Ann Doherty, the chief executive of the University of Limerick Hospitals Group, has told The Clare Champion of her “upset” at instances where people attending the emergency department in Limerick experience “reduced privacy and dignity.”
Ms Doherty was responding to the Health Information and Quality Authority (HIQA) report, published last Friday, which highlighted a number of patient safety risks in the hospital group.
One of the areas pinpointed in the report was the negative impact arising from overcrowding at the emergency department in University Hospital Limerick.
“It impeded access to patients for care and observation, reduced privacy and dignity, increased the risk of transmission of infection and prevented adequate cleaning of the department,” the report read.
“It upsets me and I have said that,” Ann Doherty commented. “Dignity and respect is a very important value for me as a human being, for me as a practitioner and for us as an organisation. Our emergency department, in its current state because of its size, does not in any way facilitate being able to adhere to those values all of the time. I’m not trying to defend the indefensible. It aggrieves me if there’s any delay for any patient in emergency care,” she said.
However Ms Doherty refuted the suggestion that, with reference to Clare, part of the solution to emergency department overcrowding in Limerick, was to re-open the Emergency Department in Ennis 24 hours a day, seven days a week.
“There hasn’t been a 24-hour A&E in Ennis since 2008. I think we need to remember why we changed it. We changed it because there wasn’t the volume of cases to maintain the expertise of the practitioners and to be able to have the staff available on a 24/7 basis. That hasn’t changed,” the UL hospitals CEO stated.
“There’s more than one solution, than just opening another emergency department. I’m not convinced that would assist because you wouldn’t have the expertise available. For patients, the life-saving measures are about having competent people in the right place at the right time,” she added.
Ms Doherty did not accept that UL hospitals management needed a HIQA report to inform them what the issues were. She pointed to her foreword in the hospital group’s Operational Plan 2014.
“I talk about how we have challenges in relation to the organisation and how that affects the emergency department. So it didn’t take a HIQA report to highlight anything. We have challenges and we have been working towards addressing them. They weren’t created overnight nor can they be fixed overnight. The report does reinforce the issues in relation to the risks we have but they are risks that we have identified ourselves in our own risk register. That is why we have put arrangements in place to try and mitigate those risks bearing in mind that the ultimate solution is never deliverable in 24 hours,” she pointed out.
In their report, HIQA suggested that the enlarged emergency department in Limerick, currently under construction, will not be complete until 2017. However, Ann Doherty took issue with this assertion.
“I don’t work for HIQA. Our intention is to open our department in 2016. The shell of the building is built. We’re finalising the appointment of the contractor for the fit out phase. The building is on schedule time line wise, from my perspective,” she said.
Ms Doherty accepted that some patients are inordinately delayed while awaiting treatment in Limerick.
“There are a group of patients who experience unacceptable delays in accessing the emergency department. Some of that is about patient flow. We have put arrangements in place, for example, to ensure that we don’t have delayed discharges. We have weekly meetings with our colleagues in the community around any delays for patients who might need access to continuing care or community based services. Also, it’s about patients who are coming in for surgery coming on the day of surgery, rather than the day before. All of those things help flow,” she maintained.
“From an emergency department perspective, it’s very challenged from a space perspective and that’s why we’re building a new department, which is only part of the solution. We have to have all of the other pieces in place as well be it short stay units, assessment units, utilising of the beds across the region, the local injury units and the medical assessment units,” Ms Doherty stressed.
She believes patients should make more use of model-two hospitals, like Ennis.
“I know not all of the people in Clare would agree with that but a model-two hospital is the right solution for the population. We need to make sure we utilise that facility which is fantastic with fabulous staff in order to deliver the services across the region. We have moved a lot of stuff to day surgery but there’s always more we can progress to day surgery. We’ve got the local injuries unit out there and we’ve also got the medical assessment unit. Both facilities are about people avoiding having to come to an emergency department. Remember an emergency department is for people who have had an accident or an emergency,” she noted.
Other risks identified within the emergency department in Limerick were delays in the admission of children to wards, while being accommodated in adult surroundings. According to the HIQA report, this was despite the fact that a new children’s area had been developed but remained unopened.
“When the current emergency department opened, prior to my time in Limerick, there wasn’t a separate treatment area for children,” Ann Doherty explained. “We have developed a separate treatment area for children. We got €500,000 from the National Capital Programme to do that. It’s a temporary solution pending the new department. So we have a separate area for the assessment and treatment for children. I can absolutely guarantee you that we had no breaches in children being admitted to the paediatric unit in 2013 because we classify a child as being under 14. You will notice in the HIQA report that they’re saying, that while they accept that, they would classify a child as 16. The history of this in Ireland is that the paediatric hospitals in Dublin go up to 16 but the other hospitals in the country work to 14. It’s an old department of health standard. We’re very open to moving to the new standard but we’re being judged against a standard that isn’t an applicable standard to us,” she added.
Ann Doherty accepted there were occasional issues with reference to cleaning the emergency department. “Yes, if the department is really, really busy it is really difficult to do the cleaning. That doesn’t mean that we don’t do it. Absolutely. It makes it more difficult but that doesn’t mean that we’re not committed to doing it and work very hard to try and maintain the standard. But with the volume of people that come through the door in a 24-hour period, it is absolutely a challenge. The risks of infection are always there when anybody is in hospital. Again, we have an infection control team and we have invested quite heavily around developing standards, policies and procedures,” she said.
By Peter O’Connell