Mayo University Hospital has faced some challenges in its time - not least the recent covid 19 pandemic. However, General Manager at MUH, Catherine Donohoe, is confident HSE staff and management can keep public health services running efficiently in the busy county town facility, as more and more people around Mayo enjoy longer lifespans - up to 100 years and beyond.
Ms Donohue told the Mayo Advertiser this week: "The big change is in the complexity of patients presenting. There is a significant increase in the health care needs of elderly patients, who accumulate complexity over time and end up having to stay longer. In Mayo we have an elderly population and that has really affected MUH and thanks to modern medicine, we are all growing older and living to greater ages. It is nothing unusual now to have people in their 90s and over the age of 100 in hospital."
Regarding an alert this week advising of capacity issues at the hospital, the MUH Manager explained: "A lot of patients are suffering with respiratory illnesses and this has been happening since quite early in the year. Obviously, we are not in normal circumstances because of the last two years with covid so it is very hard to know trends. Usually, winter illnesses occur from mid- to late- December and roll on up to January and February, but this year we have had winter illnesses all through August.
"There are also always contributing factors, such as bank holiday weekends, which have an impact, because for three days there is not a full service in place. That affected us this week but by Wednesday we were better and from Thursday we should be back to more of our scheduled care. Unfortunately, it is the unscheduled emergency presentations that push us outside our capacity and we are currently experiencing surges in ED presentation while we would always have bed problems."
Inpatient bed capacity
Ms Donohoe anticipates the new ED planned at MUH will improve the emergency department situation but not necessarily the situation with inpatient beds. "Bed capacity is secondary to people waiting for admission. A lot of internal work is being done to see can we get efficiencies back to pre-covid times, where there were shorter lengths of stay. For example, we have a working team looking at early diagnostics, which would help in getting people booked in earlier for treatment."
Primary research from inpatient data is also providing valuable insights, she added. "Last Thursday and Friday we surveyed every patient in the hospital to see can we make improvements, so that we are using every bed as effectively as we can and making safe discharges. It is about getting that balance right. The staff are very motivated to try and improve things. Also extra staff were recruited as part of our winter plan and in order to liaise with our GP colleagues, to work on alternative pathways while still using acute hospital services - but not accessing them through emergency.
"We are also looking to get our Acute Medical Assessment Unit (AMAU ) up and running as before covid and in AMAU we have a consultant purely dealing with those patients."
Waiting times at A&E
Regarding the long wait many people endure on attending the ED Department, the MUH Manager explained: "There are a lot of patients and prioritisation is done on a clinical basis according to five categories from 1 to 5. Categories 1,2 and 3 have to take preference so you might come in and be identified as category 4 and see people go in ahead of you and don't understand why; but it is because of the higher clinical risk."
She added that among the improvements planned is an alert-system that would advise those arriving in ED of the expected wait times. "The more information we can share with the public, the more involved they can feel."
In terms of crisis, the hospital has escalation plans, she noted, adding: "There have been so many challenges over the last two years and if somebody asked me about handling a pandemic in the middle of it, I would not have believed it we would do it. You just don't think about it. Staff step up. People work extra hours and we always come up with solutions. Also, we work as part of a hospital group - the Saolta healthcare group (comprising seven west of Ireland hospitals ), so we are unlikely to become overwhelmed; and it is important to remember - while things escalate, they do tend to de-escalate also."
The MUH Manager also welcomes support received this year through the winter initiative funding as well as funding for a discharge lounge, to improve bed turnover rate as well as a medical ambulatory care review – which she said should make big improvements in terms of facilitating earlier discharges.
"We also have support through an increase in our physiotherapy staff, with four Occupational Therapists focused entirely on elderly care. This ensures quality, safe discharge for elderly patients and year on year you can really palpate the difference this makes, so I am excited about these innovations being introduced."
Still, there is never a time to take your eye of the ball, the MUH Manager adds, as she notes: "Right now we are bracing for a difficult winter. We are always going to be under pressure and you have to be facing challenges and reacting all the time. That is just the nature of it. "
