‘Triple whammy’ blamed for spike in trolley patients in Kilkenny hospital

Cuts in beds and GPs, along with flu epidemic, has stretched system at St Luke’s

A “triple whammy” of bed cuts, GP cuts and restricted access has been blamed for high numbers of patients waiting on trolleys at St Luke’s Hospital in Kilkenny, which has in the past been held up as a model for minimising overcrowding.

The number of patients waiting for beds at St Luke’s hit 57 on Wednesday of last week, the highest number in the country at the time, and was at 28 on Wednesday of this week.

Canny bed management, co-operation between the hospital and local GPs and regular communication have previously been cited for low numbers of people waiting on trolleys at the Kilkenny hospital.

However, local GP Dr Tadhg Crowley said the hospital has been "operating on a shoestring in terms of bed management" because of overall national cuts in acute hospital bed numbers in recent years.

“They were always short of beds, they were managing it really well,” he said, adding that in such circumstances it was “only a matter of time before an influenza outbreak” stretches the system too far.

It’s understood there are at least 10 patients with Australian flu at St Luke’s, all of whom have to be isolated, while the hospital has been requesting new beds and more nurses for some time.

Required nurses

There are 14 beds which could be opened immediately if nurses were available to staff them, and there are hopes that the required nurses will be recruited in the coming weeks.

St Luke’s had been one of the better-performing hospitals in terms of alleviating overcrowding in recent times, but has been hit badly by the influenza crisis and also suspected cases of the CPE superbug. Both flu and CPE patients need to be isolated.

Prof Ray O’Sullivan, consultant obstetrician and gynaecologist at St Luke’s, said there are “very good parts of St Luke’s, and very good people” but called for more frequent “decision-making” to free up beds.

“Personally I would stop all elective work for December and January and use the private health system to give us a dig-out . . . We need to empower consultants and demand that consultants make decisions on the care of patients who don’t have their names over the beds. Unfortunately there’s a large group of consultants around the country where they don’t seem to want to make those decisions on other consultants’ patients. That delineation of work is not in the best interests of the patients.”

The hospital’s medical assessment unit, opened in 2015, has been widely regarded as a success, but assessing 40 people “would be an extremely busy day”, Dr Crowley said. “There are 30 GPs in Co Kilkenny. If every GP sent in one extra patient, that’s 30 extra, and that’s closing down the medical assessment unit, basically.”

Own success

St Luke’s has also been a victim of its own success, he said, because “it’s drawing people from outside its catchment area to the MAU [medical assessment unit]”.

He blamed a “triple whammy” of factors for the unusually high number of people waiting for a bed lately, including cuts in funding to the GP system; waiting lists for primary care because of a lack of staff and, crucially, national cuts in bed numbers.

“No matter what primary care building you have, or system you have, people are going to have to go into hospital. When they’re very sick, you have to send them in.”

A spokesperson for St Luke’s General Hospital said there has been an “unprecedented increase” in attendances at emergency departments across the country recently, with 73 admissions to the hospital over the New Year’s Eve and New Year’s Day period. “This is a significant increase. Patients are continuing to present with a variety of complex needs; however, there is a steady increase in patients presenting with flu symptoms and respiratory-type conditions across all age groups. There is also an increase in the number of frail patients attending with chronic diseases.”