Around 2,000 bed days were lost every month at Dublin's Beaumont hospital over a 2½-year period due to the delayed discharge of patients, a new report has found.
The report from Tribal Secta, a UK healthcare consultancy, says at least 60 beds were on average taken up in the hospital every day in 2003, 2004 and during the first six months of 2005 by patients whose discharges had been delayed.
Most of these patients were elderly people waiting for long-term care.
Tribal Secta was asked to report back to the Health Service Executive (HSE) on the A&E units of 10 hospitals across the State. These reports have not been published by the HSE, but six of them have been released to The Irish Times under the Freedom of Information Act.
The report on Beaumont says a lack of alternative care for elderly and young chronic sick people means the hospital "is becoming disproportionately focused on providing long-term care for a range of complex and elderly patients, in many cases well beyond their requirement for acute intervention".
In August 2005, when Tribal Secta was carrying out its review, delayed discharges "numbered over 60 cases, accounting for some 2,210 occupied bed days lost per month".
When it analysed delayed discharges from January to June 2005, it found they peaked at 90 at one stage, but were always over 50. "For Beaumont hospital the issue of dealing with delayed discharges was the single most important issue to support patient flow." The report, commissioned to establish if any practices in the hospital were contributing to A&E overcrowding, also found many people were turning up at Beaumont A&E because of GP shortages and lack of out-of-hours GP cover in the area.
"There is a commonly-held perception that Beaumont hospital is serviced by a particularly poor primary and community and continuing care infrastructure, with lower numbers of GPs compared to other parts of Dublin and the rest of Ireland.
"There is currently no GP out-of-hours service for the local population. This has resulted in increased pressure on all access points of the hospital as patients may choose to bypass the GP and access the hospital directly."
There were a total of 49,713 attendances at the hospital's A&E unit in 2004, it said, up 3 per cent on the previous year. Some 74 per cent of A&E attendances were self-referrals and 18 per cent were referred by GPs.
Tribal Secta found that just over 1,000 patients who attended in 2004 were non-urgent and "really should be seeing their GPs" instead. There were also another 17,851 patients who "may not require the services of an emergency department" and could have been treated in "other settings had these been available".
"Thus with increasing numbers of patients arriving at the front door, and with increasing numbers of medically-stable patients unable to be discharged to an appropriate destination, the emergency department at Beaumont hospital has become the holding area for increasing numbers of patients awaiting admission, often for several days," the report said.
Overall it found the physical infrastructure of the A&E unit to be satisfactory. However, it said: "It would appear that at weekends the hospital is under-utilised and under-occupied."