University Hospital Limerick has too few doctors and nurses, and too few beds, but it has too many people coming to its Emergency Department (ED) who do not need to be there, according to staff at the hospital.
“People are going to the ED when they don’t need to. Working, fit, well people are coming in. I remember a billboard campaign in England showing people in a queue at a hospital,” a hospital nurse told The Irish Times.
“The caption over the first person was ‘should have gone to a pharmacy’, the next one read ‘should have gone to my GP’, the next one read, ‘should have gone to the local injury unit’, and the caption over a wreath at the end of the queue read, ‘should have gone to the ED’,” the nurse said.
‘There are people dying in that hospital that don’t need to die, purely because of overcrowding’
Many factors have led to Limerick’s crisis, including management failings, but the decision to 2009 to close 24-hour ED services in Clare and North Tipperary, and transfer patients to UHL was ‚and remains, a “massive mistake”, they suggest.
Ageing population takes its toll on Ireland’s health system
Clinical director at Limerick hospital where Aoife Johnston died placed on leave due to ‘serious risk’ to patients
Man died after waiting 11 hours to be seen by doctor in Tallaght Hospital ED, inquest hears
Aoife Johnston: Report into teenager’s ‘avoidable’ death warns of ‘risk of reoccurrence’ at UHL
“Reconfiguration, even though it’s over a decade ago, has contributed to where Limerick now finds itself all the time, constantly overcrowded. It was the beginning of the end because the amount of additional beds needed then were not put in place at that time,” the source said.
“You have patients coming to us from north Cork, parts of Kerry, north Tipperary, Clare and Limerick – that’s five counties. The hospital is not fit for purpose and it is not able to manage the surge in capacity,” one nurse said.
Equally, UHL ward staff point fingers upwards in the hospital organisation: “We also need senior clinical decision makers – some are excellent – on the floor of the ED more often – that is a key factor in all of this,” they suggest.
More beds are needed, but they are not the only solution. They must be staffed, and patient flow must improve, say staff, who speak privately because they fear being disciplined by the Health Service Executive (HSE) if they speak publicly.
“There is no point in putting in another 200 beds if the same practices are going to prevail. The beds will be filled very quickly but you’ve got to be moving people in and out of the system. Senior people have to see patients. It certainly is an issue.”
Last Monday, hospital management was forced to trigger an emergency when 170 people sought ED treatment during the day. This resulted in ambulances being forced to divert to other hospitals.
The most critically ill patients, especially those at immediate and serious risk of dying, were given priority, but pressures are mounting.
“Nurses are overwhelmed, just overwhelmed, it’s not their fault but patients are falling through the cracks,” said one nurse at the hospital.
Throughout the week, patients have lain on trolleys in corridors: “Patients are being triaged correctly but they are being sent to areas in the ED where there are 50/60 patients and three or four staff, you have a lot of admitted patients there that are on trolleys.
“There is no space for nurses to work. There are patients all around you. I’ve been saying this for years, there are people dying in that hospital that don’t need to die, purely because of overcrowding – The staff are just overwhelmed,” said the nurse, who spoke on condition of anonymity.
‘You can’t blame the nurses ... Burnout is the big thing, especially those with experience’
The current crisis in UHL and other hospitals is attracting more public and press attention, but the situation “is no different from what it’s been like all along, it’s extremely unsafe – everyone must know that,” said another source, again speaking on condition of anonymity.
“Even management and senior doctors are saying that on the radio – this ED is extremely unsafe. We can’t care for patients, we can’t deliver treatment, you just can’t – It is chaos in there,” they said.
“I don’t know how UHL is still surviving – it isn’t surviving, obviously,” the nurse continued.
Another UHL source agrees: “It’s the same old problems, you can predict this every year, there is a higher attendance this year due to outbreaks of Covid and flu, so respiratory illnesses are affecting the attendance numbers, but it’s the same problem again and again.”
Retaining staff is becoming more difficult: “It was chaos in the ED over Christmas, they are not keeping staff, they do nothing to try to keep experienced staff in there, and a lot of nurses with vast experience have left.”
“A lot of nurses are looking now for a way out just because it has worn them all out,” the source went on, “The hospital is not 100 per cent to blame for it, because a lot of new nurses qualifying want to travel, so they either go straight to Australia or Saudi Arabia to get experience.
“You can’t blame the nurses for doing it while they are young. Burnout is the big thing, especially those with experience. There are nurses in there who are good nurses but just not as experienced as the ones that have moved on, and you can imagine the knock-on effect that has had.”
“Limerick is the busiest ED in the country but the catchment area is massive and the hospital is not fit for purpose to be honest with you. During reconfiguration they had nothing in place to deal with the increase in patient numbers, and they went ahead with it – they let the horse out and then decided ‘we’ll build the stable now’.”
Meanwhile, Limerick City and County Council has confirmed it is awaiting a report from Limerick Fire Service which carried out an inspection of the overcrowded emergency department at UHL on Tuesday.
The fire safety inspection was carried 24 hours after UHL declared a “major internal incident” when the ED was overwhelmed with patients.
“Limerick City and County Council can confirm that that a Fire Officer carried out an inspection at the Emergency Department of the University Hospital Limerick on Tuesday January 3rd, 2023, and that we are awaiting their final report,” said a council spokesman.
Fire safety officers have previously expressed “serious concern” about overcrowding in the Limerick ED and have threatened UHL with legal action.
When asked what was the up-to-date figure for the number of patients allowed in the ED before it presents a fire safety risk, a UL Hospitals Group spokesman replied: “The cap on the number of patients within the ED as agreed with the Fire Officer is 78 patients. This total includes 49 patients in our single rooms, cubicles and assessment bays and 29 patients on trolleys on corridors. This does not include patients in our waiting areas.”
“Regrettably, the number of 78 patients can be exceeded during surges in demand for emergency care at UHL, such as those being experienced currently,” the spokesman added.