Summary metrics
HIQA analysis indicates that UHL operates with a reported emergency inpatient length of stay of approximately five days, an ED admission rate of around one-third of attendances, and inpatient bed occupancy persistently in excess of safe operational thresholds.
| Metric | UHL (best supported value) | Comparator / context | Source |
|---|---|---|---|
| Emergency inpatient length of stay | ~4.5–5.5 days | Model 4 average ~5.5–7.0 days | HIQA Work Stream 2 (HIPE-based analysis) |
| ED admission (conversion) rate | ~30–35% | Model 4 average ~22–28% | HIQA Work Stream 2 (PET + HIPE comparative analysis) |
| Inpatient bed occupancy | >85% (often ≥130% with escalation capacity) | Safe benchmark ≤85–1300% | HIQA Work Stream 2 and ESRI capacity modelling context |
Note: Outputs are illustrative and intended for scenario exploration under transparent assumptions. Interpretation should take account of recognised limitations in linking ED (PET) and inpatient (HIPE) datasets and the effects of sustained system constraints.
Background: The operational MIDCARE model provides a site-specific, dynamic view of emergency care demand and trolley pressure at UHL. It is intended to complement ESRI’s regional, population-based projections included in HIQA's review on UEC in the MW, by making key assumptions explicit and enabling scenario exploration at the level of a single Model 4 hospital. ESRI projections are regional, scenario-based estimates anchored to baseline utilisation patterns and are not designed to forecast UHL attendances directly.
Methods: Historic ED attendance data for UHL from 2014 to 2025 are used as observed baseline, with projections commencing from 2026. Trolley demand is derived from ED attendances, an ED admission (conversion) rate and average length of stay. Capacity is modelled as a separate growth process and can be linked to or decoupled from demand growth. Critical mass thresholds (multiples of K) are identified and displayed as vertical markers.
Results: The model generates projected trajectories for ED attendances, trolley demand and capacity, along with a shortfall series and critical-mass crossing years. For plausible parameter settings, the dashboard illustrates how compounded demand growth and constrained capacity can produce persistent overcrowding and recurrent breaches of critical thresholds.
Conclusions: This is a dynamic simulation model rather than a static model. By exposing assumptions and enabling scenario testing, it operationalises HIQA’s advice that ESRI projections should be interpreted alongside observed demand and site-level analyses. The dashboard is intended as decision-support to align long-term capacity planning with operational realities at UHL.
This annex supports interpretation of ESRI capacity projections alongside observed emergency department attendance trends at UHL. It is provided to ensure that operational, site-level data are interpreted consistently with the strategic evidence base used in the HIQA Mid West review.
The ESRI projections referenced in HIQA’s review are population-based, scenario-driven estimates intended to inform long-term planning for acute hospital capacity. They are regional planning estimates and are not designed to forecast site-specific ED attendances at UHL.
UHL is the primary Model 4 hospital in the Mid West and absorbs a high volume of urgent and emergency care demand. The dashboard baseline uses observed ED attendances (2014–2025) to illustrate the scale and trajectory of demand at the site level.
The ESRI projections and the operational dashboard address different but complementary questions. ESRI projections support strategic, regional planning. The dashboard supports operational scenario exploration anchored in observed UHL activity and makes assumptions explicit.
HIQA evidence indicates that demand for urgent and emergency care and inpatient capacity at UHL remains mismatched. Accordingly, ESRI projections should be interpreted as planning envelopes and complemented by site-level monitoring and operational analysis.
The dashboard serves a distinct but complementary purposes to HIQA's review. Strategic planning should be informed by ESRI regional projections, while operational planning and risk management require ongoing monitoring of observed UHL ED attendances and demand–capacity mismatch at the site level.