‘Single rooms needed for best hospital care’

CONCERNS have been raised about the pressures on the emergency department (ED) at Cork University Hospital (CUH) this winter, due to a shortage of bed capacity.

The clinical director of Emergency and Acute Care at CUH, Prof Conor Deasy, told The Echo that the hospital continues to struggle with a shortage of bed capacity.

This, he said, results in patients who need in-patient beds being stuck on a trolley at the hospital’s ED.

“This costs lives,” he said.

“Evidence published this year in JAMA - a top medical journal - from a multi-centre study performed in France, shows that for every 21 patients over 75 years who need to spend a night in the emergency department, there is an avoidable death.

“CUH needs investment to resolve this issue.”

Professor Conor Deasy, who is also a professor in Emergency Medicine at both CUH and University College Cork (UCC) and President of the Irish Association for Emergency Medicine, said that demand on CUH “has never been higher” and that attendances are up 10%, compared to last year.

Attendances of older adults aged over 75 were up 34% in October, 2023, compared to October, 2022.

He said that the number of trolleys in the ED at CUH has not increased, and that single rooms are needed so patients can get the best care.

“It is hard to envisage where we would find space to put them [the trolleys], now the wards are having to nurse patients on trolleys on the ward corridors,” he said.

“Single rooms are needed at CUH so patients can get the best care.”

Prof Deasy said that efforts have been made to make better use of beds at St Finbarr’s and Mallow hospitals, which has led to “a greater sharing of the challenge”.

“Without this - given the increase in attendances and admissions of, in particular, older adults - things would be a lot worse,” he said.

Some of the issues with capacity and patient flow highlighted by Prof Deasy were also highlighted following a risk-based announced inspection of CUH, conducted by Health Information and Quality (Hiqa) in July 2023, the report of which was published recently.

Overall, the report of the inspection against the National Standards for Safer Better Healthcare into CUH found the hospital to be compliant or substantially compliant with three national standards, partially compliant with six national standards, and non-compliant with two national standards.

Inspectors found that - while the hospital had defined management arrangements in place to manage and oversee the delivery of unscheduled and emergency care - ineffective patient flow in the unscheduled care pathway and a potential impact on the quality of care delivered, patient experience, potential poor patient outcomes, and non-compliance with patient experience times (Pet) - due to lengthy wait times - was evident.

Inspectors also found the physical environment in CUH did not fully support the delivery of high-quality, safe care - as there was a shortage of isolation facilities in CUH - and transmission-based precautions were not being applied in line with current best practice infection prevention and control guidance and standards.

Prof Deasy said there is “undoubtedly” an increased risk of the spread of infection in the ED, and said that a lack of single rooms means this is “a constant challenge”.

“Plans have been provided to HSE and Government outlining the investment needed to rectify the situation. These need to be pushed by our Government representatives,” he said.

“The investment in health facilities and services in Dublin outstrips Cork dramatically, and this inequity cannot be tolerated by the people of Cork or Munster who rely on the mothership that is CUH.”

Speaking about the HSE recruitment freeze, he said the decision was having a “toxic impact” on the delivery of improved services.

The ban on recruiting administrative and management staff was extended across the health service until the end of the year and a freeze on the recruitment of junior doctors, healthcare assistants, home helps, and other grades in the health service was put in place in October.

The HSE told The Echo that the Government funded the HSE to recruit over 6,000 new posts in 2023, to support the development of services, and that the target had been reached before the end of the year — hence the temporary pause.

“The embargo is having a toxic impact on the delivery of improved services at CUH. It is having a direct impact on patient care,” Prof Deasy said.

“Because we don’t have our complement of staff due to the embargo, we are struggling to get doctors in to work on the front-line.”

Prof Deasy said despite the many challenges faced this year, “good things have happened during 2023.

He added: “We opened a Children’s ED, we commenced our journey towards becoming a major trauma centre - which has seen the hiring of key personnel earlier this year, before the embargo hit - and an uplift in the service provided to multi-trauma patients.

“We have also reduced the time it takes ambulances to offload patients at the ED, and we have improved our delivery of cancer services.

“Every day, patients and their families benefit from the professionalism, commitment, and ability of what is truly a world-class healthcare workforce at CUH.

“It would be money well spent to equip this workforce with the tools and infrastructure we need,” Prof Deasy added,