Tragic Consequences of Overcrowded Emergency Departments

Only weeks ago, at the inquest into the death of Aoife Johnston, who sadly passed away at just 16 years of age at University Hospital Limerick, the words "warzone" and "deathtrap" were used to describe the situation at the hospital's Emergency Department.

It has now been revealed that a staggering 239 patients died on trolleys at UHL over the five-year period from 2019 to 2023. This alarming statistic was revealed at a recent regional health forum, painting a grim picture of the dire state of emergency care in the region.

The forum, which included councillors from Donegal to Limerick, discussed these figures in response to a query from Councillor Cillian Murphy for a breakdown of inpatient deaths on trolleys in emergency departments across hospitals in Letterkenny, Sligo, Galway, and Limerick.In addition to the 239 deaths at UHL, Galway University Hospital reported 195 deaths, Sligo University Hospital 150, Mayo University Hospital 117, and Letterkenny University Hospital 108. Although the specific circumstances of these deaths were not always clear, the majority occurred in highly critical situations, often in resuscitation rooms.

These figures suggest a serious systemic issue with our healthcare system's ability to provide timely and adequate care to critically ill patients. Each death represents not only a failure of the healthcare infrastructure but also an individual tragedy for families and friends, who suffer the traumatic loss of their loved ones under often avoidable circumstances.

Consequences of Overcrowding in Emergency Departments

The high number of deaths on trolleys reveals several critical issues:

1. Lack of Immediate Care: Patients with life-threatening conditions or those at the end of life require immediate and specialized care. The delay in providing such care due to overcrowding directly contributes to these deaths.
2. Psychological Trauma: For families and friends, the death of a loved one on a trolley in a crowded emergency department is an unimaginable trauma, compounded by the feeling that more could have been done.
3. Staff Burnout: Healthcare workers are pushed to their limits, managing an overwhelming number of critical cases without sufficient resources. This not only impacts patient care but also the well-being and efficiency of the staff. If staff are not enabled to deliver the care they know a patient requires, they are also being failed by the system.
4. Systemic Inefficiencies: The recurring theme of high patient volumes and inadequate infrastructure points to systemic issues that require comprehensive, long-term solutions rather than temporary fixes.

To address this hazardous situation, some actionable measures have been suggested including:

1. Increase Funding and Resources: Allocate more resources to emergency departments to expand capacity, reduce patient wait times, and ensure that every patient receives timely and appropriate care.
2. Upgrade Local Hospitals: As advocated by the Friends of Ennis hospital group, upgrading smaller hospitals like Ennis to model 3 status can alleviate the pressure on larger hospitals like UHL, ensuring a more balanced distribution of patient load.
3. Implement Alternative Care Pathways: Enhance and expedite the implementation of alternative care pathways such as the geriatric emergency care service, GP at the door service, and 24/7 medical assessment units to reduce congestion in emergency departments.
4. Monitor and Improve Care Processes: Establish a robust system for monitoring patient outcomes in emergency departments and continually improving care processes based on real-time data and feedback.

The tragic deaths of 239 patients on trolleys at University Hospital Limerick, and similar figures across other hospitals, are a stark reminder of the urgent need for systemic change. As the Johnston family said at the conclusion of the inquest, it is not enough to acknowledge the problem; concrete actions must be taken to ensure that no more lives are needlessly lost due to inadequate emergency care. The government, healthcare administrators, and community stakeholders must work together to create a healthcare system that prioritizes patient safety, timely care, and the well-being of both patients and healthcare professionals.

Written by Johan Verbruggen.