A CORK consultant has backed calls by the Irish Association for Emergency Medicine (IAEM) for steps to be urgently taken to provide suitable but functional alternatives to emergency department (ED) referral.

The call to action comes amid concerns about pressures being faced by emergency departments which are leading to significant delays and congestion.

The IAEM said that those who work in emergency medicine are “very familiar with an increase in workload in EDs when difficulties arise with accessing other parts of the healthcare system” but that EDs are seeing referrals of patients with clinical problems that would typically have been seen in primary care and referred to outpatient-type services many months ago.

It said this is “adding to the increasing numbers of patients presenting as a result of typical summer and holiday injuries and the normal throughput of medical emergencies”.

Situation in Cork

Yesterday, 42 admitted patients were waiting for beds at Cork University Hospital (CUH), the highest figure reported in the country.

Clinical lead, major trauma audit, and consultant in emergency medicine, Conor Deasy, said that CUH’s ED is “extremely busy with some patients experiencing very significant delays”.

“We are seeing many patients who in pre-Covid times would have gone to their GP,” said Prof Deasy.

“Covid has created an enormous increase in workload both in terms of diagnosis and management and the rollout of vaccines for GPs and hospitals. All this while we sail with a broken mast due to the ransomware attack,” said Prof Deasy.

Mercy University Hospital (MUH) has also witnessed a “surge” in the volume of attendances.

Three admitted patients were waiting for beds there yesterday morning.

The Cork hospitals are not unique in the pressures they are facing and the IAEM said that many of the country’s 28 EDs have seen record daily numbers of patients in the past few weeks which has resulted in severe congestion and delays, particularly for those with less acute care needs.

“This sharp increase is occurring at a time when very few EDs have a fully functioning suite of ICT as a result of the cyberattack on the HSE in mid-May,” said the IAEM in a statement.

“This, in turn, is contributing to delays as many previously ICT-enabled processes continue to have to be performed manually or are being performed with significantly limited ICT functionality.

“The fact that the effects of the cyberattack are still so significant so long after the attack is a reflection of the level of destruction the attack wreaked on the HSE’s ICT infrastructure.

“While many might understandably assume the problem had been resolved at this stage, this is very far from the case.”

Calls for rapid access clinics 

The IAEM said that it is imperative that dedicated rapid access clinics in general medicine and surgery be provided for those patients where emergency medicine has nothing to offer, as many EDs struggle to deal with the patient workload.

Meanwhile, the Irish Nurses and Midwives Organisation (INMO) has written to the HSE calling for an emergency meeting of its Emergency Department Taskforce in order to tackle what it described as unsafe levels of hospital overcrowding.

It has also called an emergency meeting of its own ED nurses section to agree on the health and safety measures needed to protect members and patients.

The INMO has reported that the number of admitted patients waiting for beds continues to increase despite the continued risk of Covid-19 transmission in hospitals, with some hospitals approaching or above pre-pandemic levels of overcrowding.

Appeal to utilise other health services where appropriate

As EDs experience increased pressures, MUH has appealed to patients needing less urgent treatment to avail of other healthcare services where possible.

“While the ED remains open 24/7, it is regrettable that patients will experience delays,” said a spokesperson for MUH.

“The pressure on the emergency department has been exacerbated by the continued impact of the recent cyberattack; however, the hospital management would like to stress that the clinical needs of all patients in the emergency department are being cared for.

“In order to relieve pressure on the ED and reduce waiting times, the hospital is appealing to the members of the public needing less urgent treatment to avail, where possible, of other care services such as their GPs, local pharmacies, or South Doc in the first instance, or to avail of services at the Mercy Local Injury Unit, St Mary’s Health Campus, Gurranabraher, which is open from 8am to 6pm.”