ICF in Limerick opens eyes to new patient-centred model of care

DEMENTIA ADVISERS

Xxxxxxx For five months of the pandemic year of 2020, the Sports Arena in the University of Limerick (UL) was transformed into a field hospital to help with the battle against COVID-19 that threatened to overwhelm the hospital services in the Midwest. The field hospital, later named the Intermediate Care Facility (ICF), turned out to be the only successful operating field hospital in Ireland during this period, catering for 188 patients. “The weekend after the University was closed, I was contacted by the Department of Health to see what the University could do to help,” said Professor Des Fitzgerald, former UL President. Des was a member of the board of UL Hospitals Group every county NOW IN FIELD HOSPITAL OPENS EYES UP TO NEW PATIENTCENTRED MODEL OF CARE (ULHG) where concerns had been expressed about the capacity within the hospital and their ability to cope if the Intermediate care facility housed in local case numbers continued to rise as expected. Colette Cowan, sports arena during COVID-19 pandemic the CEO of UL Hospitals Group had been toying with the idea now the subject of a research study of a field hospital type initiative that would help with surge capacity in some way and assist in decompressing the acute and community hospitals if needed.

The idea took hold and UL o ered the sports arena free of charge as one of the possible options. A steering group was formed, chaired by Professor Paul Burke, Chief Academic O cer with the Head of Strategy in UL Hospitals Group, Suzanne Dunne, pulling the plan together. It was finally agreed that the space would operate as a rehabilitation facility, as championed by Fiona Steed, then Group Lead of Allied Health in UL Hospitals Group. It would take patients who required rehabilitation care with complex medical discharges, out of the acute hospital setting and give them the necessary supports and therapies to facilitate their journey home or to longer term care settings. This would not only assist in positive patient outcomes but also free up beds for acute care in the hospital.

This opened the door to the more direct involvement of the UL School of Allied Health (SAH) in the process and particular opportunities for allied health profession students around placements and completing course requirements for graduation. Dr Aileen Wright, head of the School of Allied Health, said the sudden closure of the university and the almost overnight move to online teaching was very challenging for her sta .

The ICF provided an opportunity for SAH students to both complete their clinical placement requirements and also gain valuable experience in the contribution to the care of patients in the ICF, under the supervision of qualified clinicians. Nursing students from the UL Department of Nursing and Midwifery (DN&M) could also avail of the learning opportunity o ered by the ICF.

Chief Director of Nursing and Midwifery Margaret Gleeson worked on securing the nursing personnel to sta the facility. Niamh O’Grady, General Manager for Operational Services in UL Hospitals and her team ensured that all the necessary facilities and personnel were in place - porters, catering, cleaning, security – to operate the facility.

The issue of clinical governance proved to be one of the most di cult challenges to overcome as there was no spare capacity among consultants already working in UL Hospitals Group. Professor Paul Burke approached two of the most respected retired Consultants in the region – Dr Eithne Molloy and Dr Con Cronin. They agreed to come out of retirement to fulfil this clinical governance role in the ICF.

Once the planning framework was finalised, it was handed over to Breda Duggan, Project Manager in UL Hospitals, to operationalise. The logistics of turning the Sports Arena into essentially a hospital ward was a mammoth task covering everything from infection control, catering, toilet and sewerage facilities, health and safety, equipment, patient transport and security.

But perhaps one of the inspired ideas was to engage the Irish Army in the project. Once the planning was done with the project team, the local 12th battalion Infantry Unit, based in Sarsfield Barracks in Limerick, rolled in to do the ‘heavy lifting’.

“The army was amazing,” said Project Manager Breda. “They laid out the units, put wheels on wheelchairs, dressed beds … they did everything, they were an amazing bunch of men and women and they just did what had to be done.”

The doors were finally opened in the ICF on June 8th, just 10 weeks after the idea had been first floated. Consultants, allied health professionals, doctors, security, medical social workers, nurses, students, porters, cleaners, health care assistants, patient advocacy service (PALS), receptionists, caterers all came together in this 84-bed facility.

Top: Members of the Allied Health team at the Intermediate Care Facility. Front, from left: Aoife McCarthy, Senior Occupational Therapist; Joanne Mannion, Senior Speech & Language Therapist; and Mary Flahive, Senior Physiotherapist. Middle (from left): Fiona Steed, Group Lead, Allied Health; and Sheila Bowers, Dietitian Manager. with Joanne Hayes, Senior Medical Social Worker; Anne Hegarty, Principal Medical Social Worker; Catherine Daly, Occupational Therapist; Anne Harnett, Chief Pharmacist; and Scott Murphy, Physiotherapy Practice Tutor. Above left: Josephine O'Shea (91) from Oola, Co Limerick, taking exercise with Scott Murphy, Physiotherapy Practice Tutor, and Emer McGettrick, student physiotherapist: "With all the rest and exercise I’ve had, I feel so much stronger now. I have a much more positive attitude now as well." Above right: Tom Noonan from Dromcollogher, West Limerick: "I didn’t know what to expect when I was coming here, but I’ll tell you this, I couldn’t have come to a better place.”

Yvonne Young, who led the Centre in the Associate Director of Nursing role, and the entire team nurtured an ethos of kindness and compassion in the ICF that had a ripple e ect across the whole facility based on a holistic approach to care.

Patients arrived over the five month period with various needs ranging from post-operative care, to respiratory conditions, to post COVID-19 rehabilitation.

While the patients and the students were the primary beneficiaries, the sta who worked there also derived huge personal satisfaction and learning from the process. It opened their eyes to a new patientcentred model of care, anchored by e ective multi-disciplinary working in which the health and social care professionals are an intrinsic part.

The ICF closed its doors on X with the last patient discharged. The experience has thrown up many new and exciting ideas about further incorporating health and social care professionals into patient care in the UL Hospitals Group, and about the benefits of inter-discipline training and education for students and sta alike.

The Intermediate Care Facility is now the subject of a collaborative research study facilitated by the Health Sciences Academy with the Faculty of Education and Health Sciences and the UL Hospitals Group, led by Professor Judi Pettigrew in the School of Allied Health. The project aims to capture through in-depth interviews, the experiences of a wide range of stakeholders involved in the ICF from those who conceived it through to those who physically set it up to those who operated it or received care it in.