The escalating number of Covid-19 patients in intensive care units (ICUs ), combined with high levels of staff absenteeism due to the virus, is putting severe pressure on local hospitals.
The number of Covid-19 positive patients in ICUs continues to rise with University Hospital Galway's ICU operating at surge capacity since last week.
Tony Canavan, the chief executive of the Saolta University Health Care Group which runs the public hospitals in the west and north-west of the country, said the west's biggest hospital remains in Surge Level 4. "This means that we have opened up additional ICU beds. We started doing this on Monday of last week."
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This is one of the measures taken by the 700-bed hospital, which has been under enormous pressure in recent weeks coping with rising numbers of Covid-19 patients. There are currently 17 Covid patients in the 27-bed ICU at University Hospital Galway, up six from this time last week while there are four at the seven-bed ICU (five ICU and two high dependency/critical care beds ) at Portiuncula University Hospital, an increase of two. There are three Covid patients in Mayo University Hospital's eight-bed ICU now compared to one on Tuesday last. There are two vacant ICU beds currently at each of the western hospitals, UHG, Portiuncula, and Mayo University Hospital.
Other initiatives introduced to meet the demand for ICU services include the redeployment of some nursing staff to the ICU at UHG and the transfer of patients from various hospitals within the Saolta group to avail of vacant critical care beds in facilities on other sites in the region.
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Mr Canavan outlined that patients have been transferred in the last week from Mayo and Letterkenny to UHG, from Mayo to Portiuncula University Hospital in Ballinasloe, and from Portiuncula Hospital to Roscommon hospital. "This is the best way to manage ICU beds, if one hospital is under pressure, others hospitals can help. There is co-operation across the region and this has worked very well. It is not just people's own individual hospitals in their areas which are looking after them, all resources are pooled."
The cancellation of non-emergency scheduled surgeries enabled the hospital group to redeploy nurses to intensive care units. This alleviated the pressure on these facilities which treat the critically ill as well as allowing UHG to open additional ICU beds as part of its surge initiative. These extra beds could not have been opened unless staff became available and with the high level of Covid-related abseentism, staff shortfalls is a major issue in hospitals right now.
Oxygen therapy
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The CEO explained that "high level supports", such as oxygen therapy, is being provided to patients in general hospital beds across the Saolta group, which runs seven hospitals on five sites in Galway, Mayo, Roscommon, Sligo and Donegal. "This allows us to hold ICU beds for the sickest people".
But while ICUs continue to treat increasing numbers of Covid-positive patients, the numbers in Covid wards have begun to decrease. This is in line with the third wave of the virus having peaked early last week, according to the Saolta chief who presides over an annual budget of almost one billion euro.
He says the hospitals are entering a "different phase" now in terms of managing the virus. A few weeks ago the number of people contacting their GPs with Covid-19 concerns rose as did the number attending testing centres and being hospitalised because of the virus. These numbers have levelled off.
'Again, Mr Canavan says, these overall figures represent an improvement, that "the situation is not getting worse'
"The situation has improved a little in the hospitals," says the CEO. "We hit the peak early last week and the numbers [of people being hospitalised] have started to level off. It is not a dramatic reduction, but the main thing is that they have stopped rising and that is very important. Each day over the past seven days, the numbers have come down a little bit."
There were 394 Covid-positive patients in the seven Saolta hospitals last Tuesday, that figure dropped to 362 this week. The numbers hospitalised with the virus at UHG now [at the time of going to press ) stands at 98 compared with 129 last week, a figure which Mr Canavan describes as a "good improvement". There were 11 people with confirmed Covid-19 at Portiuncula Hospital and that number is now down to a "fairly stable" eight. Mayo University Hospital reported 97 coronavirus patients last week, now that number has reduced to 93. Mr Canavan stresses while these statistics do not point to a "dramatic reduction", they indicate the numbers have "stopped rising".
Absenteeism
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One of the biggest sources of pressure on each of the Saolta hospitals is the level of Covid-related abseentism, he says. This figure has "stabilised" and "slightly improved" in the last week but it is still concerning.
There were more than 900 staff across the Saolta group (which employs 10,000 people ) on sick leave last week due to having contracted the disease or being a close contact of a case. That number dropped to 800 this week. There are 342 staff absent at UHG, down from 385 last week. The current number comprises 212 nurses, 27 doctors (junior and consultant ), 68 healthcare assistants and support staff, including porters, and 25 allied health professionals, such as speech and language therapists, physiotherapists, and occupational therapists. There are 13 clerical administration staff on Covid-19 related leave. Again, Mr Canavan says, these overall figures represent an improvement, that "the situation is not getting worse".
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There has been a reduction in the number of staff on Covid leave at the 220-bed Portiuncula Hospital also, it stands at 23 this week. Ten of these are nurses and there are a small number of doctors included. Mayo University Hospital is without 147 staff currently, 81 of these are nurses and 15 are doctors.
He says it is important to remember that there are additional staff absent too due to non-Covid illness or maternity leave. "All of this makes it difficult for us to fill rosters. In order to open an ICU bed, we need enough staff to care for patients 24 hours a day, seven days a week. In ICU every additional bed requires quite a number of staff. This limits the capacity of the hospital in key areas. There is also the impact on the individuals working in the hospitals. We are constantly asking people to work overtime. In the short-term, that's OK, but the longer you do it, the more difficult it becomes. People get tired and they have other commitments. Even though there is only a very small reduction in the numbers who are off, that is really important. When people are asked to work overtime, they see the light at the end of the tunnel."
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There are Covid-19 outbreaks in six of Saolta's seven hospitals. Roscommon is the only hospital unaffected. There were seven wards impacted at UHG last week, that is down to six now. Mr Canavan says one ward less may seem like a small thing but that's not the case. "The key difference to us is that the number is not going up, it is not eight wards. It means we are starting to get on top of the outbreaks and this impacts on the availability of staff and beds." While no wards are closed at Portiuncula Hospital, some beds are closed due to the virus. The fact that fewer people are attending emergency departments has helped the hospitals greatly in terms of managing the pandemic.
Private support
The two private hospitals, the Bon Secours in Renmore and the Galway Clinic in Doughiska, continue to provide support to the public hospital system locally. There are 15 "frail elderly" public patients in the Bon Secours while there are 20 cancer patients at the Galway Clinic. "We are still in discussions with them to see how we can co-operate further. There may be opportunities to move more other patients to these hospitals."
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The hospital boss says that the latest UK figures reveal that patients are spending longer in hospital during this wave of the pandemic compared to the first wave last year. This is "almost certainly" the case here, too. Many patients, particularly older people, go to nursing homes after being discharged from hospital. However, due to Covid-19 outbreaks in some of these homes, these patients cannot return there despite being well enough to be discharged from hospital. Therefore, it is more difficult to achieve an "efficient discharge" (a term Mr Canavan dislikes using ) from hospital. "This is nobody's fault, it is purely because Covid-19 is prevalent in the community."
He says there are outbreaks currently in local nursing homes. "Over December and January particularly, the number of outbreaks increased. There are 83 long term care facilities [nursing homes] in Galway, Mayo, and Roscommon and they have come under a lot of pressure with Covid-19. With all of us working together, none of them has closed. Nursing home proprietors, community services, hospitals, and GPs are all working together to keep them running safely.
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"We are providing nursing support where we can [when staff are on Covid-leave]. Our geriatricians are also providing support to them and are in contact with them on a daily basis. At times, where appropriate, our palliative care consultants have been involved to ensure residents are comfortable and pass away in dignity. Our geriatricians and palliative care teams have been brilliant."
Improvement in four weeks
Mr Canavan says while the decrease in Covid-19 numbers in the community is a positive sign, he does not expect to see a "significant improvement" until mid February. By the end of next month, the situation should have improved "quite considerably". He believes it will take the hospitals a long time to recover from the pandemic.
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"The number of Covid-19 patients is coming down a little bit but it will take longer for the ICUs to recover in addition to getting all the outbreaks closed out and to get people back to work. There are also all the patients who have had procedures cancelled, that's a huge issue. It's a worry, we don't have the capacity to do anything about it now, but hopefully over the coming months."
He believes the hospitals are in a "better place" now than they were. "However, I am concerned about [UHG's] ICU right now, the pressure on it has continued to grow. It will do so for another while, I'd say there will be another week of growth and then a fortnight of stability. That's dependent on the Level 5 restrictions, they are starting to have an impact now on hospitals. The state of the hospitals is dependent on community behaviour, people complying with these restrictions. Some make decisions to do the wrong thing and this has a direct impact on our hospitals."
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More than 10,000 healthcare workers and 8,000 people in long-term care facilities in the west and north-west have been vaccinated against Covid-19. Residents and staff of these 83 public and private nursing homes will get the second dose this week. "I'm very optimistic the programme will run quickly, the only thing holding us back is the availability of the vaccine. Every drop of it was used and it went where it should go."
Mr Canavan says the pandemic highlighted the fact that hospital infrastructures were not up to standard. "One thing that Covid-19 taught us is the need to stop talking and start doing things. We didn't have the infrastructure to meet the needs of the west before Covid. There has been a long history of discussions on the need for a new ED at UHG and an elective hospital. Enda Kenny said [in 2015 when he was Taoiseach] that it was not fit for purpose. It has not improved since, it's got busier, and we have a pandemic now."
