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19/09/2021

UL Hospitals responds to doctors’ letter outlining safety concerns

UL Hospitals responds to doctors’ letter outlining safety concerns

Seventeen doctors signed the letter which was sent to Colette Cowan, CEO of UL Hospitals

MANAGEMENT at University Hospital Limerick say they are satisfied that any changes in practice put in place in response to the pandemic have not resulted in any significant additional risk to patients despite claims by doctors of “dangerous” practices being in place.

A letter, signed by 17 doctors from across different specialities in the hospital, was sent to the CEO of UL Hospitals Group, Colette Cowan, outlining a number of issues in areas such as the Emergency Department, Acute Medical Unit and High Dependency Unit.

The letter, seen by the Limerick Leader, outlines concerns relating to staffing, IT systems, nurse training, patient charts, and the transfer of patients to other hospitals. 

“Failure to take steps to rectify these issues will only cement UHL’s reputation as a poor place to train, which will worsen an already stretched medical service because medical registrars will not want to work here,” the letter states before giving detailed examples of alleged deficiencies.

The letter, which does not identify any individual patients,  goes on to claim that the Acute Medical Unit “is not fit for purpose”. 

“This service runs 24 hours a day at present, and is staffed overnight by one medical SHO with a medical registrar on call from home. There is no senior staffing on site because we do not have the manpower to provide this.”

In its response, UHL Hospitals Group points out that the AMU at UHL has not functioned as an AMU for the last 16 months.

“National clinical guidance developed in response to Covid-19 required us to establish a non-Covid medical pathway. Since March of 2020 the former AMU has functioned as a medical Emergency Department for stable non-Covid medical patients. Stable surgical patients are similarly streamed to the Surgical Assessment Unit, now the Surgical ED. Patients who are unstable and patients who are Covid-positive or query Covid remain in the Emergency Department,” said a spokesperson.

Outling their concerns in relation to the Emergency Department, the doctors state: “The referral of patients for admission without initial investigations (i.e. lab results and imaging) is dangerous and is not consistent with the standard of care nationally.

“This is a practice we have grave concerns about because it appears to be growing in frequency. At best this practice is frustrating, because we cannot make appropriate treatment plans or decide which patients need to be seen first without knowing the results of these investigations. At worst, it is potentially catastrophic for patients.”

UL Hospitals says the triage process in the ED and the governance of it has been agreed by the Medicine Directorate and the Executive Management Team.

“We are satisfied that any changes in practice put in place in response to the pandemic have resulted in no significant additional risk to patients. The various clinical scenarios outlined in the correspondence of June 30 do not alter this. Among the entirely appropriate initial presentations to Medical ED were cases of patients who required an escalation in care following comprehensive assessment and investigation.”

On the subject of training, the doctors claim that formal registrar teaching has been “non-existent” over the past 12 months. “This should be reinstated, and provided during working hours rather than after-hours. UHL cannot claim to be a centre for training if it does not provide training,” the letter states.

In response, management said: “Of NCHDs (non-consultant hospital doctors) entering basic specialist training in medicine in 2019, six identified UHL as their number one choice in which to train. This year it was 58. Our own end-of-year assessments for basic specialist training reported a 100% satisfaction rate. In the last year alone, we have received approval for an additional 12 medical consultants; hired additional SpRs and interns and welcomed international fellows.”

In relation to occupational therapy, the doctors stated it is a basic service in any hospital, “therefore the lack of OT staff is frankly embarrassing, particularly in a Model 4 hospital.”

“The majority of issues highlighted here are not a result of either the Covid pandemic or the recent cyberattack (though they have been exacerbated by them),” the letter states.

UL Hospitals says staff are “Welcome to discuss any matters of concern individually or through the longstanding formal structures which are in place to raise any such issues” and that “the scale of the challenge over the last 16 months has been unprecedented and has affected all its staff.

“In order to prevent infection and to maintain care for the sickest Covid and non-Covid patients, all staff have had to adapt; to re-purpose clinical space; to redesign their service; to upskill or change their scope of practice; to redeploy to areas where demand was greatest

“We are grateful for the contribution of our NCHDs in driving so much of this and in keeping our patients safe throughout the pandemic. We look forward to working with the new intake who commenced their training with us this month.”

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