Hospitals Under Pressure As EDs Face Growing Demand

The latest statistics on Emergency Care in Northern Ireland make grim reading.

The time waiting for admission through the ED to the Ulster Hospital rose in September 2021 to 13 hours 41 minutes, and across Northern Ireland in September 2021 there was an 8% increase in demand in Emergency Attendances overall with an extra 11.8% patients waiting longer that 12 hours for admission across NI.

These are some of the the grim figures as the winter pressures are mounting on the health service. The Emergency Departments across Northern Ireland are the front line in health care and have to cope with the increasing pressures on demand.

Emergency Care Waiting Time Statistics (July – September 2021)

The Department of Health (DoH) today published statistics on the time spent in emergency care departments (ED) throughout Northern Ireland during the months of July, August and September 2021.

The statistical bulletin presents information on all new and unplanned review attendances during July, August and September 2021.

It details information on the time spent in EDs during each of these months including; the monthly performance against the DoH emergency care waiting times target for EDs and the time waited for key milestones during a patient’s journey through ED, whilst they are being cared for in an ED, including the time to triage and time to start of treatment.

A number of new models of care and pathways have recently been introduced that seek to ensure that patients are able to access the right care, first time. These include Urgent Care Centres, a ‘Phone First’ clinical telephone assessment service and direct access pathways into services. These new pathways and models of care may in part explain the reduction in the number of patients attending ED by providing them with timely access to the care they require.

This information release is published on the Emergency Care Waiting Times website.

Key Points

Attendances at Emergency Care Departments:

Attendances:

• During September 2021, there were 62,882 attendances at EDs in Northern Ireland, 4,665 (8.0%) more than in September 2020 (58,217).
• Of the 62,882 ED attendances during September 2021, 53,862 (85.7%) had attended a Type 1 ED, 4,240 (6.7%) attended a Type 2 ED and 4,780 (7.6%) attended a Type 3 ED.
• Between September 2020 and September 2021, attendances increased at Type 1 EDs (5,093, 10.4%) and Type 2 EDs (787, 22.8%), whilst it decreased at Type 3 EDs (1,215, 20.3%).
• There were 192,037 attendances at EDs during the quarter ending 30 September 2021, 8.0% (14,213) more than during the same quarter in 2020 (177,824).

Left before Treatment Complete:

• During September 2021, 6.6% of all ED attendances left before their treatment was complete.

Unplanned Re-Attendances within 7 Days:

• During September 2021, 3.8% of the 62,882 ED attendances were unplanned review attendances who had returned to the same ED within 7 days of their original attendance for the same condition.Referrals by GP:
• In September 2021, one in seven (14.5%) attendances at EDs had been referred by a GP, compared with 16.1% in September 2020.

Time Spent in Emergency Care Departments:

Performance against Targets

• Almost half (48.0%) of attendances at Type 1 EDs in September 2021 were treated and discharged, or admitted within 4 hours of their arrival, compared with 60.5% in September 2020.
• Over eight in ten (84.1%) patients attending a Type 2 ED in September 2021 were treated and discharged, or admitted within 4 hours of their arrival, compared with 82.6% in September 2020.
• Almost all (99.8%) patients attending a Type 3 ED were treated and discharged, or admitted within 4 hours of their arrival, compared with 99.6% in September 2020.
• Between September 2020 and September 2021, the number waiting over 12 hours increased from 4,210 to 7,396, accounting for 11.8% of attendances in September 2021.
• Almost three quarters (70.3%) of patients attending EDs commenced their treatment within 2 hours of being triaged, compared with 84.1% in September 2020.
• During the quarter ending 30 September 2021, over half (54.8%) of patients waited less than 4 hours at an ED, compared to 65.8% during the same quarter in 2020.

Time to Triage:

• The median waiting time from arrival at an ED to triage (initial assessment) by a medical professional was 12 minutes during September 2021, with 95 percent of patients having their care needs assessed for the first time by a medical professional within 1 hour 7 minutes of arrival. Time to Start of Treatment.
• During September 2021, the median waiting time from triage to the start of treatment by a medical professional was 1 hour 1 minute, with 95 percent of patients receiving treatment within 5 hours 49 minutes of being triaged.

Total Time in Emergency Care Department:

• The median time patients who were discharged home (not admitted) spent in a Type 1 ED was 3 hours 32 minutes in September 2021, 49 minutes more than the time taken during the same month last year (2 hour 43 minutes).
• The median time patients who were admitted to hospital spent in a Type 1 ED was 11 hours 18 minutes in September 2021, 2 hours 38 minutes more than the same month last year (8 hours 40 minutes).
• During September 2021, the Ulster reported the longest median waiting time from arrival to admission (13 hours 41 minutes), whilst the RBHSC reported the shortest time (5 hours).

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1. This statistical bulletin reports the total time spent in an ED from arrival until admission, transfer or discharge for all new and unplanned review attendances at emergency care departments across Northern Ireland. The figures do not include planned review attendances.
2. Time is measured from when a patient arrives at the ED (time of arrival is recorded at registration or triage whichever is earlier (clock starts)) until the patient departs the ED (time of departure is defined as when the patient’s clinical care episode is completed within the ED (clock stops)).
3. The current draft Ministerial targets for emergency care waiting times in 2021/22 state that:‘From April 2021, 95% of patients attending any Type 1, 2 or 3 Emergency Care Department are either treated and discharged home, or admitted, within four hours of their arrival in the department; and no patient attending any Emergency Care Department should wait longer than 12 hours.’‘By March 2022, at least 80% of patients to have commenced treatment, following triage, within 2 hours.’
4. Readers are advised to be cautious when making direct comparisons between Northern Ireland and other UK Jurisdictions as waiting times may not be measured in a comparable manner.  It should also be noted that the way in which emergency care services are delivered differs between UK jurisdictions. This means that the number and types of patients included in the figures may differ between countries. In particular, the 12-hour waiting time information published by England and Northern Ireland is not equivalent and should not be compared. Further information on comparability between Northern Ireland and other UK Jurisdictions are included in:  ‘Emergency Care Waiting Time Statistics – Additional Guidance’ booklet.
5. The DoH have liaised with colleagues in England, Scotland and Wales to clarify differences between the emergency care waiting times reported for each administration and have produced a guidance document to provide readers with a clear understanding of these differences.