Rotunda warns of patient safety risk

The master of Dublin's Rotunda Hospital has warned of "unsustainable" levels of patient activity which it said is jeopardising safety at the 256-year-old institution.

Dr Sam Coulter Smith said the HSE and the Department of Health have been repeatedly notified of the clinical risks arising at the maternity hospital, which has seen births rise by a third over seven years.

Last year was the second busiest year in the Rotunda’s history, with 9,041 babies delivered by 8,845 mothers, according to the hospital’s 2012 annual report. While this was down 3 per cent on 2011, Dr Coulter Smith said the level of activity remained “extraordinarily high”, with 42 deliveries in one 24-hour period in late December.

“This level of activity is unsustainable, particularly when simultaneous emergencies occur and it is a credit to the hospital frontline staff that the safety levels are maintained,” he said.

"The HSE and the Department of Health have been notified on multiple occasions during the year of the intolerably high levels of activity and the clinical risks that arise and we will continue to address this issue with our funders."

'Extreme disappointment'

The report contains several references to the “extreme disappointment” felt by the Rotunda at the Government’s decision to build the new national children’s hospital at St James’s.

The original plan was for the Rotunda to tri-locate with the adult hospital and a new children’s hospital on the Mater site, but planning permission was refused for the building proposed and a new competition was announced.

“A lot of time, effort and significant resources had been invested in developing the case for the Rotunda to be part of this tri-location and this has been a significant setback for the hospital’s strategic plans.”

The hospital would continue to work with the HSE and the Department of Health to improve its infrastructure and provide facilities to deal with the huge increase in activity over the past five or six years, he said.

Dr Coulter Smith was also critical of staffing ratios in the hospital, saying a midwife to patient ratio of 1:50 was "completely inappropriate" for any busy tertiary referral unit and this would have to be addressed. The report says the public service moratorium on recruitment and the non-replacement of staff taking early retirement had a generally negative impact on numbers in the hospital.

Mortality rate

He promised the Rotunda would self-assess against any recommendations arising from the tragic death of Savita Halappanavar in Galway a year ago, as it had done on foot of the 2012 report into Tallaght hospital.

The perinatal mortality rate for the year was five per 1,000 and Caesarean section rates remained unchanged at 29 per cent.