A LEADING emergency medicine consultant in Cork has highlighted the urgent need to create more bed capacity in the county, and says trolley figures are high at Cork University Hospital (CUH) at the moment because there simply isn’t capacity at the hospital.
In recent weeks, the Irish Nurses and Midwives Organisation’s Trolley Watch figures and the HSE’s TrolleyGAR reports have shown that a significant number of admitted patients have been waiting for beds in Cork emergency departments (EDs).
At 8am on Monday, Tuesday, and Wednesday of this week, more patients were waiting for beds at CUH than at any other hospital in the country, while on Thursday, CUH had the second-highest number of patients waiting, according to the daily TrolleyGAR reports.
Dr Conor Deasy, consultant in emergency medicine at CUH, said that the Covid-19 outbreak has impacted bed capacity.
“At the very start there was a big push on trying to discharge patients from the hospital back to nursing homes, community hospitals and so on and we did achieve a lot of discharges initially,” Dr Deasy explained.
However, he said that as the outbreak and time has progressed, it is now “near impossible to discharge patients to nursing homes, or long-term care facilities or community hospitals”.
He highlighted how bed capacity has been reduced at some facilities where CUH would discharge patients because of the need to create physical distancing and said nursing homes, who “had a difficult time” during the outbreak did not have the capacity they had pre-Covid. He said many of the in-patients at CUH had complex health needs and could not always easily be accommodated elsewhere.
“If we had a facility capable of taking patients who have dementia, we would be able to immediately fill 20 beds,” he said.
Construction works are also underway at some of the wards which would usually be available to the ED to create more isolation spaces, which is impacting figures.
“We don’t have capacity at CUH now and that is why we have the TrolleyGAR numbers that we have,” he said.
The very shape of the emergency department at CUH has changed since the beginning of the Covid-19 pandemic.
Dr Deasy said that in the early weeks of the outbreak, when the ED was quieter, works were carried out to isolate all the cubicle space there.
“The lower numbers during the initial weeks of Covid gave us the breathing space to achieve that construction work that needed to happen to make space safer in the context of a pandemic,” he explained.
This means that while those waiting for beds at the hospital, while continuing to wait on trolleys, are doing so in single rooms created in outpatient areas or single cubicles put in place in recent weeks rather than on corridors.
Dr Deasy said there was an “aggressive sense” that this space with trolleys on the corridor should never be allowed to develop again.
“For that corridor to not develop again, CUH needs bed capacity, it needs its own bed capacity in and of its own right, but it needs bed capacity in the form of being able to discharge patients from the hospital to long-term care facilities, transitional care beds, community hospitals, and rehab beds,” he said.
The emergency medicine consultant outlined how everything and every process at the hospital is linked.
“We talk a lot about flow — so when the emergency department gets completely overwhelmed with inpatients that should be on a ward, our ability to offload an ambulance is completely compromised and so ambulances will have offload delays and that in turn causes 999 response times to be compromised and that is because upstream of that we are not getting patients out of the hospital,” he said.
Dr Deasy said investment is needed to address the issue and said there were a number of measures which could help improve the situation including the development of the planned new elective hospital in Cork and the previously mooted new acute tower at CUH, in addition to increased community capacity and rehabilitation capacity.
In the meantime, the emergency medicine consultant said that the hospital is continuing to prepare itself for expected increased demands on the system later this year in terms of isolation space and requirements for bed capacity.
“What we are concerned about is September/October time when people start presenting with chest infections and fevers and coughs, which could be Covid, but are less likely to be Covid, still have to be isolated, and we still have to deal with them in full PPE,” he said.
Dr Deasy said that while trolley figures may be higher now because not all wards that would normally be available to them are available because they are undergoing works, that this will pay dividends in autumn and winter.
“Covid has brought enormous complexity with it, both in terms of infrastructure requirements and staffing requirements and it’s not gone anywhere,” he said.
While Dr Deasy said that CUH has not had any new Covid-19 cases in recent days he stressed “we can’t rest on our laurels and say this is all over, relax, because it is not.”