One patient every minute

Shannondoc saw 'incredible numbers' during Christmas surge

ShannonDoc dealt with approximately one patient every minute last Christmas as doctors and nurses struggled to cope with unprecedented levels of demand.

The extent of the pressure facing the Mid West's out-of-hours GP service was outlined to Nenagh councillor Séamie Morris this week. He had questioned the HSE Regional Health Forum over the “disastrous collapse of the ShannonDoc services over Christmas”, pointing out that the Mid-West Hospital Campaign has also requested an explanation over what happened.

In a formal response to Cllr Morris, Maria Bridgeman, HSE Mid-West Chief Officer, spoke of the “very large surge in patients” that ShannonDoc experienced in North Tipperary, Limerick and Clare over the Christmas period.

“During peak times, ShannonDoc dealt with approximately one patient every minute,” Ms Bridgeman stated. “The out-of-hours service operated on a [24-hour] basis over Christmas and provided 579 more GP appointments - an increase of 40% - when compared to 2022.

“A significant portion of patients also presented with respiratory illness due to high levels of RSV [respiratory syncytial virus] and Covid circulating in the community at the time.

“The Christmas period is always ShannonDoc’s busiest period. In preparation for this year, the HSE Mid-West made an additional allocation of €193,000 available to ShannonDoc to roster additional doctors and nurses to deal with the increase in patient volumes. This year, the out-of-hours service rostered more doctors than previous years with a 30% increase in medical manpower on duty. The additional personnel were secured for the service notwithstanding the well-documented difficulties in recruiting skilled nurses and GPs across all health services.

“This year’s patient surge was unprecedented with patient volumes contacting the service amounting to almost three times more than last year’s levels.

“On one day alone, over 12,500 inbound calls were made to our switchboard. These are incredible numbers, which amount to almost one month of calls in just one day."

Ms Bridgeman stated that over the period December 24 to 27, Shannondoc provided 2,280 doctor consultations (up from 1,641 in 2021). North Tipperary saw a 41% increase in consultations.

“Of the total patients dealt with by ShannonDoc, 81% were categorised as routine with the remainder of patients prioritised as urgent,” she added, stressing that ShannonDoc is an urgent out-of-hours service and routine care should be accessed via a person’s own GP.

“As a result of the patient surge, during some periods at peak times on Monday, December 26 and Tuesday 27, the service was operating above its maximum capacity. In some instances, this resulted in patients having difficulty accessing the phone lines. Due to the unprecedented call volumes, it is inevitable there would be longer than usual wait times and difficulties in accessing the phone lines during peak times,” Ms Bridgeman stated.

ONLY TWO BROUGHT TO NENAGH MAU

Cllr Morris also questioned the HSE over the recently-introduced protocol that allows ambulance drivers to bring patients to Nenagh hospital’s Medical Assessment Unit (MAU) instead of Limerick. He said it had been revealed that “due to the strict criteria of who can be brought to the MAUs by ambulances, only two people were able to be brought to Nenagh in total”. The Nenagh councillor also questioned the opening times of the MAU, saying it is not open after 4pm due to a lack of diagnostics, and no labs or diagnostics at weekends. He furthermore sought a breakdown of the €5.2m in funding that UL Hospitals Group has requested for MAUs, and wanted to know why hospital trolley numbers are still so high.

Colette Cowan, CEO of UL Hospitals Group, clarified that the MAU in Nenagh is open from 8am to 6pm, Monday to Friday. ULHG has sought funding to extend the operational hours of the MAU to seven days per week.

“The bid relates to additional resources in the main and seeks funding for an additional 51.45 [whole-time equivalent] for Nenagh, Ennis and St John’s hospitals for medical doctors, nurses, allied health professionals, health and social care professionals and admin staff,” Ms Cowan stated in reply to Cllr Morris.

The CEO provided a detailed response in relation to Emergency Department overcrowding in Limerick. She stated that daily ED attendances over the last 10 days averaged 234.

“These numbers are far in excess of pre-pandemic daily average attendances (195 in 2019), and come at a time when all hospitals in the Group, not just UHL, are caring for high numbers of inpatients, many of whom include frail elderly patients with complex health conditions,” Ms Cowan stated.

SECOND 96-BED BLOCK

Construction of a new 96-bed block development is ongoing at UHL, which Ms Cowan said would take two years to complete. Half the new beds would be additional bed stock, with the remainder replacing beds currently in the multi-occupancy “Nightingale wards” in the older parts of the hospital.

The CEO said an additional 98 inpatient beds and 10 critical care beds had been delivered at UHL since the start of the pandemic, and she welcomed the Taoiseach’s recent commitment towards a planned second 96-bed block, which is provided for in the UHL site masterplan.

“UL Hospitals Group are keen that the delivery of the second 96-bed block be fast-tracked and that funding be secured in the HSE Capital Plan to deliver the additional inpatient bed block in as short a timeframe as possible. We expect that proposals will be submitted to the HSE nationally in respect of this second 96-bed block before the end of the first quarter of this year.”

Cllr Morris wanted to know why ULHG did not get one extra bed in the HSE’s winter plan despite having the worst trolley numbers in the country. “What reasons were given and what efforts were made to change this decision?” he asked.

Ms Cowan replied that an additional 302 inpatient beds are required by 2036 to meet current unmet demand, future demand and to replace outdated infrastructure in the multi-occupancy wards. “It should be noted that the allocation of funding for capital development projects is decided by the HSE nationally and not by individual hospital groups,” she affirmed.

The CEO reiterated the ULHG view that a new elective hospital is needed to serve the patients of the region.