Hospital will station GPs at A&E doors to screen patients who are ‘not sick enough'

The move comes as a new set of measures are rolled out after a winter of record numbers of patients on trolleys in University Hospital Limerick (UHL), where there have been long delays for beds.

Concern about the levels of patient distress due to the log-jam grew in recent days following an inquest into the death of Martin Abbott (65), who may have been lying on the floor for over an hour in UHL emergency department, with rigor mortis having set in by the time he was found.

The circumstances involving the care of Limerick man Mr Abbott, who attended the hospital in December 2019, were revealed as an inquest heard he was discovered lying face down beside his trolley by nursing staff.

He had received a kidney transplant several years earlier and, as he was immunosupressed, had been placed in a cubicle in the emergency department.

Three other reviews of patient deaths at the hospital are also at different stages.

The latest plan will see a GP from the local out-of-hours service screen patients arriving at the emergency department and treating them if they have a low-level medical condition.

Currently, around half of patients who attend the emergency department arrive without a GP referral, even though a family doctor may have been able to treat them in many cases.

They are spending hours waiting to be seen by emergency department staff who are being diverted from caring for more seriously ill patients.

A spokesman for the hospital said “around 50pc of patients attending the emergency department do so without a GP referral, a higher proportion than any other emergency department in the country”.

“Under the new pathway, patients will be invited to see a GP in the first instance, potentially avoiding an ED attendance with other options being available,” the spokesman added. “This may include patients being streamed to our services in St John’s Hospital and Ennis and Nenagh Hospitals.

“A primary care triage nurse will be based in triage in the emergency department and an out-of-hours GP will be based adjacent to the department. The hours of service will be noon to 10pm, seven days a week. As with other GP services, fees may apply for patients on the new primary care pathway.”

HSE chief Bernard Gloster recently cited the move as one of a package of measures being implemented to relieve pressures on the hospital’s emergency department.

Other measures include retaining some older open-plan wards with several patient beds, even when 96 new beds come on stream. It is also planned to use a new public nursing home in Nenagh as a step-down facility for patients from the hospital to allow more efficient discharges.

Mr Gloster said the plan to station a GP at the front of the emergency department “will start in a few weeks” and clinical governance will need to be finalised. This will set out how these patients are triaged and selected for consultation with the GP.

He added, however, that the GP plan had been implemented before and it was the view of the hospital that it did not make much difference.

It is also planned to have the medical assessment units in St John’s Hospital and Ennis Hospital open around the clock. However, there are no plans to reopen their emergency departments, despite the demands of local campaigners.

A report is expected in the coming weeks on the death of 16-year-old Aoife Johnston from Shannon, Co Clare.

She waited 12 hours to be treated for sepsis in the overcrowded emergency department and died two days later on December 19, 2022.

Retired judge Frank Clarke has sought more time to complete his independent investigation. An inquest into Aoife’s death is due to take place next month, but may be adjourned if the report is not ready.

Two other patient deaths have occurred at the hospital since he began his investigation last December.

A 16-year-old girl, who was having breathing difficulties, died suddenly in the emergency department on January 29. She had initially spent two weeks in hospital with a serious respiratory infection and was discharged on January 23.

She was readmitted on January 29, but collapsed and died in the emergency department. A preliminary report on the circumstances of her death has been completed and given to her family.

Last month, a 33-year-old woman died suddenly, four days after she was admitted to UHL from University Maternity Hospital Limerick. She lost her baby after she was admitted to UHL.

The next day, the woman’s condition deteriorated rapidly and she suffered a cardiac arrest.

An inquiry is under way into her death.