Emergency department at University Hospital Limerick like a 'cattle mart'

UHL had the worst level of overcrowding in 2017 in Ireland with 8,889 patients being treated on trolleys at ED

There are 40 patients on trolleys in UHL ED this Wednesday - INMO

STAFF working at University Hospital Limerick have told a Limerick TD they have never seen the trolley crisis "so bad".

Commenting on the situation, Deputy Maurice Quinlivan said: "It is not acceptable for suffering patients to be treated like this and it is not acceptable for our health professionals to be working under such strained conditions. The trolley crisis is out of control."

This Wednesday, there 79 patients on trolleys in UHL - 40 in the Emergency Department (ED) and 39 in other wards, according to the INMO. The next highest in the country is Cork University Hospital with 50.

A relative of one elderly person in ED contacted the Leader this week to say it is an "absolute disgrace".

"The trolleys are all lined up. You can barely move. There is no social distancing. There is no privacy when you’re talking to a doctor or nurse. There are elderly people with catheters. There is no dignity. It is like a cattle mart. On Sunday, there were ambulances waiting to drop patients off. They were backed up like the people on trolleys inside," said the person who didn’t wish to be named.

After contacting UHL for comment, a spokesperson said the hospital is currently managing the highest number of Covid-19 positive patients in the country (42 as of Tuesday evening, October 5), as well as a Covid-19 outbreak that has impacted four inpatient wards and necessitated the imposition of hospital-wide visiting restrictions, in addition to a sustained surge in emergency presentation and admissions.

"Our immediate focus is on managing the outbreak to ensure that patient pathways are safe for patients who need emergency care, and for those scheduled to attend UHL for surgery, diagnostic investigations and outpatient appointments, many of whose access to care has already been delayed due to the pandemic," said the spokesperson.

"Management of the outbreak has involved ongoing contact tracing and testing of staff and patients, and implementation of all appropriate infection prevention and control measures in line with national guidance, including cohorting of positive patients and contacts. The impact of the outbreak on patient flow has so far been minimised due to the additional single-room capacity created at UHL during the pandemic," they added.

However, the high number of patients waiting for inpatient beds in UHL include many people with complex medical conditions who require admission and isolation in the single-room accommodations.

During September 2021, daily attendances at the ED averaged 240, compared with 195 in 2019, the last full year of the pandemic. Average daily attendances have also increased by 22% on the daily average of 197 recorded in September 2020.

"Over the past four weeks, daily presentations reached a high of 290, and exceeded 250 on 14 days of the month. On only two days of the month were attendances fewer than 200 – 187 on September 19-20, and 186 on September 24-25. The pattern has continued into October, which to date has experienced a daily average of 231 attendances, ranging from 198 on Sunday to 261 on Monday," said the spokesperson.

UL Hospitals says while there is a context to what is happened at UHL, it "does not minimise" the anxiety and inconvenience for patients who are experiencing long waits.

"That is not the level of care we wish to provide in our hospitals, and we regret that any patient has to wait for an inpatient bed. All efforts are being made to limit wait times and maximise patient flow. However, demand for our 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," said the spokesperson.

UL Hospitals is asking people to consider all appropriate care options before attending the ED such as the Injury Unit at St John's Hospital or their GO.

"However, please be assured that if you are seriously injured or ill or are worried your life is at risk the ED will assess and treat you as a priority. We apologise to any patient who has experienced a long wait for admission to UHL during this period of exceptionally high demand for our services," concluded the spokesperson.

Deputy Quinlivan condemned the government’s "lack of response to the trolley crisis in Limerick". He described these numbers "as out of control". 

"The defeatist attitude of some would give the impression that this is just the way it is when it comes to our Health Service. But it doesn’t have to be. With targeted investment and capacity control strategies, we can have an improved health service and we can have all our patients treated with dignity.

"Despite recent nominal increases in bed capacity at the hospital, overcrowding remains a critical issue that needs to be resolved. It is not an insurmountable problem. It is high time for Minister Donnelly to step up to the plate and deliver for UHL. The staff and patients deserve better than what they are getting from the current Health Minister," said Deputy Quinlivan.

Speaking about the overcrowding situation across the country, INMO general secretary Phil Ni Sheaghdha said it is a "very dangerous situation". 

"Not only is it putting our members and their patients at significant risk of Covid infection, but it is placing an extraordinary burden on a workforce that is completely exhausted.

"Letting overcrowding escalate over the coming months, as we have seen happen year after year, is going to lead to very poor outcomes for patients at a critical time in the pandemic,” said Ms Ni Sheaghdha.

"We need to see government coming forward in the coming days with concrete plans for keeping hospitals safe for patients and staff for the coming winter. That means a detailed Winter Plan from the HSE that includes increased capacity in the community. Next week’s Budget must include plans for substantial investment in homecare packages."

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