The accident and emergency department at Kerry General Hospital is without doubt the most under-staffed accident and emergency department in the country and is struggling to cope with massive increases in patient numbers coupled with an unacceptable lack of resources. The reason it manages to operate is the hard working commitment of the staff and the assistance they receive from colleagues in other specialities in the hospital. Kerry General Hospital offers its acute services to the population of Kerry, which is approximately 132,000. It also serves parts of north Cork and south Limerick.
When it was originally constructed, attendance at the accident and emergency department was 13,500 patients per year. This has now risen to 29,000 over the past two decades. To cope with this increase in numbers, one would expect that more staff, equipment and space should have been provided. However, in contrast with other acute hospitals around the country of similar size, this has not happened. The role of the accident and emergency department at Tralee has expanded over the years. The most significant change has been in the use of accident and emergency departments as a point of first contact with the hospital for all patients requiring emergency care and few patients who are ill are admitted directly to a ward, even when beds are available.
This change occurred for a number of reasons, but primarily because of patient safety. The accident and emergency department structure is specifically geared for patient management and is ideally located to access all other areas of the hospital such as the X-ray department. Some changes have been made in recent years. Five junior doctors at senior house officer grade were appointed to the accident and emergency department four years ago. These doctors have limited experience and must work under the supervision of more senior medical staff. In October 2003, Dr. Sean O'Rourke took up the post of consultant to the accident and emergency department and in addition some internal building works have been undertaken to maximise limited space and provide two X-ray examination cubicles.
The fundamental problem that affects the accident and emergency department is one of under-resourcing. For example, the Royal College of Surgeons in Ireland recommends that for each 3,500 patients there should be one SHO. The five SHOs at Tralee general hospital should see approximately 17,500 new patients annually. However, patient numbers are far above this level, at more than 29,000. There is approval for a further two SHO posts, but these remain unfilled. I understand there is an application to seek approval for an eighth post because of the increase in the number of patients. As I previously stated, SHOs are junior doctors with limited experience. When the accident and emergency consultant is not on call, the department has no registrars to turn to for advice in medical emergencies.
Nursing levels are also a concern. With only 24 wholetime equivalent nurses in the department, each night-shift is covered by only three nurses. During summer months an additional night-time nurse is provided, but he or she is removed at the end of September. Bearing in mind that patients frequently present at the accident and emergency department late in the evening, and given that they have to wait longer to be assessed, the night-time is often as busy, if not busier than day-time. Given the pressures this degree of cover is simply not adequate.
The hospital management submitted a brief to the Department of Health and Children in June 2002, outlining the facilities required to bring the accident and emergency department up to an acceptable standard. However, the hospital is still awaiting a response from the Department regarding these proposals. The majority of patients who attend the accident and emergency department have suffered injuries of varying severity. These patients are seen and treated by the accident and emergency doctor and nurse, with the majority being discharged. Patients presenting with conditions such as chest pain, stroke, pneumonia and asthma are the second largest group. Many of these patients are sicker and older and require speedy assessment and treatment. Their conditions need to be stabilised in accident and emergency departments prior to transfer to the wards. An acute medical unit is essential for this type of patient. This type of facility has been a resounding success in Kilkenny. However, it costs approximately €1 million per year to run such a facility. Such a unit in Kerry General Hospital, located next to an operating theatre and parallel with the accident and emergency department, would be of immense benefit to this important group of patients.
There is an urgent need to increase accident and emergency medical staff to an appropriate level. The appointment of three additional SHOs and three registrars would reflect medical staffing levels in similarly sized units around the country. There is also the need to increase nursing numbers to reflect the continuing demand on the accident and emergency department in the hospital. Funding for the establishment of a properly functioning and acute medical unit should be prioritised and this should include approval for an increase in medical nursing and non-nursing staff.
Approval from the Department of Health and Children for a new accident and emergency department in Tralee is essential and the funding to put this in place should be sanctioned immediately.