Cork hospital seeks to maximise Christmas emergency room staffing

Management at one of the country’s busiest hospitals have endorsed Taoiseach Leo Varadkar’s view that nurses and consultants should not take holidays in early January.

Cork University Hospital (CUH) chief executive, Tony McNamara said the hospital is planning a strategy this Christmas which will see greater engagement with the community. This will be to utilise community hospitals and transitional step down beds as CUH seeks to manage its workload over the Christmas period.

In the Dáil on Tuesday, during a debate on plans to deal with overcrowding in hospitals, Mr Varadkar said nurses and hospital consultants should not take holidays in early January. He has also called on the HSE not to sanction additional holidays for doctors and nurses over Christmas.

Mr McNamara said the seasonal pattern at CUH most years is that the hospital seeks to send as many patients home for Christmas as is possible . This generally results in the number of inpatients in the hospital being reduced from its full capacity of 500 to around 350.

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According to Mr McNamara, the decision to close down elective surgery at CUH between December 21st 2017 and January 7th 2018 was based on an analysis of the data on emergency work and planned procedures and a subsequent analysis confirmed that it was the correct course of action.

Mr McNamara explained patterns of activity in emergency departments remain very predictable over time and in January 2018. Some 5,456 patients presented at the department compared with 4,817 in 2017, representing an increase of 13 per cent,

However the introduction of a new programme, Project Flow 17 by CUH management in mid-2017 led to a 50 per cent reduction in trolley numbers in the emergency department at 8am each morning and resulted in 120 less trolleys in the emergency department in January 2018.

“Hospitals that have busy emergency and elective services struggle to achieve a mix between the tow that enable sometimes conflicting goals to be achieved … the data clearly shows that the decision to defer planned surgical activity by one week was the correct one,” he said.

Mr McNamara said the numbers presenting at CUH’s emergency department is remarkably consistent at around 200 attendances a day of which approximately one third are admitted, resulting in the hospital needing to discharge around 65 patients a day to free up beds for new admissions.

“The numbers presenting at emergency department doesn’t change but the mix does so in summer it’s people with sports injuries, farm accidents whereas in winter we have a lot more older people with respiratory problems who take longer to be repatriated back into the community.”

Mr McNamara said in tandem with shutting down elective procedures, CUH management will seek to maximise the number of staff on duty in the emergency department over the Christmas period with a view to keeping as many beds as possible open to ensure a continuous throughput in the department.

“We are engaging more this year with the community so we can put patients through the system in the post-Christmas period with patients going into convalescent care, transitional care and community hospitals over the Christmas period and not wait until people are back at their desks in January.

“We’ve a comprehensive plan which we will be finalizing over the next few days and we will be rostering as many senior staff as we can for the emergency department and the acute medical assessment unit so as the Taoiseach rightly says, there is a constant flow of patients through the system.”