A difficult-to-treat type of disorder

Minister for Health Simon Harris has said the reconfiguration of services from Portlaoise will be orderly.

Presumably, that applies to the other eight hospitals which will be winding-down services: Cavan, Kilkenny, Mullingar, Clonmel, Wexford, Naas, Ballinasloe and the Mercy in Cork, according to <em>The</em> <em>Sunday Business Post</em>.

It brings me back to 2009, when reconfiguration started in the mid west. It was very orderly.

In spring 2009, ambulances were diverted from Nenagh and Ennis at night. The first effect was on strokes, which was a surprise.

Stroke cases no longer reached Nenagh, while the Limerick physicians said they were constantly admitting stroke patients from Tipperary and Clare.

It seems no-one checked beforehand to see what patients were being transported at night by ambulance.

After the transition, managers said it was a success, and there were only two extra admissions per night in Limerick.

Remember, the average hospital stay is one week, so those extra patients need 14 beds. None were provided. That was the start of the trolleys.

Even worse: I now know that they couldn’t know how many extra admissions there were. HSE and HiPE systems do not record admitted patients unless they are in a ward.

Later in 2009, surgery was centralised from Ennis and Nenagh. It was very orderly.

After the transition, surgical colleagues in Limerick were surprised at the number of surgical emergencies from Clare and Tipperary. Because very few operations were done at night in Ennis and Nenagh, Limerick was not prepared for a large increase in caseload.

It’s odd, because the CEO of the HSE knew. He complimented Nenagh and Ennis surgeons for managing emergency cases by day, fitting them between elective cases, instead of waiting for out-of-hours theatre time.

There were other consequences: the umbra of surgical cases had a medical penumbra.

If a medical ward patient needed an urgent surgical consult, or intermittent review by a surgeon, or just a difficult catheterisation, they had to leave Nenagh.

The unfortunate person might go from a ward bed in Nenagh to a trolley in University Hospital Limerick (UHL), causing upset to patient, family and staff, but we have no choice.

In the end, we learned not to admit patients whose problem could possibly be surgical, and it’s a surprisingly large cohort.

What was the effect on the trolleys?

Before surgery moved, Ennis and Nenagh admitted up to 200 patients between them, most of them medical. Afterwards, they had 50 beds. The other patients, mostly medical, ended up in Limerick.

No extra wards were provided. Trolley admissions proliferated. The HSE and HiPE have no records.

Then the biggest reconfiguration happened. CCU/HDU closed and the specialist nurses were re-deployed away from the wards.

It was very orderly.

Beforehand, there was a survey of the number and type of patients needing such care; beautiful new units were planned and built in UHL.

Was there a surprise this time? Absolutely! The umbra had a very large penumbra.

Nenagh used to look after patients before and after their cath lab procedures, relieving pressure on UHL. Because experienced nurses were monitoring the bank of telemetries, we managed the usual array of arrhythmias on the wards. Not any more.

But it’s worse than that.

Small hospitals like Nenagh stay safe by using CCU/HDU for a variety of situations. A ward patient who became breathless, or collapsed, was transferred immediately to CCU/HDU for assessment. If necessary, urgent transfer to UHL could be arranged, or the patient could be stabilised and return to the ward, often a short time later.

Slowly and painfully, we learned to refuse any patient who might need such support. That’s an awful lot of medical patients. That’s when the trolleys really piled high.

I’ve checked the trolley watch website. The mid west didn’t really have a trolley problem until 2009. Each orderly cycle of change in the small hospitals pushed a wave of trolleys into UHL. The major impact of service closures in Ennis and Nenagh has been felt in Limerick.

As I know too well.

On a Sunday in July, someone close to me was admitted to Limerick, seriously ill. There were no ward beds for her, or the other 25 medical admissions. Her wonderful physician told me he looked all over the hospital for a ward bed to keep her a second night, but without success.

Her family would not let her stay in hospital. They could not bear to watch their beloved relative endure the melee in the emergency department for a further 24 hours. She died some days later.

<p class=”captionMIstyles”>Was that orderly? Is that what Minister Harris intends?