Persistent overcrowding and unsafe working conditions at University Hospital Limerick is putting patients at risk, according to a letter signed by more than 70 doctors at the hospital.
The letter highlights several “near misses” at the hospital’s acute medical unit where doctors say patients almost died due to understaffing and a lack of medical cover. It says patients have to wait more than 10 hours for a bed in the unit “without any medical attention” while other “lost” patients are sometimes “missed” and are “left unseen by a doctor for a number of days”.
Poor access
The doctors say they have documented the issues so they can be prevented from happening again. “We are the doctors on the ground apologising to patients when things go wrong and all we want for our patients is to be cared for in the best possible manner.”
Because of poor access to outpatient services, “many patients remain on a ward for days to weeks waiting for review by a sub-speciality,” according to the letter, sent to hospital management, Minister for Health Stephen Donnelly and others last June.
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The 72 non-consultant hospital doctors (NCHDs), who have made a protected disclosure detailing their grievances, say previous warnings by staff have not been acted on by the hospital.
The doctors say there is “great concern” among staff about escalating clinical incidents or important issues to management. “There is fear of retribution or informal punishment should a person be identified as suggesting change or discussing pertinent issues in UHL.”
After a previous letter was written by medical registrars in 2021, they claim, there was an “internal witch-hunt” to identify the authors.
The views of the doctors accord with that of the Health and Information Quality Authority (Hiqa), whose report in June found the “overcrowded and understaffed” emergency department at UHL posed a significant risk to the provision of safe care.
Since then, HSE officials have been sent to the hospital to find ways of improving flow but ED overcrowding remains one of the worst in the State. Last Friday, there were 70 patients on trolleys in UHL, the highest figure of any hospital, including 25 on wards.
In relation to staffing, the doctors say only 38 out of 58 registrars are doing on-call, meaning this service is operating at well below capacity.
“Many NCHDs don’t want to work in UHL and actively avoid it, because of the working conditions,” according to the doctors, many of whom have moved on to work in other hospitals as part of their training.
Assessment slots
UHL said the primary concerns raised by the letter relate to patient pathways established in response to the Covid pandemic. While necessary to manage patients and protect staff, they impeded the flow of patients and reduced GP access to medical assessment slots.
Since last month, the streaming of patients in this way has ceased, thereby addressing many of the concerns raised, a spokesman said.
One of the cases detailed by the doctors was of a patient with jaundice who came to the emergency department and was triaged as part of the acute medical unit pathway. An ED nurse checked her bloods “a few hours later” and found her liver function was “seriously deranged”, according to the UHL doctors. The patient was moved to resuscitation and then the high-dependency unit and a liver transplant unit in Dublin was contacted. “This young girl could have died should she have waited a few hours more,” the doctors say.
In relation to “near misses”, the hospital said all incidents raised are followed up on to ensure necessary improvements are made. “It is essential that any member of staff who is aware of a near-miss records it on the system so any appropriate action, learning or opportunity for improvement may be taken.”
