A NURSING union has requested the Health Information and Quality Authority (HIQA) to conduct an external inquiry to establish why overcrowding is so high in University Hospital Limerick (UHL), despite the provision of almost 100 extra in-patient beds.
The nurses and midwives’ union called for HIQA to investigate what is going wrong at the hospital and make recommendations to alleviate pressure.
UHL has been the most overcrowded hospital in Ireland every day this year.
It had the highest overall number of patients waiting for care without beds in 2017, 2018, 2019, and 2020.
The INMO said that “despite significant recruitment and 100+ additional acute beds”, the hospital still faced “runaway” overcrowding.
On Friday, 52 patients were on trolleys in UHL, more than treble the number in any other hospital in the state.
INMO Assistant Director of Industrial Relations, Mary Fogarty, said frontline staff are at their wits’ end. The hospital has recruited extra staff and secured a hundred extra beds. But it hasn’t made a dent in the runaway overcrowding.
“Something is clearly going wrong in UHL. We are calling on HIQA, to urgently investigate and make recommendations.
“Overcrowding adds stress for staff and worsens patient care. It is high-risk in normal times, but doubly so during an infectious pandemic.
“The HSE have pledged not to tolerate overcrowding during Covid-19 – it’s time for them to live up to that promise.”
Responding to Clare Champion queries, the UL Hospitals’ Group stated over the past number of weeks, University Hospital Limerick, and its Emergency Department, has been managing extraordinary demand for its services, of a type and on a scale never before experienced in the Mid-West.
Despite the additional bed space opened at UHL over the past eight months, the group admitted many admitted patients have been experiencing long waits for beds.
However, a spokesman stressed this is not the kind of care the group wish to provide, and it apologised to any patient who has experienced a long wait for a bed.
The Group’s Chief Clinical Director and the Chief Director of Nursing and Midwifery have met with representatives of the INMO this week to discuss and set out specific actions for managing overcrowding in the Emergency Department in this current period of particularly high demand.
During the past year, there has been an increase in Covid-19 patients, especially during the three periods of peak transmission. There remains significant demand for beds from people who have been de-listed as Covid-19-positive, but who continue to make their recovery from the disease.
On Thursday, April 22nd, the total number of inpatients in UHL who were either query-Covid-19, Covid-19-positive, post-Covid-19, or long-Covid-19, exceeded 40.
The group stated Covid-19 infection accounts for only one aspect in the multi-faceted demand for services at UHL. During the past year, there has also been an increase in serious non-Covid-19 illnesses that have been complicated due to delays in seeking treatment during lockdowns, and which require longer recovery times.
“People are getting sicker with more complicated conditions, and patients need to spend longer in hospital to recover from their illnesses.
“Data for the first quarter over the past three years at UHL shows a cumulative increase of 0.9-days in length of stay for medical patients in the hospital. This has a significant adverse impact on the bed capacity available in the hospital on any given day.
“The group are also experiencing record levels of presentations. In the 24 hours between 8am Monday and 8am Tuesday, 241 people attended our Emergency Department. The following three 24-hour patients brought attendances of 283, 243, and 214.
“Daily emergency presentations at the hospital in excess of 200 are now the norm. The average daily attendance figure for 2019, the last full year pre-pandemic, was 197.
“The group continue to focus on all aspects of patient flow, including access to diagnostic tests that help ensure timely discharge or transfer of patients. No effort is being spared in ensuring that physical distancing in the hospital is maintained, and wait times are kept to a minimum.”
The group stressed all patients continue to receive expert medical care while they wait. Not all patients are waiting on trolleys. Most are in designated bed spaces cubicles, bays and beds in the ED, and in the non-Covid-19 emergency admission stream of the Acute Medical Assessment Unit and Acute Surgical Assessment Unit. Admitted patients are also waiting in designated surge capacity.
The additional bed capacity opened means that patients now wait in ED and designated surge areas, and the beds in the Surgical Day Ward are protected for planned surgeries, allowing access for patients who may otherwise experience delayed episodes of care.
The phenomenon of hospital crowding is multi-factorial, and will not be solved by increasing bed capacity alone. However, the group are grateful for the significant increase in bed capacity in UHL over the past number of months.
This single room accommodation has provided patients with the comfort they deserve, and allowed the group to better manage infection risk in the hospital, not least during the considerably challenging third wave of Covid-19-19 in January 2021.
This in no way minimises the upset that people feel when they experience a lengthy wait for a hospital bed, and we apologise to those people, and their families, who have been inconvenienced at this time.
Dan Danaher
East Clare correspondent, Dan Danaher is a journalism graduate of Rathmines and UL. He has won numerous awards for special investigations on health, justice, environment, and reports on news, agriculture, disability, mental health and community.