University Hospital Limerick (UHL) has a level of acceptance about the “intractable nature of overcrowding” and believes that increasing bed numbers is the only solution, the Health Service Executive (HSE) has been told.
In response to concerns around pressures on the health service in the Midwest, the HSE and the Department of Health established a support team in May to look at the issue of overcrowding.
The team was made up of Grace Rothwell, the HSE’s national director of acute hospitals, Orla Kavanagh, director of nursing and integration at Waterford University Hospital, and retired emergency medicine consultant Dr Fergal Hickey.
Bernard Gloster, chief executive of the HSE, said the team completed a nine-page report in June that detailed a number of observations and recommendations for the hospital.
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He said the team reported they did not believe capacity was the only issue, but the management of patient flow was a contributing factor.
“One of the things they said was discharges were largely unknown on any given day. In a hospital that’s under that type of pressure, that’s a very significant thing. You’ve to plan a discharge,” he said.
According to Mr Gloster, the report said every patient should have a predicted day of discharge (PDD) as they come into the hospital, which would help the hospital team to ensure patients are treated in a more timely manner.
“They also went on to say that the time of day for a discharge was a serious problem. There were very little discharges done by 11am and, in fact, by the time a lot of discharges were done, they were after 5 in the evening. That’s neither an appropriate thing to do with the patient’s time ... but it’s also not an appropriate way to run a hospital,” he said.
“The third [observation] they made was access to diagnostics – in other words CAT scan and imaging – is a big enabler to patient flow. While it has improved in the hospital, there is anecdotal evidence that it is not focused first and foremost where it should be prioritised.”
The full report is due to be published at the end of this month.
Mr Gloster was speaking following an announcement from the UL Hospital Group of the postponement of scheduled care “until further notice” due to pressures on the emergency department (ED) in UHL. This was a recommendation by the support team to “take the heat” out of the hospital and de-escalate the situation.
On Wednesday evening, there were 84 people awaiting care on trolleys and a further 58 patients in surge capacity in the hospital – meaning there were 142 people who could not be accommodated in normal hospital accommodation.
The decision to postpone scheduled care has been criticised by the Irish Hospital Consultants’ Association (IHCA), who said it was an “abandonment of the people” in the midwest.
But Mr Gloster said there are a “lot of exemptions” to the postponement of scheduled care, such as cancer care and time-critical surgeries, among others.
He added that the consequences of this action are “better than the alternative” which could see acutely ill patients waiting longer than appropriate for medical treatment due to bed shortages.
The Health Information and Quality Authority is currently undertaking an assessment as to whether there is a need for a second ED in the midwest.
Separately, a report by former chief justice Frank Clarke into the death of 16-year-old Aoife Johnston, who died in UHL after waiting more than 15 hours for antibiotics, has been completed and is with senior HSE officials.
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