Role change for Ennis hospital

AN extra 70 patients per week, who were previously treated at Ennis hospital, will be transferred into the Mid-Western Regional Hospital, Limerick, once a new model of acute care is fully introduced in the Mid-West.

 

That’s the forecast issued this week from the INMO representative, Mary Fogarty following the publication of a new development framework entitled Securing the Future of Smaller Hospitals.
The nursing union representative warned this volume of patients would increase if the service was only available on five-day-week basis.

Ms Fogarty insisted nurses felt that no further changes should be implemented in Ennis until significant improvements are seen in Dooradoyle to eliminate overcrowding in the emergency department as well as no extra beds or trolleys on wards.

“Members would support the changes if and when this is resolved. A seven-day a week service would greatly support Limerick and would be much welcomed for Ennis and this is feasible if the resources are put in place,” she said.

Another significant concern for the union official is where will patients be placed if there are no available beds in Limerick and will the ambulance services have the capacity to deal with further additional demands?
The removal of 24-hour emergency services at Ennis in April 2009 is copperfastened with the changes outlined under the Smaller Hospitals’ Framework.

According to the HSE, work is continuing on the development of a medical assessment unit (MAU) and a local injuries unit (LIU) at Ennis Hospital on the lines of changes successfully introduced in Nenagh last year and following consultations with staff, ambulance, specialist services and Clare GPs.

The LIU in Ennis will function 12 hours a day, seven days a week. Eight beds will be available in the new MAU and Ennis hospital will continue to assess and admit GP referred medical patients for less critical conditions.

Clinical director of the medicine directorate, Dr Con Cronin said the authority hopes to have these new arrangements operational in the near future.

“Our immediate priority is to ensure we have all the protocols and practical requirements in place and fully understood. A working party representing all of the hospital and professional interests including Clare GPs is engaged in this process,” he said.

According to the new blueprint, conditions such as fever, seizures, headache, serious head injury, chest pain, respiratory conditions, abdominal pain and neck/back pain will not be treated in the LIU, which will concentrate on non-life or limb-threatening injuries.

However, neither the new report nor the HSE could confirm what conditions will be treated in the new MAU because the criteria and opening hours still haven’t been decided.

Ennis is now classified as a Model 2 Hospital, which will not see a return of its intensive care or cardiac unit, so patients will have to be assessed and tracked using the national early warning score to establish if they can be treated safely in the hospital or if they need to be transferred elsewhere.

Clare GPs will play a critical role in terms of deciding whether patients with medical illnesses can be referred to the MAU in Ennis for assessment or whether they need direct transfer to Dooradoyle for urgent and critical care.

Dr Cronin explained all access to the MAU is through a GP who will make contact with a case manager in the unit. If further medical assessment or diagnostics are necessary, the patient will remain in Ennis. After being seen in the MAU, the patient could be transferred into Dooradoyle for critical care, be discharged home or secure an outpatient appointment. A consultant or senior registrar will carry out assessments. If the medical condition can be treated in Ennis, the patient could be admitted to the state-of-the-art 50-bed unit in the hospital.

Dr Cronin said the working party is working through these issues in terms of new arrangements. “Three acute medical physicians have been appointed in Dooradoyle and are running an acute medical unit. Their job will be to look at patients referred from the regional and by GPs. Their input into a fully functioning AMU will help address A&E concerns and delays on trollies.

“Ennis will be viewed in an integrated structure with St John’s and Limerick. We will be looking at patients in a different way. If they need critical care they will go to Dooradoyle and could go back to Ennis for their continuing care. Physicians in the different hospitals will work together as a team, whether the patient is in Ennis or Limerick.

“The benefits in Ennis will be continuing use of ambulatory facilities a lot more use of diagnostic facilities CAT scan and echo stress test

“It will be a very busy hospital in the context of the right patient getting to the right hospital. There are already new dermatology and rheumatology clinics and other clinics are planned in the near future.

“We will be using the four hospitals as one unit as a hub and spoke. We expect that patients from all the Mid-West will be attracted to Ennis depending on the speciality,” he said.