The Irish Nurses and Midwives Organisation (INMO) is seeking an urgent meeting with the Minister for Health over a new report which highlighted the “unprecedented strain” that emergency departments (EDs) are currently working under.

The report by the Health Information and Quality Authority (HIQA) showed that the health system continues to see an increasing number of patients presenting to EDs that is significantly higher than in previous years.

“This is in the context of a growing and ageing population, with increased delays in treatment due to sustained restrictions on non-urgent care throughout 2020/2021 and reduced attendances at GP services throughout this period.

“Adding to the growing pressures on the acute care service is the reduced access to primary care services with a predicted shortage of GPs. Consequently, issues such as reduced access to community services, limited acute and community bed capacity, ineffective patient flow and insufficient staffing levels, continue to cause overcrowding in Irish EDs,” the report stated.

The report provided an overview of HIQA’s monitoring programme against the national standards in seven EDs in 2022, which included announced and unannounced inspections. HIQA inspectors spoke with staff and management about how care was delivered, observed care being delivered and interactions with people who attended EDs, and reviewed relevant documents to see if appropriate records were kept.

The report noted that on the day of inspection, five EDs were operating above their intended designed capacity, “with some hospitals reporting that they were operating at more than double the occupancy levels they were designed to take”.

According to HIQA’s director of healthcare, Sean Egan, these findings “continue to highlight that overcrowding in EDs compromises the dignity and respect of patients, and poses a risk to the health and safety of patients”.

“Improvements are needed to ensure that there is a balanced approach to the daily operational management of patient flow, capacity and appropriate staffing, which is clearly linked to patient safety and activity,” he said.

As a result of these inspection findings, HIQA has identified four key areas for both immediate and longer-term attention to address safety issues in EDs.

These are:

-The need to continue to urgently build additional capacity within the whole healthcare system, both acute and community

-More responsive leadership, governance and management arrangements at local, regional and national level which acts to address performance issues when identified

-A more effective approach to strategic workforce planning to better anticipate and manage shortages 

-More effective identification, monitoring and management of patient safety risks associated with overcrowding in EDs.

Mr Egan added that ED overcrowding and insufficient access to acute and primary services “will continue to occur unless a system-wide approach is taken to address major structural concerns and respond to, rather than continuing to tolerate or normalise, this problem”.

Responding to the findings, INMO general secretary, Phil Ní Sheghdha, said that the report is “particularly stark when it comes to safe staffing in our hospitals”.

“According to HIQA, of the seven EDs they inspected, only one hospital was properly staffed. This is unacceptable. We know that many nurses are leaving EDs because of the conditions that they are faced with. This phenomenon cannot continue into 2023,” she insisted.

Ms Ní Sheaghdha said that the INMO has sought an urgent meeting with the Minister for Health “to discuss how a more proactive approach can be taken to tackling the very serious challenges that exist in our EDs”.

“We are strongly of the view that emergency measures are now needed to prevent the unnecessary continuation of these inhumane and undignified conditions for patients and really unhealthy working conditions for nurses and midwives and other healthcare workers,” she added.

The HIQA report on EDs can be viewed here.