EDs creaking under ‘intolerable’ pressure

The pressure on emergency departments (EDs) during the current Covid surge, caused by the highly transmissible BA.2 variant, is a source of great concern. A press release by the Irish Association for Emergency Medicine (IAEM) on Monday 28 March referred to this pressure as “intolerable”. Indeed, the IAEM stated the activity in EDs over the past few months was above the levels at other points during the pandemic, which were generally agreed at the time to be “unsustainable”. 

Reports from those delivering care in EDs indicate that the ratio of patients awaiting an appropriate space to the number of such spaces available is in the range of 4:1 to 10:1 at various times of the day. “This is far worse than has been seen previously,” according to the Association. 

The IAEM argues the transition away from face-to-face consultations in general practice to remote/ virtual consultation “appears to be an independent driver of a significant increase in ED attendances”. 

“It has been repeatedly and robustly proven over recent decades that ED crowding results in an excess 30-day mortality for all patients and the recently published research confirms that delay to hospital admission is, of itself, a cause of avoidable mortality to the patient subjected to this long wait, irrespective of overall levels of crowding.” 

In addition to the risks for patients, there are risks to staff. The extremely contagious nature of the current variant has seriously depleted healthcare staffing in all areas. However, the IAEM states that staff working in emergency medicine are particularly affected as EDs “do not have the option of closing their doors”. This has added to the strain of working within EDs, given the greatly increased level of activity. 

“Nobody working in Irish emergency medicine is at all surprised at the attrition and burnout that has resulted from this situation or the fact that staff of all disciplines and all grades are opting to leave emergency medicine or emergency nursing,” according to the statement. 

“Inevitably, this will make the care of future patients more challenging as a significant amount of clinical experience and expertise will inevitably be lost.” 

ED overcrowding has been an ongoing issue within Irish healthcare for years and has failed to be adequately addressed by successive administrations. The problem was barely tolerable before the pandemic. But Covid-19 has pushed the situation beyond the point of sustainability. 

The current crisis needs a quick and decisive response from Government and the HSE. It is also necessary that the longstanding concerns expressed by healthcare staff working in the area are finally addressed.