Sunday 26 January 2020

'Look at the trolleys mam, it's mad isn't it?' - inside Ireland's most crowded emergency department

Staff are ashamed to say they work in the hospital that broke its own record for patients on trolleys, writes Wayne O'Connor

Patients lie on trolleys in the corridors of University Hospital Limerick where staff are also dealing with a winter flu outbreak
Patients lie on trolleys in the corridors of University Hospital Limerick where staff are also dealing with a winter flu outbreak

Two Tipperary women sat chatting in University Hospital Limerick's emergency department last week. They only fell quiet when two nurses unconsciously imposed a compassionate silence on them.

It should not have surprised anyone: the hospital had just broken its own record for having the most patients waiting on trolleys in a single day. But it surprised us all.

The Tipperary women were perched by a door. It led to a corridor lined on either side by trolleys full of sick elderly patients.

Seven patients lay on trolleys on the corridor. Six patients could be seen in another one nearby, but it was the sight of a trolley in the waiting area that best exposed the unrelenting nature of Ireland's most crowded emergency department.

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Patients lie on trolleys in the corridors of University Hospital Limerick where staff are also dealing with a winter flu outbreak
Patients lie on trolleys in the corridors of University Hospital Limerick where staff are also dealing with a winter flu outbreak

Two busy nurses were pushing a man on a trolley aiming for the doorway where the Tipperary women held vigil. He was visibly ill but the corridor they wanted to bring him up was already full.

Reluctantly, the nurses parked the trolley in front of the two women so ahead of them lay this motionless, sick middle-aged man.

This caused an empathetic hush before the nurses disappeared behind the electronic doors to try to make a space for him.

"That's not even a nurse's job, to be shunting trolleys and making space," another nurse told the Sunday Independent.

This experienced nurse is tired but wants to raise awareness of the plight her colleagues face everyday in University Hospital Limerick (UHL).

The nurse was aware this newspaper observed events in the emergency department and took photographs there last Wednesday. She was not complicit in helping the Sunday Independent gain access to the emergency department to capture the images, but spoke under the promise of anonymity so she could not be accused of breaching the terms of her employment.

Health Minister Simon Harris. Photo: Frank McGrath
Health Minister Simon Harris. Photo: Frank McGrath

"A nurse should be at the bedside caring and helping a patient to overcome whatever sickness they have so they can go home.

"It is very demoralising. Making or finding space on corridors isn't what you train for. You don't study hard for that. Parents don't pay huge college fees for their children to end up doing that."

The nurses left the sick patient in front of the Tipperary women for a maximum of two minutes but the 120 seconds felt like an eternity. Nobody knew what to say. No one knew where to look. Eventually the nurses returned and wheeled the man's trolley through, the doors shutting automatically behind them.

Another man and his elderly mother walked into the waiting area looking for a patient they knew. He glanced through a glass panel in one of the doors up to the corridor and then turned to his mother.

"Look at all the trolleys, mam. It's mad, isn't it?"

Later, two more nurses pushed an elderly man on a trolley through the waiting room, again heading for the Tipperary women and their door. A hospital porter was already on the corridor.

"John, is there room up there?" one of the nurses asked.

"No, I'm bringing a trolley up there now and there's another man to come back here, too. You'll have to go up that way and come round the other side," he explained, pointing further into the bowels of the hospital building.

Minutes later, another male patient is brought through on a trolley by a nurse and a porter. This patient is covering his eyes with one hand. He is well dressed but seems to be in some distress.

The porter looks up the corridor and tells his colleague: "You're not getting up there anyway. There's too many up there. We'll have to go somewhere else."

They continue past our waiting area and follow a path worn by the previous nurses, deeper into UHL.

Last Monday, 92 patients were on trolleys, according to the Irish Nurses and Midwives Organisation (INMO), a record for any hospital in the state. The Sunday Independent counted 32 patients on trolleys in corridors at 4pm last Wednesday in one part of the emergency department. Other patients were behind curtains and could not be counted. Empty trolleys were kept in units nearby for use later in the day.

This is demoralising for staff, said a nurse working there. She feels elective procedures should be halted, to ensure adequate care can be provided when so many people are on trolleys.

"I feel there is complacency now," she said. "There was uproar last year when the figures hit 82, that was phenomenal. But 92, with all electives still proceeding?

"There is no limit to what you are expected to do and, in my opinion, on the wards, there isn't adequate patient care. There can't be because there isn't enough staff.

"Nurses at the bedside have to prioritise. We cannot do everything. It is nowhere near [the level] where safe staffing should be in normal circumstances."

Almost 14,000 patients were on trolleys in UHL last year, a 22pc increase compared to 2018, according to the INMO.

The nurse said staff feel appreciated by most patients "because kindness is usually reciprocated with kindness" but face challenging decisions such as leaving ailing patients in a waiting area while they find room for a trolley.

"You're between a rock and a hard place because if you leave him in a place where he is not observed then there are repercussions on you. You can't make it a double-decker [stacking trolleys side-by-side].

"For anybody who has been in there, in the emergency department, there is hardly walking space. You would not want to be any way overweight walking through it because it is so narrow.

"If you even tell the person in charge 'I had to leave Johnny outside the doors', the repercussions are on you because who is going to mind him when there are 92 others inside."

INMO director of industrial relations Tony Fitzpatrick, a former emergency department nurse, said the problems in UHL are "incredibly dangerous for patients and stressful" for staff. "The maddening thing is that we know the solutions which are needed. Extra bed capacity, scientifically set staffing levels, and a properly resourced community care service. But the message doesn't seem to be getting through."

Officials argue the message has hit them loud and clear but UHL concedes the service currently provided is not good enough. "UL Hospitals Group sincerely regrets when any patient admitted to our hospitals - especially frail and elderly people - has to wait on a trolley for a bed to become available," a spokesman said.

"This is not the level of service that we wish to provide. We make every effort to move people from trolleys to beds as soon as possible, and patients continue to receive expert medical care while they wait."

The hospital said it typically transfers 15 patients every day to other hospitals in the UL Hospitals Group when it is deemed appropriate. However, last Tuesday, 17 beds at the nearby St John's Hospital were blocked to prevent the spread of flu. Last Wednesday there were signs enforcing visitor restrictions at UHL because of the flu outbreak and these remains in place until further notice.

The hospital also said work on a €19.5m block with 60 beds is under way, with these coming on-stream before the end of the year.

The Department of Health said it hoped this investment, and a second MRI service launched in UHL last month would improve the patient experience. "The minister has consistently said the Mid-West has been neglected in terms of additional capacity for decades," a spokeswoman added.

Health Minister Simon Harris paid an unannounced visit to the hospital last August to meet with staff and patients.

The nurse told the Sunday Independent this had no impact and does nothing to help those who languished on trolleys in corridors last week. It did nothing to help the ill man left lying in front of two strangers in a waiting room last week. She said the staff are ashamed of where they work.

"Meeting people where I live, it is a constant topic of conversation. People tell you they dread it. They verbalise it. They say 'oh my God, I do not want to go in there'.

"If you are a very sick person, I have no doubt about the level of care you will get. People are so well looked after when they are acutely ill. But if you are moderately ill, you may languish on a trolley for the duration of your hospital stay. I have great confidence in the service and skills of the staff working here if you come in seriously ill, but it is mortifying that you are working there."

Sunday Independent

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