MANAGEMENT AT A major hospital in the north west have apologised and pledged to make improvements after a coalition of local GPs voiced “huge patient safety concerns” ahead of an expected winter surge in emergency department demand.

The Saolta group, which oversees Letterkenny University Hospital (LUH) said it has been “extremely challenged” by a sustained increase in demand and a “lack of available beds” for patients.

It comes on foot of stinging criticism by a 78-strong group of Donegal GPs who sent a letter to the Minister for Health on Monday calling for urgent action at the emergency department at LUH.

They alleged that their patients are “at risk of death” and that target times for treating conditions such as sepsis are “frequently missed”. 

The doctors have called for an external review of the emergency department to ensure improvements to the service. 

The intervention comes ahead of an expected winter surge in hospital admissions and emergency department presentations.

In their letter, which was sent to the Health Minister and leading figures in the HSE and the Department of Health, the GPs warned that they are finding it “increasingly difficult to make the decision to send our patients” to the LUH emergency department.

“We have to weigh up the clinical appropriateness of sending very sick patients to ED versus attempting to manage them at home, even though in our professional opinion they do require secondary care.”

Responding to the concerns of local doctors, the Saolta group said LUH “deeply regrets that any patient is facing a long wait for a bed” after presenting to the emergency department.

It said: “Like other hospitals around the country LUH is extremely challenged by a sustained increase in demand and a lack of available beds.

“The ED continues to be extremely busy with high numbers of patients attending, many of whom present with complex needs requiring admission.”

The group added that patient safety is “at the forefront of everything we do” in the hospital.

“We apologise for any distress or inconvenience caused to patients or their families who wait extended periods for admission to hospital,” it said.

Meeting with management

While they had secured a meeting with hospital management, the group of GPs said they felt that their patients have been placed “at risk” due to the scale and speed of change at LUH.

“We have huge patient safety concerns and while we do not take this decision lightly, we feel that the time has now come to highlight publically the current issues affecting our emergency department and acute services at LUH.”

“It is not about the standard of care our patients are receiving, but is about the timely access to that care,”the letter said.

In simple terms, the system is broken. We no longer have faith that the current system can be fixed and appropriately managed without outside intervention, support and resources.

The letter claimed that treatment times for sepsis and other conditions are “frequently getting missed” based on what patients’ and families’ experiences.

“In August, on at least one occasion that we know of, there was no ambulance available in the counties of Donegal, Sligo and Leitrim because they were all waiting for drop offs at LUH for hours.

“This was in August before the so-called ‘winter surge’. Our patients are at risk of death and we are no longer willing to stand by and watch while little meaningful change takes place.”

The letter from GPs said hospital management had outlined interventions they intend to implement for this winter during their recent meeting. 

However, the GPs do not believe that the proposed scale and ambition of these plans match the urgent need for fundamental systems change in the department.

“If no significant changes take place, our patients will continue to have unacceptable wait times to access basic emergency care in LUH.”

The letter said similar external reviews have taken place in LUH for other departments, which have resulted in improved outcomes for patients.

“We cannot continue to sit back and watch our patients wait for hours in ambulances at the door of the ED or on hard chairs waiting for treatments. Alternative pathways to hospital services need to be explored.” 

It said alternative methods seen in other regions could “dramatically decrease” GP referrals to the emergency department.

Chief among these recommendations was the provision of a medical assessment unit to prevent patients having to attend when they are seeking ambulatory investigations. 

A similar project was trialled for University Hospital Limerick following severe overcrowding last January. 

Response

In its response to The Journal, the Saolta hospital group said it had directed additional staff to the emergency department in preparation of worsening conditions.

These range from three new consultants, to “approval” for a further eight nurses and a health care assistant, while an extra porter has been rostered to assist with admission and timely movements for diagnostics.

Saolta said there is also a ‘frailty at the front door’ team which assesses patients over the age of 75 years in the emergency department. It carries out a comprehensive assessment on older people reviewing alternative pathways to avoid admission or to allow early discharge.

It is proceeding with plans for an extension to the department which is being worked on with the HSE’s Estates department.

The hospital group pointed to developments for a number of ‘admission avoidance pathways’ to help clear any logjam, including alternatives for patients suffering types of chest pain and bleeding injuries.