Cork University Hospital poised to trigger emergency escalation plan

Almost 180 nurses unavailable for work, as 84 patients with Covid-19 treated in CUH as of Wednesday night and just two critical care beds available

The revelation that CUH is actively considering the introduction of a 'tiered escalation plan' underlines the scale of Covid-19 challenge. Picture: Larry Cummins

One of the country’s busiest hospitals is poised to trigger an emergency escalation plan which was devised for, but not required, during the first wave of the Covid-19 pandemic.

News that Cork University Hospital is actively considering the introduction of its “tiered escalation plan” underlines the scale of the challenge facing this, and other hospitals as Covid-19 cases continue to soar.

Of CUH's estimated 1,400 nurses, the number who are unavailable for work because they have the virus, are close contacts of a confirmed case, or are self-isolating, has risen from just over 100 earlier this week to almost 180 by yesterday.

Of its 130 critical care nurses, 30, or almost a quarter, are unavailable for work for the same reasons.

One ward at CUH has already been closed because of the staffing shortage.

There were 84 patients with Covid-19 being treated in CUH as of Wednesday night - the second highest in the country, just two cases behind Beaumont - with a further 10 suspected cases.

Of the confirmed cases, nine had been admitted in the previous 24-hours.

Six of the confirmed cases are in critical care beds. The latest official figures show that as of Wednesday night, CUH had just two available critical care beds.

The INMO said the staffing situation is likely to worsen, especially given the childcare issues which will arise from next Monday, when schools resume with online learning.

"The system is under huge pressure," INMO spokesman Liam Conway said.

"Nurses and midwives are exhausted and now, it's like they are working with their hands tied behind their backs, in terms of staffing shortages.

"It's critically important that people heed the public health messages and stay at home because their fear is that hospitals won't be able to cope with the surge."

Medical staff at CUH have now been told that hospital management is likely to move away from the regular team-based or speciality-based approach to delivering care, towards a ward-based approach.

A source this said means that staff levels look set to reach such a critical level, that the focus will be on just keeping wards open and beds staffed.

Internal CUH staff correspondence, seen by the Irish Examiner, shows just how concerned managers are about the evolving and escalating situation, which, despite new lockdown measures, is likely to worsen over the coming weeks.

Medics have been told that given the large number of Covid-19 cases in the community, the widespread rate of community transmission, more hospitalisations can be expected and that the situation will likely escalate significantly over the coming days and weeks.

And because nursing homes have been closed to admissions, and some local step-down have reported Covid-19 outbreaks and are unable to accept patient transfers, the hospital is bracing for a large influx of patients.

It is understood that doctors in training (DITs) at CUH, who work across all specialities, have been asked to flag with management their experience in acute medicine in the event that they may be required as part of the hospital’s response to the third wave.

It could mean that surgical DITs with the right experience in acute medicine could be redeployed onto the front line of the Covid-19 crisis.