Revealed: the A&Es most at risk of gridlock this Christmas
The nine hospitals which could be A&E trolley blackspots after Christmas and in early January have been spotlighted by the HSE.
It is hoped the gridlock will not reach record levels and cause more misery than last winter.
But the hospitals which could suffer most and are earmarked for the highest level of back-up are Dublin's Tallaght University, Mater Hospital and St Vincent's hospitals.
Also on the radar are Naas General, Tullamore, Galway University hospitals, as well as University of Limerick, Cork University and University Hospital Waterford.
Hospitals are hoping to have as many wards freed up from bed blockers as the inevitable surge looms.
The number of patients attending A&Es is growing at 3.07pc a month for winter-equivalent to an extra 800 people.
New information provided to Fianna Fáil health spokesman Stephen Donnelly has shown that between January and October 2018, 30,922 people experienced waits of more than 24 hours in an emergency department (ED) prior to hospital admission. Some 10,855 of those left waiting were aged over 75.
He said: "While it's not surprising so many have endured such long waits it's still appalling and unacceptable."
It comes as one consultant warned this Christmas will be a particularly busy time in EDs as it falls on a Tuesday, with a full weekend leading up to it.
"What tends to happen, Christmas Day is pretty quiet in the morning, as the day goes on it gets busier and busier," said Dr Fran O Keefe, the Mater Hospital's trauma lead and an ED consultant.
"Christmas night can be very, very busy. Stephen's Day and the rest of that week will be horrific."
He added: "People are unsure about their symptoms, but most GPs aren't open and there are very [few] other areas where you can access care. They know the ED is open 24/7 so they come here."
Hospital groups and community healthcare organisations have said homecare packages are the key to emptying wards and creating space for patients coming through A&E.
In its final winter report, the HSE warned about the increasing pressure from bed blockers - known as delayed discharges.
As of December 14 there were 545 patients still in hospital who could not be discharged with the proper supports.
The HSE said: "This reflects a reduction on the levels in recent weeks but remains higher than that of the same time in 2017.
"Acute beds need to be available for acutely unwell patients, all sites are working with community colleagues to reduce the volume of delayed discharges in advance of the Christmas break as at present the majority of sites are in excess of their tolerance limit."
The plan which was triggered in recent weeks to reduce mayhem includes:
- Increasing diagnostic access to scans for GPs for acute presentations, and extending hours these machines work in acute hospitals;
- Outsourcing some scans to private providers;
- Having senior consultants available to make decisions about admitting patients;
- Cutting down on outpatient clinics and operations on waiting list patients;
- Postponing patients who are due scheduled scans;
- Additional emergency theatre lists will be scheduled. Early access to theatre has positive effects on length of stay. This measure recognises the expected increased demand for patients coming to A&E having suffered an accident or hip fracture;
- One member of staff is to be assigned as liaison for nursing homes to avoid residents being transferred to hospital if not needed;
- Hospitals will get an insider's view on what is happening in other hospitals in terms of trolley numbers and available beds.
It means some patients may be transferred to another hospital rather than lying on a trolley.
Health Minister Simon Harris is to convene a meeting of key officials in his Department and the HSE on December 28 and December 31.
The HSE has 550 additional homecare packages to roll out over the winter with bed blockers getting top priority for the supports. Funding has also been allocated to cover extra aids and appliances, as well as transitional beds.