Wide variations in emergency department wait times are identified in a Government report, with 23 out of 26 hospitals failing to admit patients on time.
At Tallaght University Hospital, Beaumont Hospital and Naas General Hospital, less than half of ED patients are treated within the target time.
St Luke’s Hospital in Kilkenny is the best performer, with 93 per cent of patients treated within the HSE target time of six hours in 2019. Mayo University Hospital and Midlands Regional Hospital Portlaoise are the only other hospitals meeting the target.
Interventions such as winter plans designed to reduce long waits have been “potentially ineffective” as the problems of hospitals have persisted over years, the report says.
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Further actions to remediate the situation and reduce costs should be taken, it says, as long wait times can have significant impacts on patient outcomes.
For over-75s, 99 per cent are supposed to be treated in EDs within nine hours, but in five hospitals – University Hospital Limerick, Tallaght, Naas, Mercy University Hospital Cork and Connolly Hospital – more than half are forced to wait longer.
The report identifies substantial differences in the proportion of patients who leave ED with incomplete treatment, which is another patient safety concern as well as representing inefficiency. This went from 16.7 per cent of patients having incomplete treatment at St James’s Hospital to 1.3 per cent in St Luke’s, Kilkenny.
There is also underutilisation of acute medical assessment units (AMAUs), with 19 hospitals having discharge rates from these units below HSE targets. AMAUs, when used effectively, can shorten patient stays and waits, improve treatment and reduce mortality.
Only 22 out of 30 hospitals admit more than 70 per cent of patients undergoing elective surgery on the day, compared to a HSE target of 80 per cent. At St James’s, just 16.5 per cent of elective patients are admitted on the day of the procedure.
The early admission of such patients costs St James’s €1.88 million a year, the report estimates, while nationally the costs associated with this practice are estimated at €10.58 million.
Delayed transfers of care, where well patients cannot be discharged due to a lack of alternative care options, are identified in the report as another big source of inefficiency. Seven per cent of all bed-days are taken up by patients suitable for discharge; in 2019, 240,000 beds were subjected to delayed transfers of care, falling to 142,000 in 2021. Rates varied from 10 per cent in the north Dublin/Border region to 4 per cent in Donegal.
In 2021, almost €146 million was spent treating patients in hospital who could have been treated elsewhere, the report estimates.
The report says all hospitals report hospital-acquired infections, though rates of staph infections appear to be higher in more complex hospitals. The rate of medication incidents was highest in Connolly Hospital – over 16 times the HSE target.
The analysis of hospital performance based on HSE performance data was published on Friday by Minister for Health Stephen Donnelly and Minister for Public Expenditure Paschal Donohoe as part of the 2022 spending review process.
The focus on performance was motivated by a “growing divergence” between spending on hospital and their level of activity since 2017.
Since 2014, spending on hospitals is up 66 per cent, staffing is up 44 per cent, yet hospitals discharged fewer patients in 2021 than they did in 2015. The report says this “disconnect between inputs and outputs is a concern”.
A separate report on medical workforce supply warns that reducing Ireland’s reliance on foreign-educated doctors will be a “long-term endeavour”.
There were 1,403 medical student places available in the 2021/22 academic year, the highest per capita output in the OECD, according to the report. However, as 46 per cent came from non-EU states, a “disproportionate number” of graduates from Irish medical schools do not progress to become consultants here.
“This historic undersupply of doctors within the Irish medical education and training system has contributed to a situation where there is an over-reliance on foreign-educated doctors and relatively few consultants when compared against our international peers.”
A long time frame is required to increase medical education and training places, the report says. Because of the high proportion of non-EU students educated here, there is significant capacity to increase places for EU/UK students, but there are “greater supply constraints” in postgraduate training.
It points out that for every 100 extra undergraduate places in medicine, 92 intern places have to be created five years later and 75 specialist training places another eight years on.
[ Over 100 foreign doctors sought for rural GP practices in bid to ease shortageOpens in new window ]
Mr Donnelly said workforce planning in health was a key priority for the Government. “I have made clear that we need to urgently double the number of Irish and EU students in medicine in order to meet the challenges of our growing and ageing population, and to meet our international obligation to reduce our reliance on foreign trained doctors.”
[ Hospital overcrowding is a symptom of the failure to reform the health serviceOpens in new window ]
A third report recommends the new regional health authorities be allowed funding using a capitation model adjusted for the age and sex, deprivation and “rurality” of their populations.
The shares thus allocated are likely to be broadly similar to current budget allocations, according to the report.
