New internal HSE figures confirm a recent trend whereby procedures for non-acute patients are being cancelled in order to treat emergency cases, writes Martin Wall
More than 90 per cent of people treated as inpatients in a number of acute hospitals in the first half of the year had been admitted as emergency cases, a new internal Health Service Executive (HSE) report reveals.
The figures reveal that Naas General Hospital in Co Kildare had the highest number of admissions through the A&E department, at around 92 per cent.
The report also shows that in two of Dublin's main hospitals, St James's and Tallaght, around 80 per cent of patients discharged in the first six months of the year had been admitted through the A&E departments.
Hospital consultants said yesterday that the new figures confirmed a trend observed over recent years, in which elective or non-urgent patients were increasingly squeezed out of acute hospitals.
However, the HSE says that in examining the ratio between emergency and elective admissions, it is important to note the increasing shift in hospitals from inpatient to day-case planned procedures. It also says the significant amount of work now being carried out by the National Treatment Purchase Fund (NTPF) has to be taken into account.
The secretary general of the Irish Hospital Consultants Association (IHCA), Finbarr Fitzpatrick, says the impact of the increasing number of emergency admissions can be seen in the figures for the number of elective procedures cancelled each year.
The Irish Times revealed in August that nearly 22,000 operations were cancelled by 34 hospitals across the State last year, largely due to the unavailability of beds.
Fitzpatrick says that in the late-1990s the average level of emergency admissions to hospitals was around 65 per cent. This figure has subsequently increased, and the average level of emergency admissions up to recently was 72 per cent, he says.
The HSE report reveals that in Tallaght hospital there were 2,557 elective patients discharged in the first six months of the year compared with over 10,600 patients who had been admitted as emergencies. This represented an emergency admission rate of 80.6 per cent.
At St James's Hospital 79 per cent of the 13,941 patients discharged in the first six months of the year had been taken in as emergency cases.
The figures for cancelled operations, albeit for 2005, would appear to bear out the IHCA contention that there is a link between the increasing number of emergency admissions and reduced levels of elective patients being treated.
In 2005, St James's in Dublin, the largest hospital in the State, had to cancel 4,281 operations. The hospital says some 3,598 of these were cancelled because beds were not available. Almost half the 2,264 operations cancelled at Tallaght hospital last year were also postponed as a result of beds being unavailable.
The HSE report shows that at the Mater Hospital over 77 per cent of patients discharged in the first half of the year had initially been admitted as emergencies.
At the Connolly hospital in Blanchardstown, the figure for emergency admissions was 77.2 per cent of the total number of discharges.
However, at Beaumont Hospital there were relatively more elective cases treated. The HSE report says 67 per cent of the 12,084 patients discharged from Beaumont had been admitted as emergencies.
Outside Dublin the figures for emergency admission varied considerably. At Cork University Hospital 65 per cent of people discharged had been admitted through A&E. However, at Kerry General Hospital in Tralee, the figure was 71.4 per cent.
In the midlands around 67 per cent of the 5,604 patients discharged from the regional hospital in Tullamore had been admitted as emergencies. In Portlaoise the figure was 88.9 per cent.
At Waterford Regional Hospital 65 per cent of the 14,524 patients discharged in the first six months of the year had been admitted as emergencies.
In a statement, the HSE said a key factor in the recent shift in the ratio of elective/emergency admissions had been the obligation on hospitals to refer patients to the NTPF.
It said that initially hospitals were required to carry out 30 per cent of NTPF procedures on an inhouse basis, which would result in more elective patients being treated as a percentage of the overall number. However, the HSE said that from the end of last year hospitals were permitted to carry out only 10 per cent of their work for the NTPF.
The HSE also said it was "widely acknowledged that hospitals nationally experienced a significant increase in attendances and admissions through A&E departments in the first quarter of the year to date".
The HSE said it had sought to unlock capacity in the public hospital system by accessing up to 1,000 private beds.