THE CHIEF executive of the Health Information and Quality Authority (Hiqa) has expressed her concern to the HSE over the mix of medical care provided at the downgraded emergency units at Ennis and Nenagh hospitals.
In 2009, Hiqa published a report recommending that services at Ennis hospital should be reconfigured, saying it was unsafe to retain the configuration of services as they were. It carried out its report after the deaths of cancer victims Edel Kelly and Ann Moriarty.
As part of the reconfiguration of services, Ennis and Nenagh’s 24-hour emergency units were downgraded and are open only between 8am and 8pm, with a protocol that serious cases go directly to Limerick Regional Hospital.
However, in a letter to the HSE’s national director for quality and patient safety Dr Philip Crowley, Hiqa chief Dr Tracey Cooper has stated: “It is of concern to the authority that the information provided suggests that the midwest regional hospitals at both Ennis and Nenagh continue to provide undifferentiated medical take between 8am and 8pm in the absence of clinical care pathways and no stipulated risk mitigating actions to effectively manage the acutely deteriorating patient – including the management of a patient with a deteriorating airway.”
In her letter from November last released under the Freedom of Information Act, Dr Cooper went on: “The recent information that you have provided to date suggests that while there are medium- to long-term plans in place, including the clinical programmes under development, there has been limited consideration given to the management and mitigation of immediate and current clinical risks.”
Dr Cooper asked that the HSE meet Hiqa to discuss the situation “in consideration of the potential serious risks associated with the current provision of services as outlined”.
In response, Dr Crowley wrote: “The rationale for continued undifferentiated medical take at these hospitals, pending the further centralisation of some key services at Limerick Regional, has been outlined with several meetings with Hiqa.”
In his letter Dr Crowley said: “The relevant midwest clinicians responsible for managing these patients are satisfied that appropriate risk-mitigation measures are in place.
“The development of clinical pathways is recognised by the midwest as an immediate priority area for further action,” he added.
Dr Crowley admitted that “there are some undifferentiated medical patients still being admitted to these hospitals and we are satisfied that the arrangements that are in place are appropriate to mitigate these risks”.
Dr Crowley added that “these hospitals are fully signed up to the acute medicine programme work. At the first sign of deterioration, patients are transferred appropriately to the Midwest Regional Hospital Limerick.” He said: “The local GPs have been involved in the reconfiguration of services in Ennis and Nenagh for a number of years now, and are well aware of the range of services available in these hospitals.”
