in Ireland.
“The OECD report stated quite clearly that ‘avoidable hospital admissions remain relatively high for conditions like asthma and Chronic Obstructive Pulmonary Disease which are largely treatable in primary care’ and that is most assuredly the case,” he said.
