MORE THAN 5,000 people died or were pronounced dead on arrival in emergency departments (EDs) in the past five years, including over 1,000 last year alone – almost 200 more than in 2019, new figures reveal.

Data from the country’s 26 EDs shows that Cork University Hospital saw the highest number of patients die in its emergency setting. Last year 158 people were pronounced dead there, down from 183 the year before. In 2019, 109 people passed away there.

Compared to the pre-pandemic year, ED fatalities rose in 17 hospitals in 2023. Three sites – Beaumont Hospital in Dublin, University Hospital Galway and Sligo University Hospital – saw more than twice as many deaths in its ED compared to 2019.

The figures were supplied to Irish Medical Times following a series of Freedom of Information requests and include deaths which took place in EDs as well as people who were pronounced dead on arrival.

Just a handful kept records on the average length of time patients were in ED when they died. In Beaumont, this time fell from nine hours and 54 minutes in 2019 to seven hours and 42 minutes last year.

However, in St Vincent’s University Hospital, average times rose by almost 50%, from eight hours and 33 minutes to 12 hours and 43 minutes. The Dublin hospital saw the second largest number of deaths in its ED, with 105 people passing away there last year.

In response, St Vincent’s said there are several factors that lead to ED deaths, including the number and age profile of its patients and their level of illness. It added that all deaths in its ED are reviewed by the hospital to improve its outcomes.

A statement from the hospital said that it is “serving a catchment area with the highest number of older people and more nursing homes than in any other part of the country.”

Deaths in EDs have made the headlines in recent months in the wake of the inquest into the death of sepsis patient Aoife Johnston, which recorded a verdict of medical misadventure.

Two days before her death, the 16-year-old experienced a lengthy wait for treatment at University Hospital Limerick (UHL).

In the last five years 239 people died in the ED at UHL. However, while 58 patients passed away there in 2019, this number fell to 41 last year.

A total of 5,428 people died in the country’s EDs in the past five years. While 1,161 people died in Irish EDs last year, the figure is slightly down on the 1,210 deaths seen in 2022.

However, it is 182 more than the 979 who died in 2019.

A total of nine hospitals saw ED mortality figures stay the same or fall, including Our Lady’s Hospital in Navan which experienced just one ED death last year after a new HSE plan meant that ambulances would no longer bring critically ill patients to the Meath site.

President of the Irish Association for Emergency Medicine, Prof Conor Deasy, pointed to a number of factors that lead to ED deaths, including that the survival rate for out-of-hospital cardiac arrest (OHCA) is just seven per cent. “These cases are brought to the nearest ED, and so understanding that a proportion (of deaths) are OHCA is worthwhile,” he said.

He also referred to the issue of nursing home residents who are in the process of dying being brought to an ED, which in some cases can lead to a more traumatic death than if the person remained in the home.

“Because nursing homes, at night-time in particular, and out-of-hours, can struggle to get access to primary and palliative care, they will call an ambulance. And that patient is brought into the emergency department breathing their last, and dies within a few hours,” he added.

“It takes up a lot of resources in the emergency department that contributes then to the waiting time for other patients. And being shuttled out of your nursing home into the back of an ambulance is not a dignified death.”

Hospitals also face challenges in trying to safely transfer critically ill patients once they arrive in the ED.

“We would prefer patients, if it is looking like they are on a palliative trajectory, to have a single room,” he explained.

“Often hospitals don’t have a single room to give to these patients, or you don’t want to move them down a corridor or up the elevator to that single room, for fear of them dying en route.

“If a patient is likely to die imminently, they’re not likely to go to the ICU either, so they effectively have their care delivered in the emergency department. But it’s not as we would like it.”

In response, a HSE spokesperson pointed to the rising rates of patients going to an ED in recent years. Last year there were more than 1.47 million new and return ED attendances, compared to just over 1.36 million in 2019.

“High level data available on the number of deaths in EDs does not distinguish between those who were expected to die, those who suffered sudden catastrophic medical or surgical conditions, those who were victims of trauma or those who deteriorated unexpectedly in the ED,” the spokesperson said.

“As the number of people living in the community with chronic life-limiting illness increases we expect to see greater numbers presenting in crisis to the ED, as the service that is always available and seen as the access point to unscheduled care.”