Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank the Deputy for raising the issue. Letterkenny General Hospital has an average of 98 presentations to its accident and emergency department on a daily basis. I have been advised by the HSE that over a period of several days last week the hospital encountered a spike in demand, where there were more than 120 presentations on each of the three days involved. Coupled with this was the acuity or degree of complexity in sickness of the patients. Sicker patients typically require more complex care and for longer periods. A series of measures was undertaken to manage this surge in volume, including a message to the public to avoid the accident and emergency department if possible and for people to contact their GP to see if their emergency merited them attending the department. This is a usual response for hospitals to pursue in the event of unusually high demand and this is not unique to LGH. All acute general hospitals are faced with these challenges when it comes to a spike in demand.

LGH has taken a range of measures to deal with increased demand and is working closely with the special delivery unit, SDU, on an almost daily basis to manage and identify strategies to expedite patients' journeys through the hospital. An additional 19 beds were opened in the hospital in July this year while the SDU funded a further 11 beds in primary and community care to expedite discharges from the hospital by creating additional capacity for patients who require step-down care before they return home. The navigational hub bed management unit was set up to improve the efficacy of management of inpatient beds in the hospital.

Further measures include prioritising patients who require diagnostics, other interventions for patients who can be discharged on same day and working closely with colleagues in primary and community care to minimise the impact of delayed discharges in the hospital. Letterkenny General Hospital has one of the lowest levels of delayed discharges in the country. Last week, there were no delayed discharges compared with more than 300 in the Dublin hospitals. Today at 8 a.m. only one patient was waiting on a trolley and by 2 p.m., there was none.

A consultant physician has been appointed to lead on the acute medical assessment unit, AMAU. All medical referrals to the accident and emergency department are directed to the AMAU where a senior decision maker can assess and treat patients, thus avoiding admission. There also has been a reorganisation of work practices of the consultant and non-consultant hospital doctor staff in order that those who are on-call to the accident and emergency department have no other commitments elsewhere in the hospital. For instance, the surgeon on-call does not do any scheduled care in theatre that day. This has led to a much more timely response in seeing emergency presentations.

The hospital's patient flow policy was also recently reviewed and updated. The outcome was the adoption of a range of measures to expedite patient flow throughout the hospital such as improved discharge planning with the aim of discharging patients by 11 a.m., meaning the bed is freed up for another patient earlier in the day. The measures include nurse-led discharge and the identification of estimated date of discharge for each patient. The patient flow escalation policy has been also updated.

The target waiting time from presentation at the accident and emergency department to discharge or admission is six hours. LGH meets this target 87% of the time. The hospital experienced an unexpected spike in demand over the usual demand, therefore, additional special measures were taken to respond. All patients who presented to the accident and emergency department last week were assessed and treated as required.

As well as the exceptional measures outlined, the modern facilities created through the rebuilding necessitated by the flooding events in 2013 will ensure patients have improved access to safe, sustainable services for the long term. This is a direct reflection of the commitment and hard work of staff and management of Letterkenny General Hospital, the rebuild steering group and Saolta University Health Care Group.

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