The public was enraged when news broke out about Aoife Johnston’s, a 16-year-old teenager from Co Clare, demise at the University Hospital Limerick in December 2022. Recognised as the most congested hospital across the State, it was likened to a “battlefield” by medical staff who worked upon the weekend of Johnston’s death.
The independent investigation led by former chief justice Frank Clarke, disclosed a number of problems during her hospital stay. Being classified as a category two patient, she should’ve received medical attention within ten minutes. However, Clarke revealed that due to the intense demand and limited staff, it took over ten hours to attend all category two patients.
Delays played a significant role in the ensuing tragedy. Johnston had to wait for more than 13½ hours post her hospital admission for treatment. Even after her antibiotics prescription, she had to wait for an additional hour for administration.
Johnston, who was at risk of sepsis, was not given the standard care. She wasn’t transferred to the Resus area post-triage; instead, due to overcrowding, she was sent to zone A in the Emergency Department (ED). Consequently, sepsis documentation was not completed, undoubtedly resulting in ED nurses and doctors remaining unaware of her sepsis risk, despite being flagged by a GP and nurse.
The Clarke report starkly presented the myriad problems within the hospital. Terms like ‘risk’ appeared 58 times, ‘ad hoc’ 16 times, and challenging was used 23 times to describe the circumstances on the night of the incident.
Johnston’s story serves as an alarming indication of the broader issues the University Hospital Limerick faces, known as the health service’s problem child. Despite claims from the Government of increased funding, underlying issues such as overcrowding and inadequate staffing persist.
Clarke’s report further underscored these concerns, pointing out significant staff shortages the night Johnston sought medical attention. It was running with five nurses less than needed and was also short of one doctor.
The Clarke concluding remarks were clear, given the severe pressure that the clinicians and nurses were under, medication delivery delays like the one seen in Johnston’s case were inevitable.
The major concern in UHL at Dooradoyle is the issue of capacity, a widely acknowledged problem that Clarke has honed in on, analysing how it has led to the present predicament of the hospital. In 2009, other emergency departments in the midwest were shut down, causing all critical emergency patients to be referred to UHL in Dooradoyle.
An important 2008 assessment, known as the Horwath report, emphasised that the halt of operations at other EDs should not have taken place before Dooradoyle’s facilities were expanded. The report noted that although further expansion projects are underway even now, Dooradoyle’s capacity still falls notably short of the requirements stated in the Horwath report. This was to be a prerequisite before the closure of other EDs in the Midwest Region.
Moreover, with the uptick in acute service demands in the region after the Horwath Report was published, the earlier estimations for the necessary improvements to Dooradoyle are likely outdated.
Thus, the prevalent issue of hospital overcrowding is unsurprising. Last Friday recorded 45 patients on trolleys and another 45 in overflow spaces at UHL. This was observed in September, prior to the unavoidable seasonal increase of respiratory illnesses.
But the question remains: What does this mean for hospital patients and staff in terms of their safety? While Clarke recognises that systems have improved over the past couple of years, without tackling the bed scarcity issue, he warns that the likelihood of recurring risks remains.