A modern hospital with medieval foundations
There’s a remarkable yet reassuring dichotomy story writ large in the annals of St John’s Hospital in the heart of Limerick city today. It is of an old hospital, Limerick’s oldest, that dates to darker days of even more deathly epidemics, such as cholera, typhus, and typhoid.
A creaking and capacity strained 99 bed hospital of narrow corridors and constricted rooms, its 20th century constructs mixing with old limestone remnants of the original 15th century Walls of Limerick. Yet, for all its reminders and challenges of past, it’s a hospital very much of the present and with a definite focus on the future, and it’s a hospital that still puts the patient at the centre of everything.
It may be wrapped by medieval city walls, but the remarkable thing is that, in contrast with those ancient surrounds, it’s a hospital of innovation. A hospital breaking new boundaries, meeting new needs with new approaches and practices and all with a ‘patient first’ approach.
Then again, St John’s has always been about meeting the greatest medical demands of the day, right from its very foundations in 1780 when Lady Hartstonge responded to the needs of the destitute in Limerick by creating the first ‘fever hospital’ in Ireland (or Great Britain for that matter), fitting out the old ‘guard house’ with beds and whatever essentials she could get to help the helpless.
As epidemics evolved, so too did the hospital; the take-over of it by the Little Company of Mary sisters in 1888 enhancing care and operational standards. The raison d’être of the order, physically caring for the poor, sick, suffering and dying people in our midst, was an imperative for the time.
Through the decades it met, struggled with, and saw off pretty much everything that was thrown at it, not without pain and loss but always with courage and resilience. Much of the 500-year-old city defence walls may have gone but St John’s remains at the frontline of health responses, finding new ways for innovation.
It was such last year when Covid hit, turning the clock back to origins of the ‘fever hospital’. The words of its CEO Emer Martin in a short video documentary titled House of Courage synopsises this latest heroic frontline siege of the Limerick hospital: “There’s a lot of history behind these walls, but so much of it is about the courage of St John’s and the people who come to work here every day. It was that way in 1780 and it’s still that way today.”
It’s a hospital, the only acute voluntary hospital still standing in the city centre, that’s always served the people of Limerick well, has always put them first in return, St John’s has a special place in the heart of Limerick people, as borne out by patient feedback to this day. As is often said locally, “everyone has a St John’s story”.
It’s the proverbial underdog that never gives in, using whatever resources it can to succeed and today that’s very much about innovation.
In fact, it’s flourishing in a classroom in the Old Medical School, otherwise the ground-breaking Rapid Innovation Unit (RIU). The Science Foundation Ireland sponsored unit uses 3D printing and other engineering pathways to find live patient-centric solutions, as explained by the unit’s Director, Leonard O’Sullivan, who works on the project with Kevin O’Sullivan, Research Lead and Aidan O’Sullivan, Technical Lead.
“We just saw potential benefit from having a natural innovation unit between a hospital and university, working with clinical stakeholders in University of Limerick Hospital’s Group to identify unmet needs from patient quality of life perspective,” he says. “It was really important to move out of the university and embed this into the hospital setting and St John’s has been a great partner in this. We are using 3D printing to be able to innovate and create the novel medical devices of the future and get them onto patients as quick as possible.”
One of the many examples of this ‘living lab’ at work is resolving catheter issues for a teenager who had cystic fibrosis. “The child had a feeding tube into the stomach that had a problem. It resulted in the child being unable to feed successfully. It just took 24 hours to design a solution, get it made on-site and put it on the patient. The child would not have been a good candidate for surgery because of the medical condition so that was a really good outcome.”
He adds: “We’re throwing away shackles of old-fashioned manufacturing methods. What we have in St John’s is a pilot to demonstrate this. It’s a ‘factory in a box’. The digital element is important. We identify the opportunity with front line staff and then digital manufacturing kicks in.”
The old hospital’s ability to meet today’s needs is also reflected in how it is dealing with one of the biggest threats to patient care everywhere today: infection control. The appointment last year of a new Director of Nursing, Michelle Burke, to also take on the role of Director of Infection Control, the only hospital in the country to twin these roles, reflects just how seriously St John’s is taking on the threat.
“There’s a lot of history behind these walls, but so much of it is about the courage of St John’s and the people who come to work here every day. It was that way in 1780 and it’s still that way today.”
— Emer Martin, CEO, St John’s Hospital
“The first day I walked on the ward I thought the beds are so close, the rooms are so tight but what it does is it makes us sharper. It’s managed so well by our staff that infection rates here are very, very good. For example, CPE bug rates are high in the Mid-West, yet our infection rates are so low. We work hard at it. That’s the way it is here. When things are hard, people get on with it. No matter what we do, patient care is at the centre of it.”
Andrew Scott’s contribution in setting up a regional service in respiratory care is another example of how St John’s is a patient-first hospital. “My goals since I have started in July 2020 are to develop a Respiratory and General Internal Medicine centre of excellence. I have from the beginning had excellent support from the senior management in St John’s Hospital. Everyone here is enthusiastic to develop St John’s into something we can all be proud of,” he says.
“Recently we have initiated a lung function lab in St John’s which will provide basic respiratory tests to the patients of the region which is something that was greatly missing over the years for patients in St John’s. We’ve also introduced the indwelling pleural catheter (IPC) service for managing malignant pleural effusions, which is another first for patients in the region.
“Internationally this is now recognised as a first line option for the management of malignant pleural effusions. The patient can normally go home the next day. We train family members to look after patients at home following this very simple procedure, allowing patients to have more control over the management of their own care in the later stages of their diagnosis and to have more time with their loved ones.”
Some 240 years after Lady Hartstonge’s intervention, St John’s is still putting patients first and finding innovative new ways to care for them.
St John’s Hospital
St John’s Square, Limerick, V94H272
T: (061) 462 222
W: www.stjohnshospital.ie
