A TEN per cent increase in the number of beds, a three-fold rise in the number of critical care beds, the recruitment of more than fifty additional staff and a return to work for many more who had retired.
These measures all form part of extensive, ongoing preparations at Letterkenny University Hospital for the expected increase in Covid-19 patients presenting to the hospital in the coming days.
Hospital staff have moved patients to alternative facilities within the hospital for the expected surge of people with Covid-19 with experts predicting that it will be two weeks yet before peak figures for the disease are reached in Donegal.
Earlier this week, six Intensive Care Unit (ICU) beds in Letterkenny were being occupied by people fighting for their lives because of coronavirus.
Up to last week there were only five critical care beds available in Letterkenny but that number has already been ramped up to 14 with a further four ICU beds due to come on stream in the coming days.
Meanwhile, construction work is ongoing on creating an additional 38 beds on two separate sites within the LUH campus – bring the total number of beds to 391.
The recruitment of additional staff also continues at pace as management seek to protect the health and safety of the 1,800 plus workers in Letterkenny University Hospital.
Speaking to the Donegal News this week Mr Sean Murphy, General Manager, LUH, confirmed that there had already been ‘significant’ instances of Covid-19 in Donegal.
“We are seeing these numbers grow day by day. There have been some deaths in Donegal and, unfortunately, we will see a deterioration in those numbers in the coming days,” he said.
On Monday evening there were 36 confirmed cases of coronavirus in Donegal, a fifty per cent rise in the figures (24) from twenty four hours earlier. There had also been four deaths recorded in the North West.
“We’ve already seen the ongoing and significant build up in the number of cases and the number of patients with symptoms. We’re probably still a few weeks away from the peak and, while everything is speculation, they’ve been reasonably accurate with their figures,” he warned.
There will be no room for complacency even when that peak is reached.
“We’re in for a marathon. Getting to the peak won’t mean it’s over. Just because we get to the peak doesn’t mean it disappears. An awful lot of preparation is required in the build up to the peak, to get past it and then to continue to provide for patients afterwards,” Mr Murphy explained.
“A huge amount of work has taken place in Letterkenny University Hospital over the last number of weeks and I want to acknowledge the commitment and dedication of all our staff as we prepare for this unprecedented public health emergency,” he added.
The hospital has moved and reconfigured existing inpatient wards to facilitate the treatment of suspected and confirmed Covid-19 patients in the safest possible way. Extra critical care capacity has also been created in the ICU to allow staff to treat more patients, should that be required.
“We’re also converting two areas into additional bed capacity and one of the new wards will be in the fixed base building as you drive in the main entrance,” he said.
From Friday last, Letterkenny University Hospital has effectively been operating as two separate hospitals on the one campus. Patients coming into the Emergency Department are being divided into Covid and non-Covid categories.
“We’ve turned the Medical Assessment Unit into a respiratory unit with its own X-Ray room which allows us to stream patients who are potential covid risks away from other patients. There’s also specific covid dedicated wards throughout the hospital,” he said.
Indeed, the hospital has also managed to put in place two separate clinical teams – those dealing with covid-19 patients and those dealing with other patients.
“We’re working very closely with our Infection Control team. They’re putting in a super human effort.
“From last Friday, all staff coming into contact with patients who may have covid have been directed to wear masks and gloves to protect them and to minimise the risk of spread. We’ve tightened up on those directions over the weekend and we’re reviewing them on a regular basis,” he said.
To help support the greater workload, LUH is currently employing additional porters, domestic staff, general support staff, pharmacy technicians, laboratory staff and nurses among others.
In some areas, where specialised skills sets are required, a number of staff have agreed to come out of retirement on a part-time basis.
People continue to get ill for a variety of reasons that are not Covid-19 related. One of the challenges for staff in Letterkenny is to make sure that all patients who require clinical care are looked after in a safe, secure manner.
“Fractures still happen and orthopaedic clinics still go on. Likewise, the maternity unit can’t simply close down while there are surgical and medical cases. Again, it’s a matter of trying to maintain the existing service while also looking at the opportunity to redeploy staff to support their colleagues elsewhere. There’s been huge co-operation across all disciplines in that regard,” Mr Murphy said.
“It’s much more complex that it may first appear. We have to have teams in place 24/7 in sufficient numbers so that we don’t burn out our staff. It took a lot of logistics, changes to rosters and goodwill,” he added.
“For example, the number of ICU beds went from five to eight last week. We’re also using an area around the theatre complex for another six which brings the number up to fourteen.
“Today, six of those beds are being used and, unfortunately, it looks like more than less beds will be needed over the coming weeks,” he said.
“We have the capacity for fourteen but we’ve equipment coming on Friday which, with up skilling etc, will open four more bringing to eighteen the number of ICU beds,” he added.
PPE and FLOODS
To ensure that there’s enough staff to maintain so many ICU beds the hospital has to protect its own staff from becoming ill.
“That remains a key challenge. They all need to be fit for duty in the weeks ahead as we see more and more patients presenting.
“It’s all very reminiscent of the floods more than six years ago when we got the ED back up and running within 21 days. That took a huge effort and we’re seeing the same response this time around.
“We don’t always get it right but this has been a trojan effort by all concerned and the work and commitment the staff are bringing to this is second to none. Remember, they too have families and they’re giving it their add,” he added.
Last week nurses raised serious concerns about a serious shortage of protective clothing when dealing with Covid-19 patients in Letterkenny.
“There’s a whole range of supplies needed on a daily basis and it’s important that we don’t run out of anything. We’re getting a delivery of supplies from China today for example
“We have PPE (Personal Protective Equipment). However, there are certain areas that continue to be problematic. We did run out of visors last week and we asked staff to use goggles which, in turn, put a huge stress on the number of goggles we had in supply. While we don’t have the levels of PPE we want it’s unfair to say that we don’t have PPE. It’s about sustaining what we have. We have daily meetings but I want us to be able to look a week ahead of ourselves,” he said.
Meanwhile, visiting restrictions continue at LUH with the exception of end of life situations and that is expected to continue over the coming weeks.
“We fully appreciate how difficult that is for our patients and their families but we must do it to protect our patients in the first instance but also our staff,” Mr Murphy said.