30% of admitted patients discharged within 24 hours ‘crazy’

Three out of every 10 patients admitted to hospital are discharged within 24 hours or under, according to new figures that senior doctors say point to a substantial level of unnecessary admission of patients.

Five out of every 10 children admitted to hospital similarly spent one night or fewer in a bed before being discharged, the figures from the Health Service Executive show.

In 2018, the HSE recorded 293,976 hospital discharges, of which 33,929 (11.5 per cent) were logged as same-day discharges and 55,510 (18.9 per cent) as having a length of stay of one night. The rest had a length of stay of greater than one night.

The highest level of short-stay patients was recorded in the Children’s Hospital Group, where 22.5 per cent of patients were discharged on the same day as they were admitted and 27.1 per cent spent just one night in hospital.

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Many patients end up being admitted unnecessarily to hospital because the services they require are not available in the community, Ken Mealy, president of the Royal College of Surgeons in Ireland, said.

“A huge proportion of the patients we admit have respiratory problems such as asthma or COPD (chronic obstructive pulmonary disease) and who cannot get the chronic care they need in the community.”

Hospitals also struggle to get senior staff to work in emergency departments, especially at night, he added. “We have too many inexperienced doctors at the front doors of our hospitals admitting patients who could be treated in the community.”

Broken system

However, he pointed out that some of the same-day discharges may have been appropriately made to acute medical assessment units. In addition, patients would also have spent varying amounts of time in an emergency department prior to admission to the hospital.

Another senior doctor described the figures as “absolutely crazy”. He said: “They show that far too many patients are being admitted unnecessarily. If we didn’t admit them, we wouldn’t have any trolleys.”

Much inappropriate admission of patients takes place at night-time, he said, when hospitals are staffed by junior employees. “It’s as much about how we work as whether we have the resources. There’s a complete lack of decision-making capacity and diagnostics when we need it.”

Prof Sherif Sultan, a Galway-based vascular surgeon, said he regularly comes across patients on his wards who should not have been admitted. "The system is broken but the issues are clear. Out of hours GP services are very poor and medicines can't be prescribed 24/7 except in hospitals.

“When patients arrive at the emergency department they are seen and triaged by totally inexperienced physicians who can’t make any sound clinical judgment due to lack of availability of a consultant on the front line, so patients with flu, renal colic, chest infection, food poisoning and mild infections are admitted – this only happens in Ireland.”

Acute hospital and community services need to be better harmonised, he said, while 24/7 pharmacy services could be provided by using automated dispensing machines. Lab testing and ultrasound services also needed to be provided on a round-the-clock basis.