The team given the duty of addressing the issue of overpopulation at University Hospital Limerick (UHL) stated their confusion over who is in day-to-day control of the healthcare institution. The Health Service Executive made public two analyses concerning the midwest hospital on Friday; one was an impartial analysis by ex-chief justice Frank Clarke examining the death of 16-year-old Aoife Johnston, and the other, spearheaded by Grace Rothwell, the HSE’s national director of acute hospitals, focused specifically on the midwest’s overwhelming patient numbers.
Skepticism over patient and staff safety has been expressed due to large numbers of patients waiting on trolleys, delaying appropriate treatment. In the Rothwell review, the support team looked into potential patient management alternatives in the hospital, such as referrals to acute surgical assessment unit, the acute medical assessment unit and geriatric emergency medicine unit.
The report denotes the lack of capability for these units to operate given the amount of admitted patients in the emergency department (overpopulation) and in various assessment units. In relation to staffing, “significant vacancies” at the clinical nurse manager level were identified as a key issue.
The report also observed trolleys in an overwhelming majority of the wards visited and found that the policy relating to their usage was ambiguous. The continuous presence of ward trolleys places an unwarranted burden on the staff occupying busy acute wards.
The team also observed substantial disparities during weekends with greater admissions than discharges. This persistent imbalance is causing a build-up of overcapacity, which the facility is unable to remedy in the face of constant elevated levels of demand and acuity.
In response, the UL Hospital Group this summer initiated a two-week “reset”, in which scheduled healthcare was delayed to address a historical surplus of inpatients, followed by a gradual resumption of services. The report into overcrowding was compiled by Ms Rothwell with contributions from Orla Kavanagh, the director of nursing and integration at Waterford University Hospital, and Fergal Hickey, an emergency medicine consultant before his retirement.
In a separate development, an inquiry led by a former Chief Justice into the passing of a young girl from Co Clare, Ms Johnston, identified a number of concerns with the care she was provided.
The investigation found instances where critical systems and care procedures in the hospital were either not enforced or only existed irregularly, with examples being the sepsis pathway and capacity management escalation protocol.
Former Justice Clarke revealed that senior hospital management took decisions to alleviate overcrowding, but “lower-level managers were sometimes confused about the specifics of these decisions”.
He also drew attention to broader issues within the hospital, warning of an increasing population’s impact on hospital services’ capacity.
The investigation provides 17 suggestions for the Health Service Executive, all of which have been accepted by HSE’s chief executive, Bernard Gloster. Amongst these recommendations are calls for an evaluation towards potential hospital site expansion, an overhaul of hospital communication procedures, and a review of doctors’ roles synchronization in Emergency Departments, particularly during hectic periods where all doctors have many patients to look after.
Notably, the report refrains from attributing any blame to specific individuals, much to the dissatisfaction of the Johnston family who said the report failed to resolve conflicting pieces of evidence. They have asked for the report to be released fully without redactions to showcase its flaws, says the family’s lawyer, Damian Tansey. However, the final version of the report obscures the clinicians named.
Mr Gloster has assured that the report has initiated accountability protocols, with further processes to be carried out privately. He asserted that the onus was on him to ensure accountability and cannot be delegated to Justice Clarke. He further explained that if the inquiry singled out individuals, it would jeopardise its legal standing and the rights of those named, making fair disciplinary actions unlikely.
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