HDU admissions at Rotunda often exceed capacity

Admissions to the high-dependency unit (HDU) at the Rotunda Hospital in Dublin have increased by 76 per cent since 2018. This reflects the growing clinical complexity and surgical case volume at the hospital, according to its annual report for 2023.

The report noted that admissions to the HDU often surpassed bed capacity. “Compounding the issue, the HDU lacks ensuite facilities and adequate infection control and air-handling systems, as highlighted by previous external inspections, making addressing these deficiencies a top priority,” stated the report.

To cope with demand, HDU-level care is often provided in single-occupancy rooms on the adjacent gynaecology ward, “placing significant strain on nursing and medical staff and compromising the quality of care typically provided by HDU nurses.”

In 2023, some 353 women required admission to the Rotunda HDU, mainly from the obstetric service (325).

Obstetric haemorrhage was the most frequent indication for admission. This reflected an increasing postpartum haemorrhage (PPH) rate “consistent with a national trend, as well as an abundance of caution in managing care for these women”. The Rotunda has also implemented Measured Blood Loss, which has improved the detection of women with PPH.

Gynaecology admissions rose significantly in 2023, which was “most likely” due to a higher surgical caseload through additional theatre capacity. Most gynaecology cases were admitted for monitoring after elective surgery due to a pre-existing co-morbidity or had more complex pain management needs.

There are two beds designated for high dependency care, with staffing capacity for a maximum of two admissions. In 2023, some 21 per cent of days saw an occupancy of three or even four women in need of HDU-level care.

The Rotunda also has a pathway to ICU beds at the nearby Mater Misericordiae University Hospital, for women requiring higher-level intensive care.

A new HDU, which will have three beds, is planned in the Rotunda’s critical care wing development. A hospital spokesperson said this would be a modern, fit-for-purpose facility allowing staff to deliver “appropriate care to this group of high-risk patients”.