THE RANGE of services currently provided at Ennis General Hospital are unsustainable and unsafe, according to a report published yesterday.
The report, which follows an investigation into the quality and safety of services at the hospital upon the revelation last year that at least two cancer patients – Ann Moriarty and Edel Kelly – had been misdiagnosed, says acute, complex and specialist services should be discontinued.
“Continuing these acute services, including acute and complex surgery, cancer surgery, level 2/3 critical care and 24-hour emergency department services, in their current structure, exposes patients to potential harm,” it says.
It recommends daytime minor-injury services should be developed at Ennis instead.
It also says ambulances carrying children or pregnant women should bypass the hospital and take their patients instead to the Mid-Western Regional Hospital in Limerick. There are no paediatricians or children’s nurses in Ennis nor any obstetricians or midwives.
The report, published by Hiqa, the Health Information and Quality Authority, does not recommend Ennis hospital’s closure. It says the hospital has a role to play but a different one, more in the area of diagnostics, day surgery and rehabilitation as part of an integrated regional hospital network.
The report says there are insufficient numbers of patients presenting for major surgery to keep theatres open around the clock or to maintain the skills of staff.
The investigation team found that, for example, Ennis did a total of nine colectomies (removal of the large bowel) last year.
“This indicates that Ennis does not see sufficient volumes of patients requiring acute and major surgical procedures to maintain the skills and expertise of clinical staff.
“The investigation team believes this represents potential serious risk to patients,” the report says.
The provision of more staff and resources at Ennis would not address this fundamental issue of low patient volumes in specific areas. There is an increasing body of evidence to show that outcomes for patients are better when care is provided by teams treating higher numbers of patients.
The investigation found that while breast cancer services ceased in Ennis in September 2007, some patients were still self-referring or being referred by their GP. It also found that some serious adverse events brought to its attention by seven families who came forward were not on the Ennis hospital incident-reporting system and there was no system at the hospital for logging verbal complaints.
During the investigation, Hiqa found a number of serious patient-safety issues which it immediately brought to the HSE’s attention. These were issues around delays in transferring critically ill patients from Ennis to Limerick and intensive care service.
In all, the report makes 65 recommendations, 19 of which have a national significance.
Diane Whittingham, chair of the investigation team, said the recommendations present difficult and significant challenges.
Dr Tracey Cooper, chief executive of Hiqa, said the current economic climate should not hinder the report’s implementation.
Asked why the report did not answer questions raised by the families of Ms Moriarty and Ms Kelly, she stressed the investigation was never meant to be a forensic examination of individual cases. It set out to review the totality of services at Ennis and this was made clear in the terms of reference for the investigation.
Dr Alan McKinney, a member of the investigation team, said even if certain services were unsafe, it would have been “wrong to suddenly close a hospital until properly safeguarded alternatives are in place”.
Ennis is an 88-bed hospital which dealt with more than 6,000 admissions and more than 19,000 emergency department attendances last year.