Report finds 23 out of 26 hospital emergency departments fail to treat patients on time

Substantial inefficiencies in the way hospitals are run are identified in a Government report, which finds 23 out of 26 are failing to treat emergency department patients on time.

The report expresses concern over a “disconnect between inputs and outputs” in hospitals, and highlights a “growing divergence” between spending and activity since 2017.

The number of patients discharged by hospitals actually fell between 2015 and 2021, despite funding being increased by 66 per cent and staffing by 44 per cent around this time.

An estimated €146 million was spent treating patients in hospital who could have been treated elsewhere in 2021, the report estimates. Hospitals could save another €10 million by delaying the admission of more elective patients until the day of their procedure.

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Further savings could be achieved by bringing hospital-acquired infections under control, it finds.

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.

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.

Amid evidence of wide variations in hospital performance, the report points out that Tallaght University Hospital, Beaumont Hospital and Naas General Hospital treated less than half of their ED patients on target.

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.

For older people, 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 of over-75s are forced to wait longer.

Further actions to remediate the situation and reduce costs should be taken, the report recommends, as long wait times can have significant impacts on patient outcomes.

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 ranged 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 under-utilisation 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.

Another HSE target is for at least 80 per cent of patients undergoing elective surgery to be admitted on the day, but at St James’s, the State’s largest hospital, this happens with just 16.5 per cent.

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. Rates varied from 10 per cent in the north Dublin/Border region to 4 per cent in Donegal.

Incoming HSE director general Bernard Gloster highlighted his dissatisfaction with the level of delayed transfers of care in his first interview earlier this week.

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 timeframe 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.