Fire chief turns up the heat on overcrowding in emergency department

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University Hospital Limerick

THE Limerick Fire Authority has warned of legal action if management at University Hospital Limerick (UHL) fails to comply with a fire safety notice issued in respect of the hospital’s emergency department.

After receiving a complaint about overcrowding, the fire authority conducted an inspection of the emergency department on March 26 last.

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Chief Fire Officer Michael Ryan said that 38 patients were on trolleys along the aisles in the care/observation areas and this was well in excess of the 29 trolleys allowed by the Fire Safety Notice.

“It is a matter of serious concern that the safe number of trolleys in the emergency department specified in the Fire Safety Notice has been exceeded. In the interest of the safety of patients, staff and visitors, it is essential that the number of trolleys is restricted to 29 at all times in the emergency department,” Mr Ryan stated.

However, responding to the fire authority’s concerns, UL Hospitals Group chief executive Colette Cowen, said that if they were to keep to the current fire safety notice at all times, services would close or be diverted outside the region, creating clinical risk and a threat to life and limb.

The written exchanges between Mr Ryan and Ms Cowen were released by the UL Hospitals Group under Freedom of Information legislation.

The emergency department at UHL provides the only 24-hour emergency care unit across a population of around 400,000 in Limerick, Clare and Tipperary, as well as parts of north Cork and Kerry.

The reconfiguration of all 24-hour services in the region to UHL was signed off on in 2009 by the Fianna Fáil/Green Party coalition government.

As part of an agreed Fire Safety Notice, a limit of 79 was set as the safe level of patient numbers in the emergency department at any one time, including a maximum of 29 patients on trolleys.

Despite implementing extra initiatives at the hospital to “improve patient flow”, Ms Cowen acknowledged in a letter to Mr Ryan, that a breach of both limits occurred on 16 occasions last April.

In a letter dated May 8, Mr Ryan stated that the number of trolleys in the emergency department was a matter of ongoing concern to the fire authority.

“If the terms of the Fire Safety Notice are not being complied with, the Fire Authority will make an application to the District Court under Section 5 and 20 of the Fire Services Acts 1981 and 2003,” the Chief Fire Officer added.

In a letter to Mr Ryan last April, Ms Cowen outlined the changes made to ensure that the hospital came into line with the Fire Authority’s instructions.

She added  that UHL is the only site serving Emergency Care in the Mid West with a population that is socially deprived alongside high numbers of frail elderly people”.

“In comparison to other major centres in Galway, Cork and Dublin, we have 200-250 less inpatient beds, yet UHL is the second busiest hospital for attendances to its emergency department in the country.”

Ms Cowen said she “fully respects the requirements of the Fire Authority” but she argued that, with only 451 beds, “our demand far exceeds our capacity”.

“Despite it all, staff ensure patients are treated and cared for immediately to ensure a speedy recovery or onward treatment, to prevent adverse outcomes,” she added.