Increase in A&E delays, watchdog claims

A NEW report by the State’s spending watchdog found that there was an increase last year in the number of patients who had to wait for lengthy periods in emergency departments for admission to hospitals.

The report of the Comptroller and Auditor General, which was published yesterday, found that more patients requiring admission had to wait for a period of longer than 12 hours in the first five months of 2009, compared to the same period in the previous year.

“[A total of] 46 per cent of patients were waiting 12 hours or more in early 2009,” the report stated.

The Comptroller and Auditor General’s review said that the provision of appropriate care for emergency cases in hospitals within a reasonable timeframe was being adversely affected by the restricted availability of key resources.

The report said that 23 of the 33 hospital emergency departments examined as part of the review had delays in accessing senior decision makers.

It found that access to consultations from specialities within the wider hospital was rated as unsatisfactory in most cases.

It also maintained that in most cases, there was considerable scope to improve the timeliness of diagnostic support and that four emergency departments, in the South Infirmary in Cork, Roscommon, Nenagh and St Johns in Limerick, had unsatisfactory access to those services.

“The waiting time for bed accommodation following decisions to hospitalise emergency patients was unsatisfactorily long in most cases,” the report also stated.

The Comptroller and Auditor General’s report also said that there were considerable differences in the cost of treating patients who presented at emergency departments in hospitals around the country.

The report said that the number of patients dealt with by medical staff ranged from 8.15 to 30.57 per day across the different emergency departments.

The report also said that the cost of treating patients who presented at emergency departments ranged from €85 to €281 per attendance.

It also found that there were considerable differences in emergency department capacities.

The review involved an examination of emergency departments in 33 of the country’s 50 acute public hospitals.

It said that in 2008, the departments examined as part of the review had had over one million attendances. Approximately 25 per cent of emergency cases were admitted to hospital following assessment, while the remainder were treated and discharged.

“While the direct cost of emergency departments before taking account of overheads is estimated at €196 million, ultimately in the hospitals examined, care for those patients who had to be admitted cost an additional €1.5 billion in 2008,” it stated.

The report said that the provision of alternatives to acute hospital care by means of strengthening primary and community care services could reduce reliance on the acute hospital services and demand on emergency departments.

However, it said that community initiatives needed to be evaluated to determine their relative cost effectiveness and, to the extent that they are found to be more economic and effective, integrated into the primary care team model. It said that this could also help reduce recourse to the emergency services.

Minister for Health Mary Harney said that a considerable number of actions had been taken to improve the delivery of services in emergency departments, many of which were consistent with the report’s recommendations.

The HSE said that 54 per cent of patients who required admission had access to a bed within six hours.

However, the Labour Party said that the report was nothing short of damning. The party’s health spokeswoman, Jan O’Sullivan stated: “The report points out in black and white, what we all have heard at local level, that the situation is getting worse.”