Issue of safe and timely transfer of patients across CUH is unresolved

The CUH terrain is unsuited to trolley transfer, says Health Correspondent Catherine Shanahan.

Issue of safe and timely transfer of patients across CUH is unresolved

For anyone not familiar with Cork University Hospital (CUH), it’s built on terrain a BMX rider could have a field day on — undulating, dotted with embankments and littered with speed ramps. In fact back in the day, when the hospital was more promise than achievement, it was a playground to motocross riders and scramblers.

Within this physical setting, transporting a patient by trolley across campus could make for a bumpy ride.

The notion, therefore, of transferring patients with an emergency medical condition 800m across campus by trolley, from the acute mental health unit (AMHU) to the emergency department (ED), seems fraught.

Yet this is what the HSE is proposing following a review of patient transfer policy governing the safe transfer of patients from the AMHU to the main hospital.

To be fair, the revision was prompted by tragic circumstances — an inquest during the week revealed how a heartbroken husband has not forgiven himself for not taking his wife straight to the ED rather than the AMHU after she took a massive overdose.

Marian O’Reilly was 41 minutes waiting for an ambulance to arrive from Fermoy to take her just 800m across campus. While the inquest heard the ambulance delay was not a factor in her death, her husband, Henry O’Reilly says he is haunted to this day by his decision not to take her straight to the ED rather than the AMHU.

“I am constantly wracked with guilt as I feel if I had gone to the ED, she would be alive now,” Mr O’Reilly told the inquest.

Clinical director at the unit, consultant psychiatrist Eamonn Maloney, told the inquest the transfer policy has been revised since Mrs O’Reilly’s death. A trolley can now be used in an emergency where ambulance delays pose a risk to the patient.

Des McSweeney, a mental health nurse working in the AMHU, says the issue of how emergency medical cases would be transferred was a concern among staff even before the unit was built.

Prior to the opening of the new €15m unit in August 2015, mental health patients were cared for in a ward in the main hospital, eliminating any requirements for ambulances. Now, the issue of transfer crops up again and again. Tying up community-based ambulances seems a waste of resources, Mr McSweeney says.

Furthermore, ambulances, hardly thick on the ground, are sometimes hard-pushed to arrive in a timely fashion. Mr McSweeney wrote to HSE management expressing his concerns. He also wrote to Health Minister Simon Harris and Mental Health Minister Helen McEntee.

Siptu health division spokesperson Sharon Cregan, who represents Siptu members at the unit, has also highlighted the use of community-based ambulances as one of their concerns.

Mrs O’Reilly’s ambulance travelled from Fermoy. Documents obtained by the Irish Examiner from the HSE under FOI show units from Youghal and Macroom stations have also responded to calls to transfer patients 800m across campus.

The FOI says emergency calls are responded to by the nearest available ambulance: “These may belong to other stations who happen to be on the Cork campus and not necessarily belonging to CUH.”

However, an examination of response times shows that some ambulances did travel from considerably further afield than CUH — as in the case of Marian O’Reilly.

In total, the log shows that ambulances were summoned to the AMHU 33 times in 2016, of which 21 were emergency calls, two of which were cancelled. This is at odds with the figure given out at the inquest. Dr Maloney said emergency transfers between the AMHU and CUH’s ED are rare, occurring maybe three times a year.

FOI documents also show Dr Maloney requested a meeting with HSE management, including those in charge at the AMHU, on March 16, 2016, 10 days after Mrs O’Reilly passed away, to discuss the issue of patient transfers.

An email to colleagues reads: “I’m sure you are all aware there have been some issues in relation to the transfer of patients between AMHU and ED/CUH. I suggest we meet to discuss how these issues might be addressed.”

In any event, it now appears patients can be transferred by trolley if waiting for an ambulance poses a risk. A copy of the patient transfer policy at the inquest said as much.

Curiously, a copy of the same policy released to the Irish Examiner this week under FOI bears no reference to using a trolley. Mr McSweeney says he is unaware of any revision.

He also says the only trolley currently at the AMHU is “dumped” in the unused nurses’ office in the high observation ward, “next to other bits of broken furniture”.

“I don’t think this trolley is suitable for external transfers as it does not have straps to secure a patient in the way that the ambulance service has straps on their trolleys. If it hit a curb during transfer, a patient could fall off,” he says.

And so it seems the issue of safe and timely transfer of patients across the CUMH campus remains, for now, unresolved.

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