Cancellation of scheduled appointments and operations across mid-west not solution for overcrowding

The IHCA has urged health service management to significantly increase bed capacity and maximise operating theatre usage across the University of Limerick Hospitals Group (ULHG) to address the repeated cancellation of hospital appointments and operations in response to ongoing emergency department (ED) overcrowding.

In January 2023, there were 2,095 hospital appointments and operations cancelled at hospitals across the Mid-West, 1,252, of which were at University Hospital Limerick (UHL). This compares with 1,435 cancellations across the ULHG in December 2022. A total of 3,530 appointments or operations were, therefore, cancelled in the space of two months during the winter period, with 2,127 of these at UHL alone, which continued to witness some of the highest numbers of people being treated on trolleys and awaiting admission to a hospital bed.

The IHCA’s analysis comes as UHL management confirmed that the number of people seeking emergency treatment reached 270 in a single day, surpassing pre-pandemic levels.

The Association says the overcrowding crisis and increase in cancellations are being compounded by a severe lack of adequate acute bed capacity and consultant vacancies in the region.

Admissions through the ED at UHL account for 83 per cent of inpatient bed days, leaving limited capacity for the scheduled essential surgical and other procedures, which are frequently cancelled to accommodate spikes in demand for emergency care.

An additional 302 inpatient beds and 63 day-case beds are needed by 2036 to address current shortfalls and meet increased patient demand, according to a patient flow report, carried out Deloitte, published in September 2022

While a new 96-bed unit is under construction at UHL, it will take two years to construct and will only offer 48 additional beds, with half of the stock replacing old beds.

Limerick also has one of the lowest number of consultants both at a hospital and Hospital Group level, with a half to a third the number compared with similar model 4 hospitals. The Deloitte report found that UHL has 38 per cent fewer consultants than the Mater Misericordiae University Hospital, Dublin, and 52 per cent fewer than St James’s University Hospital, Dublin.

The cancellation figures across the ULHG form part of a wider analysis which showed almost 45,000 hospital appointments across the country were cancelled in December and January – with more than two-thirds (30,529) of all cancellations occurring in just nine hospitals, including UHL.

Consultants in Limerick are concerned that overcrowding pressures will remain a significant long-term concern and result in even more cancelled appointments and operations in the months ahead.

They say what is needed as an immediate priority are an additional 100 hospital beds, and at least 400 extra inpatient and day-case beds over the next number of years to meet growing demand. Theatre usage also needs to be maximised, with operating theatres in the region not running anywhere near capacity due to significant staffing deficits.

Commenting on the cancellation figures, Mr Colin Peirce of the IHCA, Consultant General and Colorectal Surgeon at UHL, said: “Cancelling essential appointments and operations, as is happening again this week across the region, should not be the go-to solution, but is a persistent and serious knock-on effect of the extreme lack of capacity and overcrowding at our hospitals.”

“Medical and surgical staff on the ground have never experienced such sustained levels of stress and moral injury from not being able to provide the care that their patients desperately need.”