No elective surgeries will be scheduled at Midwest Hospitals for close to three weeks, as part of efforts to ease potential overcrowding pressures after Christmas.
The UL Hospitals Group has implemented a number of measures ahead of what it expects to be a “testing period” over the coming weeks.
The UL Hospitals Group says reductions in scheduled care early in the New Year have been a feature of it’s hospital sites in recent years, to help manage surges in medical patients associated with winter viruses and illness.
Elective surgery is not being scheduled at any of the six hospital sites in Limerick and Ennis from December 27th until January 15th, but emergency and trauma theatres will remain open.
It’s anticipated that additional recruitment and enhanced services such as the APP Car service and the Geriatric Emergency Medicine Unit will have a positive impact on addressing unscheduled care demand over the coming weeks, as well as the expansion of the Pathfinder and MAU services.
Enhanced arrangements are also in place under the Integrated Urgent and Emergency Care Plan, with additional staff rostered across bank holidays, including medical consultants and radiologists, to facilitate patient flow and more timely discharge.
Additional allied health professionals and patient flow co-ordinators are also rostered to work bank holidays during the Christmas/New Year period.
Medical Assessment Units will be open every day, with the exception of Christmas Day, while the Injury Unit at Ennis General will remain open throughout the holiday season, including on December 25th.
The hospital group says it will also continue to work in close collaboration with HSE Mid West Community Healthcare, to expedite discharges to continuing care and rehabilitation care settings in the community.
Today, nurses at University Hospital Limerick recorded the lowest trolley numbers since August 4th, with 59 waiting for beds during morning rounds.
It’s only the second time trolley numbers at University Hospital Limerick have dipped under 60 in almost five months, according to INMO figures.
The UL Hospital Groups Full Statement
Reductions in scheduled care early in the New Year have been a feature in UL Hospitals Group’s sites in recent years, to help us manage surges in medical patients associated with winter viruses and illness.
Elective surgery is not being scheduled on any of the Group’s sites from December 27th until its resumption on Monday January 15th. Emergency and trauma theatres will remain open during that period.
Indeed, the surge in emergency presentations since the beginning of December (an approximate daily average of 239 patients) has been such that there have already been some deferrals of scheduled care during that time, in line with the Group’s Escalation Framework for reducing pressure on the ED in UHL and improving patient flow across all our sites.
It should be noted that any decision to cancel scheduled activity is not taken lightly, especially in the cases of patients who we know have already faced long waits for treatment. We endeavour to reschedule all patients as soon as possible.
We go into this holiday season having increased resources and developed several alternative care pathways over the course of 2023 and this should help us better manage demand as we head into a challenging period.
Additional medical (consultant and NCHD) staff have been recruited in our ED in the last year. We have implemented Safer Staffing in our ED in 2023, increasing the number of nursing posts by 21.5 whole-time equivalents, and also recruited additional ANPs and clinical skills facilitators to improve nursing skillmix in the department.
In the last 12 months, we have seen an increase in activity in our Injury Units and in our Medical Assessment Units, all of which have moved to seven-day operations over the course of 2023.
New hospital avoidance and pre-hospital care pathways have been established, including the APP Car service and Geriatric Emergency Medicine Unit, while existing pathways have been expanded, such as Pathfinder which, working with NAS colleagues, we have extended into Clare and Tipperary.
Model 2 hospitals are also accepting appropriate ambulance calls at their Medical Assessment Units in line with a new protocol.
These new and enhanced services leave us in a better position to address unscheduled care demand than a year ago. However, we fully expect the coming weeks to be a testing period.
Enhanced arrangements are in place under the Integrated Urgent and Emergency Care Plan which has been agreed with HSE Mid West Community Healthcare.
From the hospital perspective, these measures include the reductions in elective activity across all sites between December 27th and January 15th to better manage any surge in medical admissions; and additional staff rostered across bank holidays, including medical consultants and radiologists to facilitate patient flow and more timely discharge. Additional allied health professionals and patient flow co-ordinators are also rostered to work bank holidays this Christmas/New Year period.
Medical Assessment Units are open every day with the exception of Christmas Day while Injury Units will remain open throughout the holiday season, including on December 25th.
In respect of step-down care and delayed transfers of care, we continue, in line with our Escalation Framework, to work in close collaboration with our colleagues in HSE Mid West Community Healthcare in order to expedite discharges to continuing care and rehabilitation care settings in the community.
UL Hospitals Group retains a particular focus on delayed transfers of care, and in national terms, consistently has the fewest numbers of patients who are medically fit for and awaiting discharge but on the DTOC list.
At 2pm on Wednesday December 20th, the national number of DTOC patients was 459. UL Hospitals Group had 19 of those patients, or 4.1% of the national total, across UHL, Ennis, Nenagh and St John’s Hospitals.
Eight of these patients, 1.7% of the national total, were in UHL.
This national and local data is available daily from the HSE’s Urgent & Emergency Care Report (TrolleyGAR), which is available at this link.
All of our internal and collaborative work to expedite step-down care and delayed transfers of care goes on alongside the other specific measures provided for in the Escalation Framework, including the opening of surge capacity in UHL and across all sites; transfers of patients on trolleys in ED to our inpatient wards; additional ward rounds by medical teams to expedite discharges or to identify patients suitable for transfer to Ennis, Nenagh and St John’s Hospitals.
