Lack of obstetrics theatre is a big risk at Kerry hospital

The lack of a dedicated obstetric theatre in University Hospital Kerry (UHK) poses the greatest risk to patient safety and care, according to documents obtained by the Irish Examiner.

Lack of obstetrics theatre is a big risk at Kerry hospital

Consultant obstetrician/gynaecologist at the hospital Dr Mary McCaffrey said despite the identified risk, repeated business cases for provision of a new theatre “never seem to get incorporated into any building plans”.

The lack of a dedicated theatre has consistently ranked number one on the hospital’s risk register, with a maximum rating of 25, which according to the HSE’s own assessment tool equates to “extreme” risk.

This means the probability of an adverse event is “almost certain”.

While women had no reason to fear giving birth at the hospital because the risk was “managed well” there was “always the potential that something could go wrong”, Dr McCaffrey said.

The fact that outcomes for mothers and babies were good was due to the risk being well managed or they had been “extraordinarily lucky”, she said.

However, failure to have a dedicated theatre for obstetrics was having a negative effect on other parts of the hospital.

“Best practice dictates that there should be one dedicated obstetric theatre so that an emergency could get in at short notice. The problem with not having this theatre is it affects the overall efficiency of the hospital in terms of surgery,” she said.

As a result, patients scheduled for non-urgent procedures had operations cancelled at short notice to accommodate obstetric emergencies. While UHK has a suite of five theatres, they are “available to everything”, Dr McCaffrey said.

Running a service in this manner meant staff were in a constant state of high alert, she said.

“Orthopaedics gets gazumped all of the time. They could be due to embark on a complex case knowing anything is likely to happen. But there seems to be a lack of appreciation about how it affects the hospital. Senior management have done nothing,” Dr McCaffrey said.

The need for a dedicated theatre had been discussed as far back as 1998.

Dr McCaffrey believes it would not be “a big job”.

“You can buy self-contained theatres, in a box almost, it could be done for quarter to half a million.”

The irony was “if some disaster befalls a patient”, it would cost the hospital far more in terms of litigation.

Documents obtained by the Irish Examiner under Freedom of Information show the CEO of the South/South West Hospital Group, Gerry O’Dwyer and chief clinical director, Dr Rob Landers, wrote to the HSE almost a year ago highlighting the deficit.

In a letter to Liam Woods, national director of the acute hospitals division, they said the “main area of concern” for the obstetric service at UHK was the “number one risk on the hospital’s risk register”.

They said a business case had previously been submitted and they described the risk as “critical”.

They suggested, as an interim measure, providing a second on-call team 7/7 at a cost for a full year of €817,000.

Following queries from the Irish Examiner, the HSE confirmed the absence of a dedicated obstetric theatre remains the number one risk at the hospital.

In 2015, 1,406 babies were delivered at University Hospital Kerry.

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