50,000 walk out of A&E as waiting-time crisis deepens

This includes patients who may have serious medical conditions but leave A&E because they cannot stand the overcrowded conditions and trolley gridlock.

An average of 4,000 patients a month who are registering at emergency departments in the hope of being treated are walking out before being discharged.

Some do so without even being seen by a nurse, the figures, obtained by the Irish Independent, reveal.

They show for the first time the true scale of the A&E crisis, which extends well beyond the official count of patients who are waiting for a bed in order to be admitted.

Although there are numerous reasons why patients leave without being treated, the figures confirm that hospitals with some of the most persistent overcrowding are also experiencing the highest level of walkouts.

In October last year, 613 patients left the Mater Hospital in Dublin before discharge and 375 left University Hospital Galway.

During the same month, University Hospital Limerick lost 303 patients in this manner.

Hundreds also deserted the emergency department of Tallaght Hospital and St Vincent's Hospital.

The problem extends to children's hospitals. The figures show that 71 young patients were removed by their families from Our Lady's Hospital Crumlin and 67 left the emergency department of Temple Street Hospital.

The HSE said these patients who bailed out were recorded under the heading "did not wait". The spokeswoman said the patient may have chosen to leave either before or after triage by a nurse.

Admission

They may also exit without waiting to see an advanced nurse practitioner, a junior doctor or a consultant.

In some cases, they will have seen a doctor but leave without waiting for tests, test results or admission to a ward.

The HSE says that when a patient registers at reception "this is taken to mean that they are requesting help and the advice in such circumstances, irrespective of whether a health professional has seen and advised that individual, would be to remain until admitted or discharged".

It is acknowledged that some of the patients had minor complaints and others may have been drunk or have taken drugs.

But the high number of walkouts inevitably includes many patients with potentially serious physical symptoms or mental distress and who are at risk.

Commenting on the figures, Dr James Gray, emergency consultant at Tallaght Hospital ,said a functioning emergency department should not have a walkout rate of more than 2pc to 5pc.

"The reasons are multiple, but poor conditions like overcrowding and long waiting times to see a clinician are fundamental," he said.

Dr Gray, who is also a medico-legal expert, pointed out that some patients who are feeling better or have decided to seek alternative treatment can decide to walk away.

In cases where drink, drugs or mental illness are involved, doctors want to know if the patient has the capability to make the decision for themselves to leave.

Dr Ken Egan, chairman of the National Association of GP Co-operatives, which provide services out of hours, said he had seen older patients who were frightened of going to emergency departments because they were so afraid of ending up on a trolley.

He said: "They say, 'I am not going to hospital' - even though they are quite ill."

Dr Egan, a GP in Ballindine in Mayo, said: "The overcrowding is putting people off. You could have somebody who is suicidal or another person who has a silent coronary.

"If someone goes in with serious indigestion, they should have all the necessary tests done before they walk away. Coronaries can be missed."

Health Minister Simon Harris has said a review of hospital beds is to be carried out to see where they are most needed in order to help alleviate the trolley crisis