Works ongoing to address overcrowding crisis at Mayo emergency unit

A number of actions are in progress at the emergency department of Mayo University Hospital (MUH) to improve the health and welfare of patients presenting at the facility, the Saolta University Health Care Group has confirmed.

A number of improvements have already been carried out on foot of concerns raised following an inspection conducted at the facility last August by HIQA.

Some other works are also ongoing and are expected to be completed before September.

In response to a question submitted by Castlebar Councillor Michael Kilcoyne ahead of today's meeting of the HSE West Forum, Ann Cosgrove, chief operations officer of the group, gave an outline of the work.

She stated: "A unit which was previously used as an acute Covid assessment unit is now used as part of the emergency department and all ambulatory patients are seen and managed through that unit.

"The unit is now open from 8 a.m. until midnight seven days a week. This has reduced the streaming of patients through the emergency department.

"Since the HIQA visit the acute medical assessment unit has become more functional as an acute medicine unit, pathing other patients out of the emergency department.

"While this is unfortunately compromised on many occasions as an escalation area for patients awaiting an inpatient bed, there is work ongoing to free up that area for patients requiring acute medical assessment.

"The hospital has opened a further four beds in St. Johns Ward in the Sacred Heart Hospital bringing it to 28 patients and it is at full occupancy at all times.

"MUH has also secured funding to have a discharge lounge which should help with early allocation of beds to patients on trolleys by moving patients from the ward areas whilst they are awaiting collection and medical discharge letters.

"The expectation is that it will open in July, coupled with another area for a medical review clinic for ambulatory medical patients, which should strengthen the use of the acute medical assessment unit.

"The acute ambulatory clinic is to promote early discharge and to have hospital admission avoidance.

"The hospital has also secured funding to progress with cardiology services on site.

"This will result in a reduced admission rate and reduced length of stay for a large portion of medical patients.

"This will also facilitate alternative pathways for GP’s to chest pain clinics.

"This will all start to develop in July/August of this year which should in turn reduce the number of patients that are being cared for in the emergency department on trolleys.

MUH has a quality improvement committee for the emergency department where we are looking at internal streaming of patients, ensuring patients are reviewed by internal teams efficiently so patients who do not require admission get an earlier discharge from the emergency department.

"The hospital has also carried out a training programme for all of our staff in the emergency department in dealing with difficult situations in an efficient and compassionate way and communication between staff and the public, ensuring that the patient is priority at all times.

"This training was completed in February/March of this year.

"The quality improvement team has an ongoing focus on the key standards for safe care in the emergency department.

"There has been supplementary training done for staff in the department to ensure that they are all confident and competent in managing paediatric attendances in the emergency department.

"MUH has a quality improvement plan in place following the HIQA visit. The plan is updated on a regular basis and worked through the directorates structure in the hospital reporting back to the hospital management team regarding areas of improvement.

"We had stated that we would get external support for a quality improvement team and that has been in place since the end of 2022.

"There is also a “Length of Stay” Working Group formed in the hospital, looking at new pathways of care and efficiencies in the overall length of stay of patients.

"It includes teams within the hospital looking at efficiencies regarding delayed discharges, ensuring we have it at a minimum at all times.

"We have reduced down our 14 day length of stay significantly over the last number of months and continue to work on this with our colleagues, both in the community and acute services ensuring we max out on any opportunity.

"The hospital has worked with the national team regarding the safe nurse staffing levels and will be recruiting in line with the approvals for those in the same way as all emergency departments nationally.

"MUH has progressed work in having a more in-depth tracking system in the emergency department to help our team internally and to share information with the patients in the waiting area regarding wait times for the different clinical categories that exist in the department and those should all be operationalised by July of this year.

"The hospital secured funding for Older Person Services for HSCP staff, which will also help with the flow and ensure that there is follow through for the Frailty Team at the front door so elderly patients will have a focus.

"Whilst the number of patients on trolleys on a daily basis has not reduced, the length of time that patients are spending on trolleys has reduced.

"The other issue that remains a priority is the progression of a ward block.

"The brief is almost complete for the updated development control plan for the hospital, including a proposal for a 75 bedded ward block.

"We have been working with our estates department to progress this.

"Funding has been allocated for an extra two side rooms on one of our wards going into this winter.

"MUH is also about to open a new medical day unit which should facilitate in better access for patients and not result inpatients coming into the emergency department.

"The hospital has had improvements in our ambulance turnaround times for having a percentage rate handover less than one hour.

"We acknowledge there is work to be done before we can meet all of the National KPIs but this is all progress that has happened.

"The hospital has also appointed a patient advice and liaison service coordinator and a patient engagement staff manager who have looked specifically at areas of improvement within the emergency department.

"MUH has ongoing audits being run by senior nursing teams to ensure patients care, albeit in the wrong environment, is delivered at the same clinical standards as they would for a patients on a ward.

"It has increased the number of nursing staff allocated to care for the patients that are on trolleys and we have appointed a new CNM2 to coordinate the care of those patients.

"Our two quality improvement teams continue to look at and work on the update of the emergency department, acknowledging very much that it is a hospital wide system to improve.

"We need to have efficiency and length of stay in all of our wards compliant with our discharge management plan and encourage all members of the public to work with us to make sure when our patients are no longer requiring acute care, they can be efficiently discharged to another area of care or home to their families for the next step of their recovery."