The chief executive of the Saolta University Health Care Group, which runs seven public hospitals in the west and north-west of the country, is optimistic that the organisation will not have to activate its surge plan to cope with the growing demand for services due to Covid-19.
Tony Canavan said while the hospitals, which are located on five sites in Galway, Mayo, Roscommon, Sligo, and Donegal, are fully prepared to cope with major medical incidents such as the pandemic and can expand intensive care capacity if needed, he believes that this will not be necessary now.
This is despite the fact that the number of Covid-19 patients in local hospitals has been increasing steadily over the last number of weeks and that all of their ICUs are operating at almost full capacity. However, little more than a third of patients in these units [eight of 25] have the coronavirus.
He also outlined that Saolta will continue the relationship it formed with the local private hospitals during the start of the pandemic.
“Even in our most difficult days in April we didn’t have to activate the surge plan and I feel optimistic that we will not have to activate it now either,” he told this newspaper.
The Level 5 restrictions, greater knowledge about the virus, the ability to access services in private hospitals, additional accommodation, and improved systems for transferring patients from emergency departments to other areas within the public hospitals, have helped the facilities cope with rising demands. These are not only for general hospital services, which increase annually in winter due to flus and various respiratory conditions, but also because of the health emergency.
Mr Canavan said the current situation in the Galway hospitals could best be described as “very busy” as would be expected at this time of year. However, the number of patients on trolleys awaiting admission in the emergency department is much lower than for this period last year.
“Last Thursday there were 11 people on trolleys in Galway but this improved by the weekend and there was no-one on trolleys on Saturday and Sunday. This time last year it was not unusual to see 40 plus patients on trolleys. While the number of people attending the emergency department is back up to where it was last year, what has changed is we have improved our processes in the hospital. We are moving patients faster [from the ED] and we are accommodating patients every day in our Acute Medical Unit and our Acute Surgical Unit. This is not ideal but it is preferable to waiting [on a trolley] in ED.”
He said this was a challenging time for the health service but he was confident that it would be able to meet the public’s needs.
“At the end of March there was a decision taken to cancel all outpatient appointments and scheduled surgical activities. Now we are trying to continue with all surgeries and outpatient appointments while managing Covid-19. That is the challenge. We have surge plans in place on all our sites and all of them are prepared to expand capacity in ICU if necessary. That would involve the redirection of some staff and the redesign of some areas for ICU but we have not had to do this so far.
“We have a facility to increase beds in ICU. One of the key parts of the surge plan is to increase this capacity. This is partly to do with equipment (ventilators ), space, and staffing. That [staffing] is the tricky bit. We have them and they are trained but they are working in other areas currently. Last March we had staff ready to go because we had cancelled all our surgeries and outpatient appointments.”
Knowledge
Greater knowledge about the virus today is beneficial, he said. “We are in a better position now because we know more about Covid-19 and we can almost predict what is going to happen.”
There are currently eight patients with confirmed Covid-19 in ICUs in the west and north-west. Three are in UHG and there are another three accommodated between Portiuncula and Mayo University Hospital. The remaining number are in Sligo and Letterkenny hospitals. The highest number recently was nine which was recorded two weeks ago.
“All of our ICUs are busy. They are currently operating at very close to 100 per cent capacity. But this is not because of Covid-19. Only eight of all the patients in our ICU beds in the west and north-west are Covid patients.”
The CEO said the numbers of such patients in ICUs has increased “very slightly” and “slowly” in the past fortnight. “The suspected number of cases tend to be very low because our testing results are available very quickly. This has improved a lot since March/April. In some cases, they are available within a number of hours. On Tuesday there were 16 suspected cases in all of the [seven] hospitals in the west and north-west.
‘Manageable’
He stated he viewed the current numbers as “very low and manageable”. “However, the bit we are watching closely is that they are still rising. We look at two things together, patients on trolleys and Covid-19. It’s much, much more difficult to manage patients waiting for beds and dealing with Covid-19. It is a huge burden on the hospitals.”
The total number of people being tested for Covid-19 in the three western centres at Galway Airport, Castlebar, Co Mayo, and Castlerea, Co Roscommon, has dropped dramatically from a peak of 1,000 per day the week before last to about 500 per day this week.
Mr Canavan attributed this “quite considerable” reduction in demand for testing to the fact that people were no longer circulating because of the Level 5 restrictions - many were not going to work or to the shops.
There are currently about 50 Covid-19 positive patients in Saolta’s seven hospitals in the west and north-west. On October 21 at the start of Level 5 the number was a little lower, it was averaging around 45. The figure has increased very slightly since the start of November.
Mr Canavan said he hopes the numbers are stabilising and that the positive impact of the latest restrictions will be seen over the coming two to three weeks on hospital bed occupancy.
Private hospitals
He outlined that Saolta will continue the relationship it formed with the local private hospitals during the start of the pandemic.
“We are continuing to have discussions with the Bon Secours and the Galway Clinic. We are working with the Bon Secours Hospital on the provision of additional diagnostic services, such as MRIs, CT scans, and probably some cardiac diagnosis over the winter period and the first four months of next year. Last week we started transferring some patients to the Bon Secours. We are aiming to transfer 10. These patients would come from our frailty service, older people mainly from UHG. They might be admitted [to UHG] for a medical condition, then be transferred to the Bon Secours Hospital for further treatment before going home. We are also in discussion with the Galway Clinic with the hope of using some of their beds.”
He said he is confident that the decision taken by the Government to move to Level 5 restrictions will work.
“While nobody wanted the country to advance from Level 3 to 5, this decision made a difference in relation to the health service. What we are seeing over the last number of weeks, from the second half of October, is that the numbers of patients with Covid-19 in hospital beds, has increased very steadily. And it is continuing to increase up to this week. That is telling us there is a time delay between the decision by the Government to implement Phase 5 and the impact on the hospitals. It takes time for that to filter through,” he concluded — Mary O’Connor
