Report calls for major changes at Limerick

Health Minister Dr James Reilly's new Special Delivery Unit (SDU) has recommended that improvements in managing hospital capacity and an initiative to improve hospital management performance be put in place at the Mid-Western Regional Hospital in Limerick.

The report also says when hospital capacity is under pressure, the option of reopening closed beds for short periods should be considered before deciding to place extra patients on wards.

The Irish Nurses and Midwives Organisation (INMO) says the report backs up its previously expressed concerns about patient safety issues at the hospital's overcrowded emergency department. The INMO has held a number of work stoppages in Limerick  in protest at overcrowding and hospital cuts.

It says the recommendations in the report were currently being considered. According to the Department of Health, the SDU is planning to conduct a performance diagnostic analysis of the emergency care system in the whole acute hospital sector over the coming months, and the Limerick review was part of this analysis.

The Limerick recommendations include that the hospital's bed plans be immediately reviewed with a view to reallocating some existing nursing and support staff to expand the flexibility of available medical bed days.

The report also says with some improvements in length of stay and some reorganisation of existing capacity, the system can be brought into balance and trolley numbers reduced.

The report says where additional beds are placed on wards to house overflow ED patients, clinical risk assessments must be conducted to check that space and facilities are adequate.

It says the full capacity protocol, which includes placing extra beds on wards, should only be used as a final step in the hospital's escalation plan to meet increased patient demand. The option of opening closed beds should be considered first.

The SDU review also says the anticipated volume of scheduled admissions and the hospital's capacity to meet expected demand should be reviewed and a bed management system empowered to ensure variation in surgical demand is reduced.

The clinical head of bed management must have devolved authority, responsibility and accountability for all admission, transfer and discharge processes.

The report says expert managers should be brought in to support existing management at the Limerick hospital. This should be focused on improving management performance.

It says the hospital should consider an organisational development programme to address issues of professional leadership and to improve staff relationships.

The review also says a patient flow response team should be established to streamline patient movement through the system and the situation regarding medical leadership at the hospital should be resolved, leading to the prompt filling of an executive clinical director post.

The INMO and another nursing union SIPTU, attended an LRC conciliation conference with the HSE on the Limerick hospital issue today.

The INMO said the report backed up its previous calls on the hospital to reopen closed beds when necessary to deal with pressure on services. The union also noted that the report said the placing of beds on wards, which it has opposed, should only be used as a last step to deal with a capacity crisis.

The nurses' union said the recommendation that there should be a new bed management system indicated that hospital management now has to take responsibility for timely patient transfers and discharges.

It claims what it had been saying about the hospital's capacity issues had now been verified by the SDU.

The INMO said no time should be wasted to ensure services at Limerick are made safe.

[Posted: Wed 05/10/2011]