Hospital faces war on three fronts

UHL reports 89 suspected cases of Covid-19, the highest figure of any hospital in the country

UNIVERSITY Hospital Limerick is coming under considerable pressure dealing with overcrowding, a Covid-19 outbreak in two wards as well as looking after an “extraordinarily” high number of patients with suspected incidence of the virus, it emerged this week.
The flaghship hospital was treating 89 suspected cases of Covid-19, compared with 23 in St James’ Hospital, Dublin, five in Sligo and four in University College Hospital, Galway on Tuesday.
It also had the highest number of confirmed Covid-19 cases in the country with 23, one higher than Cork University Hospital on 22.
An analysis of offical Covid-19 figures in public hospitals has revealed 11 hospital had no suspected case, four had one case, six had two cases and four had three cases on Tuesday.
This has been a trend for a number of days. HSE statistics show there were 86 suspected Covid-19 cases in UHL on September 19, compared with 47 in St James’ Hospital and eight in Tallaght.
Suspected cases were still very high in UHL, which had 72 a day later, compared with 22 in St James’ Hospital and 10 in Tipperary Hospital.
INMO industrial relations officer, Mary Fogarty described the number of suspected cases in UHL as “extraordinary”.
Ms Fogarty pointed out that overcrowding hampered infection prevention and control measures, and increased the risk of the spread of the virus in the hospital.
She said the nursing union would be seeking an explaination for this very high figure, which was worrying.
Senator Timmy Dooley has predicted a difficult winter for health services in the region due to the ongoing overcrowding at UHL, and the delay in some patients attending their GP for medical intervention.
The Clare Deputy is still getting regular representations from very ill constituents about long waiting times on trolleys and lack of public beds. He said the Department of Health and the government will have to continue significant investment in staffing in public hospitals.
He described the presence of 55 patients on trolleys in UHL on Tuesday as very significant, in view of the fact the weather is mild, and the hospital’s hasn’t had to cope with ‘flu yet.
He hopes there will not be any new Covid-19 variant to add further difficulties to the pressures in the ED at the moment.
“Serious illness doesn’t improve by people staying at home so the reality is we are going to have a very difficult winter.
“There can be no suggestion that money that were put into health services can be reduced as the pandemic seems to be on a downward trend because Covid-19 will have an ongoing impact on hospital services for at least two years.
“It will take time to work through the backlog and the increasing waiting lists. Ennis Hospital and St John’s Hospital are full and there are no nursing home beds either. We need to see more beds provided in Ennis and UHL.”
Deputy Dooley is aware of the significant investment in community supports, which facilitates the transfer of in-patients to long-stay residential care or back into their home with care packages.
He has recently been informed the funding for Fair Deal doesn’t come as quickly as it should, which is delaying some hospital transfers.
“There is a proactive approach to moving patients out of hospital. Those who are ready to come home are doing so with significant home car packages, particularly those who needed convalesence. Patients are receiving support from physiotherapists and other professionals to get them back on their feet.”
He hopes new primary care health facilities will help alleviate problems in the long term.
Visitor restrictions have been introduced on two wards at University Hospital Limerick following an outbreak of Covid-19.
Visiting on the two affected wards has now been restricted to compassionate grounds only and relatives and loved ones have been informed of same.
Visiting on other inpatient wards is unaffected and is facilitated by prior arrangement.
The flagship hospital is also dealing with a high number of patients on trolleys. The number of patients on trolleys totalled 55 in UHL on Monday, the second highest in the country, just slightly lower than University Hospital Cork on 56, according to the INMO’s Trolley Watch.
This figure had increased from 37 on September 17 before falling to 47 on Wednesday.
Contact tracing and testing of staff and patients is underway and staff are now, in line with the national guidance, putting into effect all the appropriate infection control measures to mitigate the risk to patients and staff.
In response to queries from The Clare Champion, a spokesperson for the UL Hospitals’ Group said, “UL Hospitals uses ICNet, the group’s infection control software, to record all Covid-19 tested patients. These include suspected cases based on symptoms in our Covid pathway; surveillance testing including in the management of outbreaks; admission screens including in the non-Covid pathway and all patients tested for other reasons (e.g. pre-procedural tests).
“This system was reconfigured specifically for the Covid-19 pandemic. Accurate, real-time ICNet tracking of all suspected and confirmed Covid cases, with data immediately accessible to all frontline clinical staff and senior management, forms a cornerstone of UL Hospitals successful Covid IP&C strategy and permits efficient allocation of finite isolation rooms.
“The figures in the national daily operational reports represent a point in time. Suspected Covid-19 patients who are waiting for a test result one day may be recorded as a positive case the following day. There may also be cases where patients who are Covid-19 not detected in an initial test, but about whom a level of clinical suspicion remains, may subsequently test positive in a retest. Positive cases may also be picked up through screening exercises carried out on the recommendation of microbiology and infection prevention and control teams.”
On September 20, there were 81 new cases in Limerick, 21 in Clare, and 21 in North Tipperary.
On September 21, there were 51 cases in Limerick, 13 in Clare, and 11 in North Tipperary.
Between September 8 and September 21, 1,156 Covid-19 cases were recorded, including 770 in Limerick, 309 in Clare, and 152 in North Tipperary.
There were 1,218 cases of Covid-19 in the Mid-West over the previous 14 days, including 751 in Limerick, 319 in Clare, and 148 in North Tipperary.
The Emergency Department at UHL remains exceptionally busy. High volumes of attendances, including many frail elderly patients with complex medical conditions who require admission, have continued over several weeks now.
In the last seven days, attendances at the ED in UHL have averaged 240 per day, compared to 195 in the last full year prior to the pandemic. The 282 patients who presented over the 24-hour period last Friday is one of the highest figures ever seen at UHL.
At 2pm on Tuesday, September 21, there were 21 admitted patients on corridors in the Emergency Department.
The group regrets that any patient has to wait for a bed and every effort is being made by management and staff to reduce these wait times and to maximise patient flow.
It continues to follow its escalation plan, which includes additional ward rounds, accelerating discharges and identifying patients for transfer to our Model 2 hospitals.
However, current demand for its services is multi-faceted and high numbers of admitted patients require a level of care that, for the Mid-West, can only be provided at UHL. In general, patients currently admitted to UHL are sicker and with more complicated conditions, and require longer inpatient stays to recover.

by Dan Danaher