At the Regional Health Forum today I had asked a series of questions looking for what I consider to be fairly basic data with regards to where patients attending the Emergency Dept. (ED) in UHL come from and what percentage of them actually needed to be at the ED, or could have been treated at the local Injury Units (LIU) or Medical Assessment Units (MAU).

• Can I be provided with the following data with regards to the operation of the ED in UHL in 2022; 1) Can I be provided with a geographic breakdown, by county based 
percentage, of the presentations to the ED in UHL? 2) What percentage of the presentations to the ED in UHL take place 
between 8pm and 8am Monday to Friday, and on Sat/Sun? 3) What percentage of those assessed in the ED in UHL could have 
been clinically assessed and treated in a MAU or LIU? 

• In 2022 I was provided with a breakdown of the numbers attending the ED through the NAS for the first 7 months of the year. Of the 4122 attendees, 45 were Echo priority, more than 1800 were Delta priority, leaving approx. 2270 lower priority calls. Can I be provided with information from UHL as to how many of these lower priority calls could have been treated in either the MAU or LIU in Ennis.
• Can I be provided with a 24-hour time chart showing the flow of patients by county through the ED in UHL for 2020 & 2021?

At the core of the three questions I asked today, was to get understanding behind the overcrowding situation in the ED at UHL I firmly believe that if we don’t understand the systemic situation and have the data to back us up, we can’t begin to address the problem. Its also important to be clear that I’m coming at this from a solution focused perspective, I want information that might shed a light on the pathway out of the crisis in the ED, rather than just pointing out the problems.

Only one part of the question 1 was answered, (part b, see below), showing 27% of the ED attendances in UHL occur when our LIUs and MAUs are closed to the public. While it might sound simplistic, I would have thought extending the opening hours of these would be a start. It’s also very interesting to note a small difference per night between mid-week and weekends, with just over 3,000 patients average nightly.

Total ED Attendances 2022: 79,891

Total ED Attendances 8pm – 8am:  Monday to Friday 15,358 (19%)

Total ED Attendances 8pm – 8am: Saturday/Sunday 6,517 (8%)

Of course the data from the other two parts of question 1 are critical to understanding if and when this might be worthwhile, but the response to those “It is not possible to determine if a case assessed in the ED could have been treated in an MAU or Injury Unit as this information is not recorded in such a way that a report can be easily generated. This would require the manual review of each individual presentation, this is also the situation for the county based data requested.” means we are completely flying in the dark… and to be honest I find it absolutely extraordinary that the geographical breakdown as to the originating location of the patient, and clinical determination as to whether they could be treated in LIU or MAU isn’t gathered… at the most basic level this is surely fundamental to understanding the root causes of the crisis situation the ED finds itself in, and indeed fundamental to putting management solutions in place.

I asked a colleague of mine who does data analysis about this yesterday and she was completely gob smacked that this information isn’t readily available, in fact every single person I asked about it over the last 24 hours also refused point blank to believe its not.

Again, for question 2, I cannot believe this information isn’t available, maybe I asked the wrong agency, and I should have asked the National Ambulance Service (NAS) instead… but if UHL and indeed the HSE want to solve the problem that is overcrowding in the ED then surely knowing where patients are coming from, their arrival pathways and the clinical determination behind those pathways, is at the most basic level of data gathering. I’m not an IT expert, but I do know some people who are, and this isn’t anywhere near what could be considered a complicated gathering or analysis of data… and it needs doing…! To paraphrase an old saying, the best time to start doing it was 20 years ago, the second best time is today.

Anecdotally NAS staff would tell me 50% of their patients could be treated outside of the ED in UHL, to their immense frustration. I refuse to believe that our overworked and fraught ED staff don’t share the same frustrations on a daily basis as they deal with patients that could have been treated in the injury clinics and MAUs…Maybe the short term solutions to easing the overcrowding of the ED lies in addressing processes across the wider health care system. I really welcomed the change of process within the NAS that sees our MAUs being utilized, but surely the next step is to allow them to do exactly the same for our Injury Units… depending on the demand based on geography, and on clinical assessment and acuity, hence the first 2 questions, and opening for longer, with times that are based on evidence of need, hence the last question. The graph I received does not show me what I asked, the x/y axis are numbers of patients and time across months and years, rather than patient flow across a 24 hour period. I will update once I get that information.

What are next steps, I have contacted my two party Oireachtas colleagues to ask if they will speak to the Minister for Health, Stephen Donnelly, about getting this sort of data from the ED in UHL. I suspect they will be told its an operational matter but to be honest that is a punt to touch rather than a commitment to working toward a solution. Of course, resources and infrastructure are also crucial; otherwise the crisis will just shift to other areas of operations with subsequent delays for the public in the Mid West.