Report on possible second hospital emergency department for Limerick to be published next year
University Hospital Limerick has routinely experienced the second highest number of presentations to the ED per annum compared to other hospitals.
The final report from Hiqa into whether a second hospital emergency department is needed for the Limerick region won't be published for a year, the health watchdog has said.
Terms of reference for the review were published on Wednesday afternoon, and it says an interim report will be given to the health minister six months after it begins.
This follows outrage across Limerick, Clare, and north Tipperary at continued overcrowding in University Hospital Limerick.
Pressures have led to cancellations of elective operations and appointments at five hospitals locally since August 8.
Hiqa (the Health Information and Quality Authority) will look at the case for having a second ED in the region, based on population increases in recent years as well as overcrowding pressures.
It said while other hospitals also experience overcrowding, the scale of what happens in UHL has “consistently been greater” than anywhere else.
In May minister Stephen Donnelly asked Hiqa to carry out the review in the wake of disturbing evidence heard at two inquests and a court case linked to the hospital.
In setting out the terms of reference, Hiqa listed some of the challenges.
“UHL has routinely experienced the second highest number of presentations to the ED per annum compared to other hospitals, while also having the second lowest number of inpatient beds of the Model Four hospitals in the State,” it said.
Historic factors include the impact of closing smaller A&E departments at nearby hospitals in 2009 without following through on bed increases for UHL.
When emergency departments in Ennis, Nenagh, and St John’s hospitals were closed on safety grounds, it was advised UHL would need 267 extra beds among other supports.
“Such an investment did not occur prior to the reconfiguration of services,” Hiqa said.
The review will also take account of investment since 2019 and the likely impact of construction on overcrowding.
“In 2020-21, very significant capital investment occurred at UHL with the building of a new ED, a critical care block and 98 new beds.
"A further 96 bed block is currently in the advanced stages of construction, and a second 96 bed block is also at an early stage of development,” the review stated.
More beds are expected under the Acute Hospital Inpatient Bed Capacity Expansion Plan, including step-down transition and rehabilitation beds, it noted.
The review will also look at changes caused by a growing population. At national level, the population grew by 13.7% between 2014 and 2023 and the number of over-65s, who often require more hospital care, grew by 37%.
The review, which will also include external input, will look at similar health systems in other countries as well.
An expert advisory group will include patient representatives and operational, clinical and nursing expertise.
A Clinical Advisory Forum will include healthcare workers from emergency medicine, acute medicine, surgery, anaesthetics, paediatrics, National Ambulance Service and local GPs among others.
The Midwest Hospital Campaign said a year is an “unacceptable length of time” to carry out this review.
“It is neither exaggeration or hyperbole to state that lives are being lost now,” they said.
“The crisis at UHL has been the subject of several reviews and none have had any meaningful impact on the patient experience. Indeed, during the past fifteen years, the UHL ED has only become a more dangerous place in which to seek treatment for a medical emergency.”
They called on Hiqa to include families whose relatives died on a trolley in UHL or as a result of spending time on a trolley there.
“This must be a truly independent review as promised, and the sectoral interests of any individual group must not dictate the outcome and recommendations,” they urged.
