Injury Units – fast, efficient, high quality service for thousands of patients in Midwest every year

Wednesday 31st January 2024 ¦ AT A TIME of high demand for emergency care in the Midwest, the three Injury Units at Ennis, Nenagh and St John’s Hospital, are providing a fast, efficient and high quality service for thousands of people every year who need timely treatment for minor injuries.

Speaking on the latest episode of The UL Hospitals Podcast [see Notes for Editors], Dr Cormac Mehigan, Consultant in Emergency Medicine and Clinical Lead at the Injury Unit in Ennis Hospital, described the Injury Units at Ennis, Nenagh and St Johns as rapid, efficient, high-level facilities with good outcomes for patients, 12 hours a day, 365 days of the year.

Over the past five years, the three Injury Units have been a crucial pathway for the hospital treatment of minor injuries in the Midwest, and a total of 46,704 patients attended the units during 2023.

Total Group-wide Injury Unit attendances for 2023 were 6% greater than in 2022, and since 2019 have grown by 40% - see below

Staffed by Emergency Medicine Consultant-led expert teams of Registered Advanced Nurse Practitioners, Registrars, and administrative support, the Injury Units provide timely treatment for minor injuries that are non-threatening to life or limb but still require expert, prompt attention. No appointment is necessary, and the service is free to those who are referred by GP.

Explained Dr Mehigan: “Primarily we see adults and children over the age of five who have minor injuries to the legs below the knee, and to the upper limbs from the clavicle or collarbone down to the fingertips. We can also deal with some wounds.” Patients can also get an x-ray at their Injury Unit without having to wait a long time.

Dr Mehigan added: “The things we don’t see are major medical emergencies such as strokes, heart attacks, severe abdominal pain, bad chest pain, seizures, diabetic comas, the really bad medical emergencies.”

He acknowledged that “for most people, the desire is to have the treatment they need as close to home as possible, “but unfortunately, that can’t always be delivered, and if you need more sophisticated care, then that needs to happen in Limerick, and most people understand. I think some people present who really don’t know there is no longer an emergency department here… and if they’re not appropriate for the service, we have to send them on, either by their own transport or if they have a significant medical problem we would organise an ambulance for them”.

He explained that there are ‘borderline’ cases on the very edge of criteria for Injury Units that may be dealt with in the Unit, including chest injuries and cracked ribs from sports matches. However, in the most serious of such injuries the potential exists for leakage of air or blood into the chest cavity, which may tilt the condition into something that requires emergency medicine care in the ED in UHL.

“We encourage people to call ahead and ask if they have any doubt, and in those borderline cases what we always say is, 'Come and see us and if we need to redirect you we can redirect you'... Certainly people can ring ahead and ask and we can let them know whether we can see them, and we have many calls every day asking that exact question,” Dr Mehigan said.

• For a list of injuries that can be treated in Injury Units, visit the HSE website here.

Another important characteristic of all three Injury Units is the nursing grade of Advanced Nurse Practitioner. These senior specialist nurses can, like doctors, lead the process from admission, right through to discharge.

As Dr Mehigan’s Injury Unit RANP colleague, Mhairi Barron explains on the podcast: “When patients attend the Injury Unit, they can be seen by either a Nurse Practitioner or a Doctor, and as a Nurse Practitioner, we can see all patients within criteria, and perform a full episode of care.”

Such staffing and skill mix helps to ensure timely, efficient patient journeys with positive outcomes. Injuries of the type outlined by Dr Mehigan can be treated in a fraction of the time that would be required if a person who suffered, for example, a sprained or broken arm, attending the increasingly busy Emergency Department (ED) at University Hospital Limerick, where care is prioritised for the most seriously ill or injured patients.

Telling the UL Hospitals Podcast of the services provided by the team at Ennis Hospital, Dr Mehigan said: “In the Injury Unit, the majority of people would be seen and discharged in between an hour and two hours, and many in under an hour, which is a fantastic level of care. So I would encourage anyone who has an injury that fits the criterial for an Injury Unit to attend here in Ennis.”

Dr Mehigan said the service had ample capacity to cater for even more patients. He pointed to the recent €2m refurbishment of the Injury Unit at Ennis Hospital as an indicator of the importance of this flagship UL Hospitals Group service in the context of the national HSE strategy on treatment of minor injuries. The Midwest units are three of 11 such facilities nationwide.

“What we had previously was in a small part of the old hospital that was really unfit for purpose. It only had two clinical areas that we could see patients in and it really limited flow through the department. Now, we have five cubicles, and it improves flow, people get through, the flow is maintained, and hence our ability to see patients,” he added.

Dr Mehigan said he is proud of the service he and his Injury Unit team provide for the people of Clare. In 2023 the total number of patients attending the hospital's Injury Unit and Medical Assessment Unit combined was 22,642, which, Dr Mehigan pointed out, is in excess of the numbers treated annually in the local Emergency Department in Ennis in the first decade of the 2000s, prior to the reconfiguration of services in the Midwest. “So what we’re providing is a really good service for the people of Clare. People who need more sophisticated care need to go into Limerick, where they can provide that care, but here in Ennis Hospital we do provide a fantastic level of care for people who attend appropriately,” Dr Mehigan said.

He concluded: “The Injury Unit provides a fantastic level of care for the people of Clare. It's rapid, it's efficient, it's high-level, and people get good outcomes. And for me it's a fantastic service in a really nice, state-of-the-art facility which has been purpose-built.”

NOTES FOR EDITORS

Injury Unit Opening Hours & Contact Numbers

All three UL Hospitals Group Injury Units in the Midwest are open seven days, 365 days a year. Opening hours and contact numbers are as follows:

• Ennis Injury Unit ¦ 8am-8pm ¦ 065-6863121
• Nenagh Injury Unit ¦ 8am-8pm ¦ 065-6863121
• St John’s Injury Unit ¦ 8am-7pm ¦ 061-462303

The UL Hospitals Podcast A new podcast series exploring the services of UL Hospitals Group through the eyes of those who work there. Available on Spotify, Acast, Apple and Amazon. Homepage on the HSE website at this link.