Despite a team of HSE experts being deployed to University Hospital Limerick, to ease the country’s worst hospital overcrowding, patients remained backed up on trolleys inside the corridors of the ailing emergency department.
It is a week since Limerick Coroner, John McNamara, returned a verdict of medical misadventure at the inquest into the death of UHL patient Aoife Johnston, (16), who lay dying on a chair at the overcrowded and understaffed ED in December 2022.
On Wednesday 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 dysfunctional department.
The INMO said it counted 102 patients waiting for a bed, a reduction of 21 trollies from Tuesday.
Photos taken inside the ED on Wednesday show the hospital could still not offer patients privacy nor dignity as they squeezed together in the embattled 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 ou of the department.
Staff appeared to be working under less pressure than they would otherwise usually, however numbers of patients appeared to be increasing again as lunchtime drew closer.
Around 20 people were in the hospital’s reception area waiting to be triaged around midday.
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 its not enough”.
Aoife Johnston was referred to UHL with suspected sepsis, which, under HSE protocols, required she be seen by a doctor within 15 minutes of presenting at the hospital.
However, Aoife was not triaged for an hour and 15 minutes, she was not examined by a doctor for 12 hours, and she did not get the life-saving antibiotics - which she had so urgently required - for 15 hours and 15 minutes.
By the time Aoife received the antibiotics, which the inquest heard would have likely saved her, it was too late, she had deteriorated too long, and was transferred from the ED to the Intensive Care Unit where she died.
The HSE and UL Hospitals Group have apolgised 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, and that it 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.
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 on Wednesday asking what latest measures it had been introduced to try to ease pressure on the ED, UHL said: “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 to 24hr operation on weekdays has been expanded, and it has launched 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; 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," they said.
