Significant reduction in hospital discharges and surgical care over past year

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Data on the impact of the COVID pandemic on hospital discharges and surgical care will be presented at the National Healthcare Outcomes Conference today.

In a presentation to the conference, Mr Kenneth Mealy, Co-Lead of the National Clinical Programme for Surgery and Chair of the Board of the National Office of Clinical Audit (NOCA), will outline a significant reduction in hospital discharges and surgeries between the calendar years 2019 and 2020*, and an increase in waiting lists.

  • There has been an 18% decrease in total discharges across all specialties and a 20% decrease in elective stay discharges.
  • Cancer discharges have decreased by 15%. There has been a 26% decrease in colorectal cancer surgery and a 38% decrease in breast cancer surgery**.
  • There has been a 26% reduction in all emergency surgery and a 15% reduction in emergency colorectal surgery.
  • Respiratory discharges have decreased by 21%. COPD and asthma discharges have decreased by 23% and 26%, respectively.
  • There have been 28% fewer total hip replacements and a 36% reduction in unilateral hernia repairs.
  • 34% fewer gallbladder surgeries took place.
  • Out-patient waiting lists have increased by 12.2%. The number of patients waiting for longer than nine months has increased by 40.8%.
  • Waiting lists for day cases or inpatient care have increased by 31.7%. The number of patients waiting for longer than nine months has increased by 111.1%.

Commenting on the data, Mr Mealy said: "At this point of the pandemic, we have more questions than answers about why we have seen this dramatic decrease in discharges and surgical care. The data presents us with an opportunity, however, to understand the factors behind hospital admissions. Perhaps more care can be appropriately provided for in the community. Perhaps better access to senior decision-makers and diagnostics would reduce the need for hospital admissions and give more timely hospital care for those who need it."

Mr Mealy said that "scheduled healthcare will always be compromised when hospitals are under pressure. Data from NOCA indicates that high quality patient care has been provided throughout the pandemic, however, it is clear that our failure to separate scheduled surgical care and emergency care has exacerbated the negative impact on non-COVID medical activities.

"Some patients have been appropriately cared for in the community, others remain on or have been added to a waiting list. There is a clear impact here for serious non-COVID conditions. It's important that these patients are quickly identified, so they can receive the care they need. Many will be in pain and their conditions will deteriorate while they wait."

Professor Jan Sorensen, Director of the Healthcare Outcomes Research Centre at RCSI, said: "The data presented by Mr Mealy today highlights the challenges ahead for the health services. This calls for tough decisions towards future use of healthcare resources and an urgent need to integrate service data into the decision-making process. As the end of the pandemic is approaching, a sustainable approach to managing the growing waiting lists in a resource-constrained system will be to base decision-making and resource allocation on clear outcomes-based criteria."

Established in 2016, the Healthcare Outcomes Research Centre is a leading Irish research centre dedicated to the development and dissemination of evidence-based research on healthcare outcomes that will inform healthcare policy and improve patient outcomes.

Questions around how healthcare provision can be sustained during the pandemic will be addressed during today’s conference. Speakers include:

  • Ms Jessica Matrinez, Senior Programme Officer, the Bill and Melinda Gates Foundation – 'Future directions for healthcare'
  • Mr David Meredith, Partner, McKinsey & Company – 'Learnings for future healthcare policy'
  • Mr Michael Dowling, President and CEO, Northwell Health, USA – 'Learning for the acute hospital sector'
  • Dr Niek Klazinga, Head of the OECD Health Care Quality Indicator Programme – 'Impact and learnings: an OECD perspective'
  • Mr Paul Reid, Director General, HSE – 'Organising future healthcare'

The full programme with registration details is available here

* Data extracted from NQAIS/HIPE 2020, National Pricing Office, HSE

** This data relates solely to care provided within the public health system and does not account for care that might have been provided through the private system