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Saturday 17 March 2018

Crowded A&Es put patients at risk in flu outbreak

Five dead, including toddler, after spike in infection rates

James Reilly, inset, ambulances outside Beaumount Hospital
James Reilly, inset, ambulances outside Beaumount Hospital

Eilish O'Regan and Joanna Kiernan

A WORSENING flu outbreak has the potential to "spread like wildfire" in overcrowded hospital emergency departments, a leading consultant has warned.

There is growing concern about the spread of influenza, with the number of reported deaths rising sharply in the past week amid a spike in people contracting the virus.

Five influenza-associated deaths have been reported – including a child under four. And the second largest hospital in the country, Beaumont in north Dublin, was forced to impose visitor restrictions at the weekend as it is in the grip of a flu outbreak.

But Dr Fergal Hickey, president of the Irish Association of Emergency Medicine, warned that the seasonal spread of flu was being exacerbated by overcrowded emergency departments.

His warning comes as fresh figures seen by the Irish Independent show the extent of the wait facing many emergency patients in hospitals nationwide.

The HSE set a target to have all patients admitted to a bed or discharged and sent home within nine hours – but every single hospital has failed to fully meet this target.

Almost a third of patients are enduring the misery of trolley ordeals of nine hours or longer in the most overcrowded hospitals.

And the worst performing hospital is Beaumont, which is the local treatment centre for Health Minister James Reilly's constituents.

Other poor performers are Cork University Hospital, Connolly Hospital in Dublin, St James's Hospital, Dublin, and University Hospital Galway.

Asked about the link between overcrowded hospitals and the influenza outbreak, Dr Hickey said that it was a dangerous combination.

"You have a lot of people compacted into a very small space. If you have patients with contagious flu coming in it is like throwing a match to a tank of oil," he added.

The increase in flu cases has also led the Health Protection Surveillance Centre (HPSC) to call on people in high-risk groups to get vaccinated against the virus.

During the first week of this month, the rate of people presenting to their GP with influenza-like illnesses around Ireland increased to 32.4 per 100,000 population, from a rate of 20.5 per 100,000 just the week before.

This stark increase has exceeded the "baseline threshold" of 21 per 100,000, the number which is used to assess influenza activity in Ireland.

Despite the fact that the young and elderly are most vulnerable, the most pronounced increase was among the 15-64 age group.


"It is still not too late for people who are at risk of the complications of flu to get vaccinated against the disease if they have not already done so," said Dr Joan O'Donnell of the HPSC.

Liam Doran of the Irish Nurses and Midwives Organisation said: "Influenza outbreaks happen, but the problem at the moment is that this increases the problems in our overcrowded A&E departments.

"You can't separate people, and the issue is compounded by cross infection. An influenza outbreak is the last thing that our understaffed and overworked A&E departments need."

Meanwhile, both medical staff and patients criticised the findings that the nine-hour target at emergency departments was not being met.

Stephen McMahon, CEO of the Irish Patients Association, said that this target did not compare favourably to the UK's standard of four hours.

"I think the non-achievement in hitting these treatment targets is an indicator of performance in the acute system," he said.

Dr Hickey acknowledged that singling out emergency departments for league tables was "naturally unfair".

But he insisted they do reflect the work of a hospital as a whole.

"It's about whether the hospital can provide beds for patients who need to be admitted to a ward from the emergency department. This is lost on hospital management. It is not an emergency department target, it is a hospital target."

And Dr Hickey, who is emergency consultant in Sligo General, said some patients may never get a bed and are in the emergency department for a day-and-a-half before being sent home.

He added: "If you come in with a stroke or something that requires you to be admitted to hospital, the only way you can be admitted is if there is a bed for you.

"You can be lying in the emergency department but you will take up a space there. You have a series of knock-on effects."


Delays in patients transferring out of hospital continue to be a major reason for a lack of available beds, despite pledges to fix the problem.

"The emergency department is a barometer of a hospital problem," he added.

Commenting on the situation in Beaumont Hospital, Dr Reilly said it had taken a number of steps already to cope with the increased demand.

He said a number of beds had become available and all medical posts have been filled since January, with an additional six nurses appointed in the past eight weeks.

Irish Independent

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