Hospitals under pressure as number of ‘older and sicker’ patients seeking care surges

The number of people attending hospital emergency departments (EDs) has reached record levels, prompting a fresh round of cancellations of procedures and appointments for patients.

Almost 28,000 people attended an ED last week, the highest figure in the history of the Health Service Executive (HSE).

The increase in demand has been driven by a surge in attendances among people aged over-75, which is up by more than 45 per cent on last year and 18 per cent on 2020.

HSE chief operating officer Anne O’Connor said the older people attending hospital at present are sicker and frailer than before, and have to spend longer there when admitted. She said hospitals are full and are using more of their available capacity for longer.

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“Older people coming forward now are sicker, frailer and more deconditioned, so they need to stay in beds for longer,” she told a media briefing on Thursday.

As a result, the HSE said hospitals across the State, particularly in the south, had started curtailing services.

University Hospital Limerick, Cork University Hospital, Galway University Hospitals and St James's Hospital in Dublin have all had to cancel elective work in the past week as demand for ED services increased.

‘Real concern’

With almost 2,000 over-75s admitted to hospital last week, she said there was a “real concern” about the number of older people presenting. Officials are uncertain whether the trend is the result of a later winter peak or due to wider demographic changes.

Officials are also seriously concerned about trolley numbers which are almost three times higher than at this time last year, though marginally down on 2020, when flu was rife.

Ms O’Connor said it was inevitable that patients being admitted will spend a period of time on a trolley, but said the most important thing was how long they spend in an ED. More than 95 per cent of patients are admitted or discharged within 24 hours, the target set by the HSE.

At present, 425 hospital beds are being used for emergency surge capacity, meaning they are not available for other patients.

The number of delayed transfers of care, for patients who are well but unable to move to step-down facilities, has risen to more than 600, thereby further contributing to congestion in the system.

Covid-19 outbreaks

One factor is the higher number of Covid-19 outbreaks in older person services. The HSE is currently unable to discharge treated patients to about 50 per cent of nursing homes because they have outbreaks. Another challenge is the recruitment of sufficient carers to look after discharged patients at home.

The number of Covid-19 patients in hospital continues to fall, however, and stood at 595 on Wednesday evening. About half of these were admitted due to Covid-19 while the others are in hospital for other reasons and have since been diagnosed with the disease.

More than 820 additional acute beds have been opened since the start of 2020, along with a range of other investments in services, but the HSE says this additional capacity has been more than used by the demands placed on the system by the pandemic.

While private hospital capacity is increasingly being used to treat emergency patients and to provide elective care, the HSE says this sector is itself coming under increasing pressure due to rising demand.