Almost 1,300 people died due to delays in hospital admission from A&E, data suggests

Almost 1,300 patients died over the winter as a result of delays in hospital admission from emergency departments, according to an analysis of Health Service Executive data.

The death toll is 174 higher than the 1,104 excess deaths linked to healthcare delays that were estimated to have occurred last winter, the Irish Patients’ Association said. This exceeds the 155 people who died in road traffic incidents last year.

The association based its estimate on HSE data on patient experience times, which shows 104,818 patients have waited more than six hours to be admitted this winter.

There is one death within 30 days for every 82 patients forced to wait more than six to eight hours for a bed, British researchers estimated in a study published in the Emergency Medicine Journal last year.

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Applying this ratio to the Irish figures, the association estimates 1,278 excess deaths occurred among Irish patients in the winter period up to January 29th. It said questions needed to be answered as to why patients were having to wait longer for a bed despite the addition of 332 beds last year.

The estimate used does not take account of beds in private hospitals, which the HSE has at times relied on to ease the pressure on the public system.

The Health Protection Surveillance Centre said access to healthcare was one important factor that may have impacted on excess mortality this winter. However, it stressed that flu and pneumonia accounted for a “significant proportion” of the additional deaths.

Ireland reported excess deaths for several weeks this winter, with 75-84 year olds the most affected, a spokeswoman said.

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“Reassuringly, as levels of these respiratory virus infections have fallen since early-mid January 2023, the level of excess deaths has also fallen and now no excess mortality is being recorded for late January/February 2023.”

The Department of Health noted that a number of different methodologies have been developed by organisations and academics nationally and internationally to try to estimate levels of excess mortality “and it should be noted that estimation methods vary widely”.

“As we have experienced a winter of high levels of influenza cases and hospitalisations, it would not be unexpected to see excess mortality,” a spokesman told The Irish Times.

Fergal Hickey of the Irish Association of Emergency Medicine described the patient group’s estimate as “probably conservative”.

“When someone in their 70s or 80s dies no one asks ‘was there a delay in their treatment’. It is only when they are young that it gets attention,” he said.

Among the reasons put forward by the UK researchers for a link between hospital delays and excess deaths are slower access to vital treatments resulting in longer hospital stays, the risk of hospital-acquired infections, and physiological and psychological deconditioning.

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Stephen McMahon of the Irish Patients’ Association said the estimate was not intended to cause embarrassment or to undermine the “fragile trust” in the health service. “This brief aims to inform and generate discussion with policymakers and stakeholders to better improve the quality of the HSE’s management information systems.”

Almost €900 million has been committed to the HSE’s winter plans over a three-year period, he pointed out.

Across Europe, a spike in excess deaths this winter has caused concern, amid claims it is partially driven by delays in accessing treatment. In the UK, the Royal College of Emergency Medicine recently estimated that between 300 and 500 excess deaths a week were occurring due to these delays.