A crack team of HSE experts are being parachuted into Cork University Hospital (CUH) and Galway University Hospital (GUH) to battle chronic patient overcrowding, the Minister for Health said Thursday.
CUH was the most overcrowded hospital nationally Thursday, with 60 patients on trolleys in its emergency department and on wards while there were 23 on trolleys in GUH.
Stephen Donnelly said he was deploying the same HSE National Support Team to CUH and GUH that was sent to University Hospital Limerick (UHL) last April, and which has managed to “eliminate trolleys from wards” according to the Limerick Hospital Group’s chief executive, Professor Colette Cowan.
There were 58 patients on trolleys in UHL Thursday, and while that was two less than the most overcrowded hospital, it was a significant improvement on when 126 patients languished on trolleys at the hospital last April - the highest number of patient overcrowding in any Irish hospital.
Speaking at the sod turning on a 96 single-bed block at UHL, Minister Donnelly said: “I have now said to the HSE that I want the same team to go into Galway and into Cork. We know that Cork and Galway are under significant pressures, so what I want to make sure is that the managers and clinicians there have access to the same ideas and (measures) that so far appear to be working in Limerick.”
Minister Donnelly said the country was in the grip of a “capacity” crisis, which was a symptom of “many many years of inadequate investment” in hospitals like UHL.
However, half of the 96 beds that are to be opened in UHL in two years are actually additional beds - the remaining 48 beds will replace current bed stock located in not-fit-for purpose 'Nightingale wards'.
Minister Donnelly said CUH and GUH could benefit from the same restructuring of patient flow at UHL, which has produced “very positive” results, which has seen “trolleys taken off wards, and the (reduction) of average length of stays” for patients.
Extra nurses
While overcrowding remains a major issue in the Limerick ED, funding has been approved for 30 extra nurses at UHL’s under pressure ED as part of the HSE’s hospital winter plan and Safer Staff initiative, however these extra nurses have yet to be recruited.
A plethora of “hospital avoidance measures” aimed at keeping patients out of the hospitals ED and or being treated from their homes, particularly elderly patients, are now coming on stream.
An Older Person Assessment Centre (OPAC), located near the under-pressure ED will open from next Monday, where “the idea is to assess people to ‘discharge’ and not to assess to ‘admit’”, explained Prof Cowan.
“They might need occupational therapy, physiotherapy in the home, rather than staying in here in our ED or on a trolley,” she said.
The HSE’s intervention at UHL has “sped up the system, so there is no trolleys at ward level, and we have seen a drop in the number of trolleys in the emergency department, and equally the length of (patient) stay has gone down,” said Ms Cowan.
The hospital is currently “achieving an average of 15 transfers a day” to step-down or Model 2 hospitals in the mid west region and recent additional funds have allowed it to appoint a Head of Operations (on an interim basis), as well as ten additional Patient Flow Coordinators “of whom six are in post and already making a difference”.
During September, the number of patients in UHL with a length of stay greater than 14 days was reduced from 132 to 118, saving it 490 bed days, and thus “increasing our capacity”.
It has also “significantly increased” referrals to multidisciplinary community intervention teams following resulting in average patient stays that are “lower than at the same period in 2021”.
A ‘Frailty at the Front Door’ initiative, coupled with time-sensitive targets, which improve transition of patients to community healthcare services and timeliness of care, particularly of elderly patients has recently been introduced at the Limerick ED.
Meanwhile, Minister Donnelly said he wanted to see more emergency medicine consultants on the floor of emergency departments for “much longer hours than there currently are” to continue improvements in patient flow.
There are currently 110 ED consultants nationwide, and minister Donnelly said he has sanctioned the recruitment of a further 51 “as a first step in increasing the workforce”.
He did not rule out the possibility of sanctioning a modular-build elective hospital for Limerick, and cited a facility located just off the site of Tallaght Hospital where he said shops were retrofitted into four day—case surgical theaters, “and on the back of that, Tallaght have managed to reduce their inpatient day case list by nearly a third in one year; it’s very effective, and what I like about it is that it can be done relatively quickly”.
