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Rapid action required to ease intense pressures on Emergency Departments in Northern Ireland

29 April 2021

Quarterly figures released today by the Department of Health Northern Ireland for January to March 2021 (Quarter 4 2021) show that more than 10,000 patients were delayed by 12 hours or more, equal to more than one in 12 patients.

This is a decrease of almost 3,000 patients when compared to Q4 in 2020. While the raw number of patients has gone down, the percentage of attendances waiting 12 hours or more has gone up from 8.58% Q4 in 2020 to 8.73% in Q4 2021.

In Q4 2021 there were 118,627 attendances to Type 1 EDs across Northern Ireland. This is a decrease of 22.4% compared to attendances in Quarter 4 of 2020. However, attendances increased by 26.68% from February 2021 to March 2021.

Despite the quarterly decrease in attendances, four-hour performance has continued to deteriorate. In Q4 only 55.8% of patients were treated and discharged or admitted from a Type 1 ED within four hours of their arrival. This is down by 2.9 percentage points compared to Q4 in 2020.

The data also show that in Q4 2021 an average of 3.1% of patients left Type 1 EDs before treatment, equal to nearly 4,000 patients. However, one hospital showed that in March 2021 10% of patients left before treatment.

Dr Paul Kerr, Vice President of the Royal College of Emergency Medicine Northern Ireland, said:

“Since January, hospitals and Emergency Departments have been under continued pressure. While things have eased from a covid perspective, we are entering the next phase of recommencing hospital activity and services.

“Demand is increasing, evident by the 26% jump in attendances from February to March 2021. With this jump comes a significant rise in the pressure on staff.

“In March 2021 over one in twelve patients were delayed by more than 12-hours. This is a shocking figure and action is needed to tackle this – these long delays put patient safety at risk, especially with covid still prevalent in the community.

“More concerning is the data that show in March 2021, an average of nearly four per cent of patients left the Emergency Department before treatment, equal to nearly 2,000 patients. At one hospital 10 per cent of patients left before treatment. These patients may be in a serious condition and they have not received the treatment they need. It is unconscionable that we are unable to provide care for everyone.

“These intense pressures and long delays mean we are also beginning to see a return of crowding in our departments. This is exacerbated by exit block, which is usually a result of flow issues and strongly linked to hospital-wide capacity.

“Last week we launched our campaign Summer to Recover: Winter-proofing Urgent and Emergency Care for 2021. This outlines a series of actions that the NI Government, Health and Social Care Northern Ireland, NHS Boards and ED Leadership Teams can take to ready their departments for what could likely be another gruelling winter.

“As the data show, January to March has been incredibly difficult. Exhausted staff have been working under increasingly high pressures, with limited capacity and resources. Numbers of ambulances have been queuing outside departments, waiting to admit patients. We have been really struggling; the pressures have been intense and with no beds to move patients to, there has been an element of powerlessness.

“Staff cannot go through that again. Patients cannot go through that again. Yet, long delays and crowding are already returning. If demand for urgent and emergency care continues to increase, or if we see a further wave of covid, Emergency Departments will once again be in a very precarious position.

“Going into the pandemic we were underprepared and were in no way ready for what was to come. Now we must learn. We have a chance to change the way we deliver care and remedy the areas that were lacking.

“But we must rapidly take action. First and foremost, we must expand capacity. Then we must look at alternative care and ensure all patients have ready access to it. And ultimately, the pandemic brought inter-departmental and cross-specialty collaboration, we must capitalise on that to maximise flow throughout the hospital.

“If we fail to act or even learn from what went wrong during the waves of the pandemic, then Emergency Departments and hospitals will very soon face the same intense pressures and slip into the same practices that were so detrimental before the pandemic.”


Notes to Editor

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