Will tragedy be the catalyst to ensure safer emergency service at hospital?

Tragic loss and misdiagnosis have marked bittersweet turning points in the past in bringing change and reform, particularly to hospital cancer care. Will the agonising decline of Aoife Johnston (16) in the waiting room of University Hospital Limerick, only metres from where she could have received potentially life-saving treatment, be the catalyst to ensure a safer emergency service for the people of the mid-west?

Yesterday morning, as the inquest into the teenager’s death concluded, Limerick again had the highest number of patients in the country waiting for a bed, with 33 in its emergency department and 49 on trolleys elsewhere.

The words of emergency consultant Dr James Gray at the inquest yesterday were ominous, when he said as long as there are patients on trolleys and the emergency department is overcrowded, it will remain dangerous.

Unfortunately for patients, there is no quick fix to solving the crisis in Limerick, although lessons about reducing risk must surely be learnt and implemented now.

Its biggest obstacle is that it remains the only 24-hour emergency department open for the whole of the mid-west, with a catchment of over 400,000. If you need serious medical attention, there is nowhere else to go.

Add to that a growing demand, with the numbers of attendances at the emergency department up around 14pc already this year, many of them people over 75 years of age.

The hospital is still struggling with too few beds, making trolley gridlock unavoidable. Much has been made about large investment in the hospital in recent years, but regardless of whatever changes in work practices are brought in, the reality is that it has only around 530 beds. About 300 additional beds are needed.

Much has also been made of the new wards being built in the hospital. But the first 96-bed block will not be ready until early next year, leaving the risk of another gruelling winter and patient distress.

A second 96-bed block has yet to get under way. Some 16 rapid-built beds are also due but these will not be ready until next December.

So what happens in the meantime? Much hope rests on step-down beds coming through in Nenagh, Co Tipperary. A 50-bed nursing home in Nenagh was originally due to be the new home for older residents who were looking forward to moving from their outdated St Conlon’s nursing home.

Another 20 step-down beds are due in Co Clare. It could be late summer when these safety valves become available to allow more discharges from the hospital.

Other measures such as virtual wards – where patients who should be in hospital will be monitored electronically at home – are also part of the list of measures quoted to alleviate overcrowding.

The opening hours of acute medical assessment units in Nenagh, Ennis and St John’s hospitals are also be to extended to 24/7 on a phased basis.

The reality of the slow pace of providing more beds in which to put patients is one that HSE officials and politicians are loath to highlight when they are photographed in hard hats and yellow hi-vis jackets at the Limerick construction site.

Other changes may make more immediate improvements in the emergency department, such as having more senior doctors on duty until late at night.

It is still unclear if the numbers are there to ensure this level of cover, and it was recently noted that there was a relatively low take-up of new work contracts for consultants allowing for more flexible rostering.

Limerick has also been accused of not discharging enough patients at weekends. But more analysis of this is needed – are there enough supports, and with many patients coming from rural areas in other counties, how safe and feasible is this?

Another criticism is that Limerick has been too slow to invoke measures such as cancelling elective admissions of patients on waiting lists to keep beds free for those coming through the emergency department.

But this comes at a price. And in recent weeks, specialists from other hospitals have spoken about the impact of this on patients needing time-critical cancer surgery, for example.

The patient whose surgery is cancelled may be tomorrow’s patient on an emergency department trolley.

One of the difficulties the hospital faces now will be recruiting and retaining staff, which was already a problem.

The high turnover of nursing and junior doctors in the emergency department has previously been identified, leading to low experience levels and “low situational awareness”.

The hospital is now overseen by one of the six new regional organisations in the HSE, which are supposed allow more local decision-making.

This latest overhaul has yet to prove if it is another HSE false dawn.

But in the case of University Hospital Limerick, the hope is it might bring some regional focus and knowledge lacking under the old regime.