The lack of capacity at University Hospital Limerick (UHL) came into focus this week, after it emerged there was no bed to accommodate an Ennis patient in a wheelchair.
Councillor Ann Norton has confirmed that there was no bed available to accommodate her daughter, Nicole, who suffers from Cerebal Palsy and a number of other medical conditions, when she attended the new Emergency Department (ED) on Thursday last.
With 51 patients on trolleys in the new €24 million state-of-the-art ED at UHL on Tuesday morning, councillors from Clare and Limerick tabled numerous related motions about overcrowding and bed capacity at UHL at a HSE West Forum meeting later that afternoon.
In recent days, the UL Hospitals Group outlined that activity has been very high, with 186 attendances in the 24 hours up to midnight on Sunday, September 24; 244 attendances in the 24 hours up to midnight on Monday, September 25 and 214 attendances in the 24 hours up to midnight on Tuesday, September 26.
Traditionally, average attendances at the ED have been approximately 150 over a 24-hour period from Monday to Friday and 120 per 24 hours at weekends.
A 17-bed short-stay unit for medical patients opened in the old ED last week.
Chief director of nursing, midwifery and clinical operations, Noreen Spillane told the forum meeting it was hoped that 20 beds in St John’s Hospital, Limerick, would re-open by the end of October, once some staffing issues were resolved.
Ms Spillane acknowledged that the lack of beds on the UHL site is an issue and she was hopeful that new beds in Nenagh Hospital would open in November.
Councillor Norton told The Clare Champion that, when she attended the ED with Nicole and her husband, Cathal,on Thursday at 3pm, they were told that there was no bed in the hospital for Nicole.
She said Nicole was placed on a drip and was treated for her ailment and, once she was happy she could manage her at home, they left at 11pm. She stressed that all the doctors and nurses were lovely and the only issue for all patients in the ED that night was the lack of beds.
She said she felt sorry for elderly people, who had to wait long periods in UHL to get a bed, which continues to be a serious problem, despite the opening of a new ED last May.
“I dread going into the ED at UHL and Nicole dreads it too. There is a calmer atmosphere now and a much bigger space in the new ED but there is still a huge volume of patients, who need to be accommodated in beds. I get calls regularly from people about waiting times for a bed in UHL.
“Beds that are closed in the region, such as the 20 beds in St John’s Hospital, need to be opened immediately. Until more beds are provided, the new ED is not going to work.
“More diagnostic services, such as an x-ray, scope or CT scan, should be provided on a 24-hour basis to reduce patients’ length of stay and to try and clear the current backlog.
“Someone has to take responsibility for what is happening. There is huge money being spent on providing services at UHL and people still are having problems,” she said.
Councillor PJ Ryan has revealed that he is receiving up to 20 representations from Clare patients and people outside the Shannon Municipal District in Clondrinagh and Caherdavin, who are very unhappy with waiting more than 24 hours in some cases for a bed in UHL.
The councillor said that, some weeks, he receives more representations about UHL than about the lack of housing, which is the other big issue affecting people.
“People were under the impression that having people on trolleys would be a thing of the past, when the new ED was fully operational. That is not the reality, as there aren’t enough beds.” he said.
Describing the 51 people on trolleys on Tuesday as “crazy” at the HSE West Forum meeting, he said he hoped the provision of an additional 17 beds in the old ED and 20 beds in St John’s would help ease the overcrowding.
He stressed that Health Minister Simon Harris needs to be told that the money for the new 96-bed block at UHL “needs to come, sooner rather than later”.
“The new ED is working well but, once you get past this, there is a stumbling block. People are being left in waiting rooms, which is better than being left on a trolley but this situation needs to be resolved,” he said.
UL Hospitals Group pointed out that the ED in UHL is the busiest in the country, with over 64,000 attendances in 2016. The numbers presenting continue to increase year-on-year and, of those presenting, the proportion requiring admission, including many frail elderly patients, has also increased.
In June 2017, the first full month since the opening of the new department, there was a 6.4% increase in ED attendances, compared to the corresponding month in 2016.
In July, attendances increased by 9.7% year-on-year. This is at the upper end of the expected increase in attendances associated with the opening of the new ED.
In addition to the increased volumes of patients attending, increased complexity and acuity is also a factor. The number of patients attending the ED requiring admission has increased by 9.3% in the year to date.
The group stated that it regrets that any patient has to face long waits in the ED during busy periods and added that a number of measures are being taken to relieve pressure on the ED, in line with its escalation plan.
Among the measures taken to relieve pressure on the ED are: the transfer of suitable patients from UHL to Ennis Hospital, Nenagh Hospital, St John’s Hospital and Croom Orthopaedic Hospital; the transfer of appropriate patients to community care settings; working closely with community intervention teams to provide antibiotics and other basic care in a patient’s home or care facility; communication with GPs to ensure patients are referred to ED, only where appropriate; extra ward rounds and, as a last resort, extra beds are put on wards.
More long-term plans to add to bed capacity in the region include a bid to build an additional 96-bed block on the UHL site. This has been submitted to the Department of Health and approval has been granted for funding of the design stage of the build.
At just over 400 in-patient beds at UHL, bed capacity at the hospital is widely recognised as being insufficient for the needs of the region.