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Inability To Discharge Patients Contributes Greatly To Trolley Crisis At University Hospital Limerick.

Firstly, one patient (Who wishes to remain anonymous) interviewed by Thurles.Info, wishes to thank and show their appreciation to the many nurses, doctors, surgeons and all the other hospital staff at University Hospital Limerick, that work tirelessly, each and every day, to save lives under, at times, some of the toughest and most frustrating working conditions one could possibly imagine.
The patient also wishes readers to note that email correspondence sent on June 23rd, June 28th, and July 1st, 2023, forwarded to Mr Stephen Donnelly, (Fianna Fáil Minister for Health), seeking answers to basic questions; while same were acknowledged by his staff, all have remained unanswered to current date, (November 8th, 2023).

Silence in the face of pertinent and direct questions usually tends to denote guilt.

The current year, 2023, has seen some of the worst figures for hospital bed shortages, with highs of up to 838 patients waiting on trolleys nationally, on just one day alone. Patients waiting on trolleys is a long-standing dangerous and persistent problem that puts lives at risk and additional strain on hardworking hospital staff.
University Hospital Limerick (UHL) is one of the biggest offenders when it comes to bed shortages, hitting a record high of 130 patients on trolleys, on just one day alone in October 2023.

When we ask our Health Minister and politicians what is the solution to this critical problem, we typically get a simple response “We need MORE beds and MORE community resources”. We are typically led to believe that a sudden surge in the number of sick people has led to the need for more hospital beds and accommodation. This may be true to a certain extent, particularly during the winter months. It is certainly true also, that we need more community resources and that UHL is buckling under the pressure of meeting the hospital needs of such an extensive geographical area.

Thurles.info has recently come to learn, however, that too many patients, coupled with not enough beds and community resources fails to explain the problem in its entirety. The trolley crisis problem, like so many other HSE issues, is much more complicated. One facet of this complicated problem relates to avoidable extended patient stays. Put simply, sometimes there aren’t enough beds, because patients who could be discharged to free up beds, can’t get out of hospital despite the very best efforts of nurses, surgeons and hospital administrators.

The letter copied here below and shared with Thurles.info (with full patient permission to print it minus personal details), describes an extreme case of unnecessary patient overstay at UHL. The patient in the case below, could have been discharged into the community after a two-week hospital stay via the OPAT (Outpatient Parenteral Antimicrobial Therapy) service. Among other reasons, the patient’s outstanding medical team wanted to get them home to their family to speed up their recovery and prevent them from picking up another hospital acquired infection, the superbug CPE, rampant in UHL.
Medical staff put everything in place for this to be achieved. They sourced an OPAT nurse from the patient’s local community to tend to the patient’s medical needs, which primarily centred around the receipt of an antibiotic. Despite everyone’s best efforts and the common sense researched benefits of the OPAT option, the patient ended up staying in UHL for an additional four weeks, a total stay of six weeks. Why? Despite a willing patient and available OPAT nurse, the hospital could not get the antibiotic from the supplier Baxter.
“Try another supplier!” I hear you shout. That would seem like an obvious and logical solution, but UHL were not permitted to explore other options because of their contractual conditions with Baxter.

First of two communications received by patient (By post) from Outpatient Parenteral Antimicrobial Therapy (OPAT):

Dear [Patient],
I am following up on your complaint you sent through ‘Your Service Your Say’ on the 1st July 2023. I have completed the investigation process pertaining to your complaint and attached the complete review for your attention.
We do sincerely apologise for your experience during your recent admission to University Hospital Limerick (UHL) that led to a prolonged stay in a bed in University Hospital Limerick.

Summary of your complaint/background.
The failure by OPAT to obtain antibiotics thus freeing up hospital beds in UHL.
Investigations.
I sought comments from the following in relation to the issues raised in your correspondence:
Outpatient Parenteral Antimicrobial Therapy (OPAT) Team UHL, who also met with you once this complaint was shared with them.
Findings
[An employee for the OPAT service not named] reviewed your complaint and met with you prior to your discharge to address the concerns you raised.

An employee for the OPAT service then provided the second and following response, in relation to the patients complaint, which read as follows:-

Dear [Patient],
Many thanks for contacting us via “Your Service Your Say”.
Unfortunately, OPAT is disappointed to hear that our service has let you down in what appears from your correspondence “an excellent experience” in UHL.
On review of your medical notes and following our discussions I would like to offer a sincere apology on behalf of the OPAT service here at UHL for our lack of communication.
It is most unfortunate that Baxter was unable to provide the appropriate [antibiotic] therapy in a timely manner to facilitate your discharge. However, while this is beyond our control at a local level, I can assure you it is escalated nationally.
Baxter is an external company that supplies the antibiotic to be administered to you in your home. However, they had issues that led to you not being able to avail of this service. You did need this therapy as part of your treatment and could not be discharged without completing a full course of antibiotics as prescribed by your treating consultant.

This supply chain issue did lead to a prolonged stay in hospital and if the service was available by Baxter you could have discharged home allowing the inpatient bed to be utilized by another patient.
We have escalated to our executive team here in UHL, who have raised it at a national HSE level. Baxter currently has the contract for this and they too are working on their supply issue.

We welcome your complaint as this affords the opportunity to continue to strive for a patient cantered quality service.

We wish you well in your recovery and please feel free to contact us again if this response does not suffice.

Recommendations.
The lack of the [antibiotic] therapy led to a prolonged stay in UHL and this drug is supplied by Baxter. We will continue to work locally and nationally to find a resolution to this, to avoid other patients experiencing this. This is as an issue for other hospitals who use the OPAT service and to avoid delays in discharges that impact on patient care, we will continue to work on a solution for this.

Conclusion.
Again we do sincerely apologise for what you experienced and hope the supply of the [antibiotic] therapy gets resolved by Baxter or another company if viable.
As part of the process if you are dissatisfied with how I have handled your complaint you are entitled to seek a review by writing to, [name and address of relevant complaints employee and section provided but not published].

The request for a review will be examined, and a Review Officer will be assigned to review your complaint. A request for review must be made within 30 working days of the date of this letter.

Please note that it is also open to you to refer your complaint to the office of the Ombudsman.

Signed.

As the letter and case above highlights, the ‘trolley’ crisis’ is not simply a question of more beds and more community services. UHL, while at the mercy of Baxter, could not discharge the patient for an additional four weeks. In addition to that patient unnecessarily occupying a bed for someone left on a trolley, the four weeks overstay undoubtedly resulted in avoidable costs to UHL, the HSE and ultimately the tax payer in terms of food, bed linen, medical supervision, blood testing and care.
Indeed, in 2019, the HSE estimated that the average daily running cost of an in-patient hospital bed across acute hospitals was €878 per night. By these already outdated figures, a two-week hospital stay would have cost €12,292. A six-week hospital stay would have cost €36,876, representing a €24, 584 hospital overspend for the unnecessary four weeks that this patient could have spent at home, under the care of OPAT community services.

As we brace ourselves for another flu season, our politicians urgently need to engage with these incredible nurses, doctors and surgeons at UHL and other medical facilities nationwide. They need to listen to the many issues contributing to the trolley crisis – just one of them being hospitals tied into contracts with companies who don’t seem to be held accountable or replaced when they have supply issues and aren’t delivering the service they are paid for.

Taxpayers wonder when they see news headlines “Minister for Health Stephen Donnelly said the HSE overspend of €1 billion is being driven by the HSE spending money in areas where it should not be spending”.

Finally, research undertaken by the unnamed patient, confirmed that 5 other patients at UHL were in a similar boat, holding up another 5 beds, each unable to access antibiotics, due to lack of supplies provided by Baxter.

A copy of this report has been forwarded to Mr Stephen Donnelly, (stephen.donnelly@oireachtas.ie), Leo Varadkar (leo.varadkar@oireachtas.ie) and Mr Micheál Martin (micheal.martin@oireachtas.ie).

This morning, November 9th, 2023 the Tánaiste and Minister for Foreign Affairs and Minister for Defence, Mr Michéal Martin, T.D., (Time 9:16 am) in an automated message, acknowledged receipt of my correspondence.

This morning, November 9th, 2023 the Department of Health, (Time 10:38 am), in an automated message, acknowledged receipt of my correspondence, stating that same would be forwarded to their officials for attention and advice. [Seo deimhniú le cur in iúl duit go bhfuair an Roinn Sláinte do chomhfhreagras agus cuirfear ar aghaidh é chuig na hoifigigh chuí le freagairt.]


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