Saolta CEO says LUH is improving, but there is still a long way to go

The CEO of Saolta says the Performance Management Improvement Unit Team which was deployed to Letterkenny University Hospital last November has led to major improvements, but there is still a long way to go.

Tony Canavan said as a result of the team’s intervention, coupled with a huge effort by staff and management locally, major inroads have been made in addressing waiting lists and ED wait times.

Mr Canavan also confirmed a further meeting will take place with GPs next week.

The issue was raised at the meeting by Cllr Ciaran Brogan, who says the hospital remains very busy, and if new processes are needed, they must be implemented………..


Report in full –

The PMIU Team commenced in Letterkenny University Hospital in November 2023 and a Terms of Reference was agreed.
The HSE National Team reviewed the day to day functioning of LUH and the Community Services within a leadership,
management, operational and clinical context to consider how improvements in LUH may be enabled in the short term.

Critically, it sought to identify what is required locally, regionally and nationally to support operational and clinical
effectiveness on a sustained basis across LUH and the Community Services. Key drivers of the Review Process are the delivery
of safe effective care for the population served by LUH and the close, integrated and patient centred collaboration with
Community Operations in CHO 2.

The primary focus remains on implementing a purposeful action plan aimed at delivering sustained improvements with a
focus on quality patient care. However, the PMIU Team also sought to harness and support what is working well as part of an
overall improvement plan.

The key focus areas highlighted are:

 System control and a Navigational Hub
 Enhancing patient flow to meet admission demand
 Patient Flow Process Improvement (Pull Approach, Flow Meetings & Huddles, Roles & Responsibilities, Escalation
 Discharge Process Improvement (Discharge before 11am)

The duration of the team’s engagement was from Friday 3rd November to Friday 22nd December 2023. Week 1 of the
engagement sought to develop a detailed set of data analytics to aid focus on the primary areas for improvement and set out
a detailed timeline plan of the work streams over the subsequent 6 weeks.

On the 24th January 2024, there was a 30 Day Report Out with the Rapid Improvement Team, Saolta Management, local
Management & the Community Team.

Improvement Scope, Objectives & Metrics
61 patients (median value) are admitted daily to Letterkenny University Hospital via the Unscheduled Care pathway (acute
medicine, emergency stay, elective stay). Daily discharges do not meet this daily demand, resulting in patients boarding in the
Emergency Department and Acute Medical Assessment Unit, admitted to ward overflow beds, or transferred to other surge
locations for overnight boarding. Additionally, most discharges happen too late in the day, leading to delays in transferring
patients from the acute floor to inpatient wards.

To address this demand and discharge mismatch, it was determined that the scope of work would be from a decision to admit
to LUH to discharge from LUH, with an improvement focus on enhancing patient flow processes at LUH, specifically:

The following improvement metrics will be tracked and monitored against the targeted patient flow domains:

• Time waiting for admission to beds from ED and from AMAU
• Discharges before 11am – 33%• Admissions before 12pm – 33%
• Number of Weekend discharges – 30% improvement

A number of actions were identified and these are being reviewed at the weekly scheduled meeting with the Rapid
Improvement Team, the Community and local Hospital Management.
Benefits to date:

 There has been a significant drop in 8am Trolley numbers in October and November.
 There has been a reduction of the number of over 75 year olds waiting for more than 24 hours
 There has also been a significant improvement in the overall number of patients waiting for more than 24 hour
which reduced from 200 in September down to 39 in November.
 There has also been a reduction in ambulance turnaround times.

A follow up 60 Day Report Out is scheduled for the 28th February 2024.

Separately figures from 2023 show that Letterkenny University Hospital made significant progress in reducing trolley numbers
at the hospital last year.

Letterkenny University Hospital continued to see high attendances across 2023 with a particular rise in older patients who
were admitted for care.

Total attendance at the Emergency Department in Letterkenny last year reached 51,822, a 9pc increase on the previous year.
The number of over 75 year olds attending the emergency department increased by over 7pc in 2023.

However, despite the increase in attendance there has been a 15pc drop in the number of patients waiting on trolley’s each
day in 2023.

Letterkenny University Hospital has also achieved significant improvements in waiting lists over the course of 2023.
LUH has reduced total outpatients waiting by 13pc over the course of the year. The hospital also decreased the number of
patients waiting greater than 15 months by 50pc.

Letterkenny University Hospital also achieved significant improvement in treating long waiters with a 78pc reduction in the
overall number of patients waiting greater than 3 years.
The hospital also reduced the total inpatient waiting lists by 47pc last year.