Better management – not just beds – needed, says INMO

New €24m ED in University Hospital Limerick ‘still sees patients waiting’

More robust action from management is called for to tackle a constant overcrowding problem at the University Hospital Limerick, according to the Irish Nurses and Midwives Organisation (INMO).

The call comes as the Limerick hospital was revealed as having the worst record for the number of patients – 8,869 – forced to wait on trolleys for a bed last year.

The hospital has regularly been the worst performing in the country when it comes to the daily tally of trolley numbers.

INMO representative in Limerick, Mary Fogarty, said that it is acknowledged that the hospital needs more acute beds but said that "even if those beds were available tomorrow, there is a need for a more robust management system for admission and discharge of patients".


And the INMO representative added that the problems are compounded by the uphill struggle which the hospital faces in recruiting and retaining frontline staff.

“We are being told all the time that staff are finding is too stressful to work in the overcrowding conditions in the ED and that they are opting for posts elsewhere in the hospital group. They are being put off working at UHL because of the ED [Emergency Department] situation and the knock-of effects for staff”.

May saw the opening of a €24 million new state of the art emergency department but the number of patients ill enough to need hospitals beds who were left waiting continued to increase.

In October 2017, it was reported that Health Minister Simon Harris had written to management at University Hospital Limerick asking how overcrowding seemed to be getting worse, despite the opening of the new facility.

Additional beds

In response, hospital CEO Colette Cowan said that the new ED was never going to solve the entire problem and that additional beds are needed with the hospital constantly operating at up to 115 capacity.

The hospital management has pointed to the fact that it has the busiest emergency department in the country with almost 65,000 attendances in 2016 and significant increases on that number in 2017, with 32,983 patients presenting for treatment in the first six months of 2017.

In a number of comments last year on the on-going overcrowding, a spokesman for the hospital said that measures including transferring patients to other hospitals and discharging patients into community care are employed to free up beds.

On Tuesday of this week, the INMO figures showed that nationally, UHL had the second highest number of patients, 55, waiting for a bed.

The hospital is also looking to the building of a new 96-bed unit which it says will be a major relief in the overcrowding situation but this is still only funded to the design stage and a design team is not expected to be chosen until March of this year.

In a statement on the INMO figures, a hospital spokeswoman said: “The numbers presenting to the ED at UHL continues to increase year-on-year and of those presenting, the numbers requiring admission, including many frail elderly patients, has also increased. There has been an increase of 6per cent in presentations to the ED during 2017 when compared to 2016 with total attendances exceeding 67,000 the highest number ever recorded in the ED, UHL.”

“Over the Christmas period, activity reached over 200 patients presenting to the ED at UHL in a 24-hour period, the highest of any ED in the country.

“Senior clinicians were on site rounding and patients who were medically well were discharged. Along with senior decision makers, the head of unscheduled care, and a member of the senior executive team were both on site at UHL and on-call to ensure patient discharges were managed optimally during this period.

“UHL has the only ED for the entire MidWest Region serving a population of approximately 385,000. Other regions in the country have five Emergency Departments each for populations serving approximately 895,000 and 710,000 respectively.

Not sufficient

UHL has 400 inpatient beds and this is recognised as not being sufficient for the needs of the MidWest Region. A bid to build an additional 96-bed block on the UHL site has been submitted to the Department of Health and approval has been granted for funding of the design stage of the build.

“UL Hospitals Group regrets that any patient has to face long waits in our ED during busy periods and any distress or inconvenience which this causes to patients and their loved ones.University Hospital Limerick is constantly in full capacity protocol.”

Sinn Féin TD for Limerick, Maurice Quinliven, said the INMO figures "are stark, shocking and totally unacceptable. They are simply incredible. 8,869 people were forced to spend a night or more on a trolley in 2017 in University Hospital Limerick.

“These are not just statistics, these are human beings. We know them because often they are our family, neighbours and friends. In many cases they are our grandparents, mothers, fathers, brothers, sisters, sons, and daughters.

“These figures must be a wake-up call to the Minister for Health. They represent more than a six-fold increase on the figures from 2006.”

Commenting on figures that show today is the worst day on record for the A&E crisis with a record-high 656 people on trolleys, Limerick Solidarity councillor Cian Prendiville said: "There can be no excuses, no cover story to explain away this A&E crisis. The government must own up and admit that their health policies, like their housing and education policies, have failed, and failed dismally. Decades of underfunding and privatisation have meant our health and public services are falling apart at the seams".