DESPITE a crack team of HSE experts being deployed to University Hospital Limerick (UHL) to ease the country’s worst hospital overcrowding, patients remained backed up on trolleys inside the corridors of the ailing emergency department today (Wednesday).
It is a week since Limerick Coroner John McNamara returned a verdict of medical misadventure at the inquest into the death of 16-year-old Aoife Johnston, who lay dying on a chair at the overcrowded and understaffed UHL emergency department (ED) in December 2022.
This morning, two years on from Aoife’s death, which her inquest heard occurred during “systemic failures, missed opportunities, and communication breakdowns”, a number of patients languished on trollies, backed up against one another, inside Zone A, Zone B, and Zone C of the emergency department.
The Irish Nurses and Midwives Organisation (INMO) said it counted 102 patients waiting for a bed, a reduction of 21 counted yesterday (Tuesday).
Photos taken inside the ED this morning show the hospital could not offer patients privacy as they squeezed together in the trolley trenches.
Patient relatives stood awkwardly bedside the trollies or sat on the end of the mobile mattresses or on chairs in the corridors, moving for staff or other trollies being brought in and out of the department.
Some reported being surprised by the reduction in the patient swell inside the ED zones, but described conditions on Tuesday as “extremely bad”.
UHL emergency medicine consultant Dr Jim Gray told Aoife Johnston’s inquest that the ED was then and still is a “death trap” due to continued overcrowding and understaffing.
Dr Gray said, in his opinion, at least 300 beds were required at the hospital to meet demand, on top of two 96-bed units coming on stream which, he said, were “a step in the right direction, but it’s not enough”.
The HSE and UL Hospitals Group have apologised to Aoife’s family who have initiated a High Court action against the two health authorities over Aoife’s death.
This morning, some of the patients who were waiting to see a doctor in the ED reported being “quickly” triaged into the department.
However, reliable sources at the hospital said there can be a brief lull in overcrowding on midweek that escalates again particularly at weekends.
“Perhaps people are too scared to come in after all of the shocking evidence we heard during the girl’s (Aoife Johnston’s) inquest,” the source said.
In his evidence to Aoife’s inquest, Dr Gray said he had been the only on-call, off-site ED consultant on the weekend she died, and that there is still only one ED consultant on call, off-site, at weekends.
Dr Gray said that he and any of the other consultants do not routinely appear on the UHL site at weekends to deal with overcrowding “because it is always overcrowded”.
He said the only scenarios that he would be compelled to attend the ED at weekends was in the event of a major emergency plan being activated by executive management or if he was informed about a specific emergency case which required his immediate attention.
The Johnston family said they support calls made in the region to reopen emergency departments that were closed in Clare and north Tipperary and reconfigured to UHL in 2009 without the impact of the extra demand at UHL first being addressed.
In response to queries today asking what latest measures have been introduced to try to ease pressure on the ED, a spokesman for UHL said that “we have increased ED staffing and enhanced a number of alternative care pathways to reduce demand and improve patient flow, including additional recruitment of consultants and NCHDs for the ED”.
A Geriatric Emergency Medicine (GEM) unit for over-75s has been expanded to 24hr operation on weekdays, as well as the launching of two collaborative services with the National Ambulance Service, aiming to deliver safe care at home for over-65s and reduce the number of ambulances bringing patients directly to the ED.
UHL said that recently announced additional investment would see safer staffing being extended to all wards in UHL; increased bed capacity in the region; and the extension opening hours of the region’s three Medical Assessment Units “to 24/7 on a phased basis”.
“A new GP and advanced nurse practitioner ‘on the door’ service has commenced at the ED in an effort to further alleviate congestion in the department.”
