AN INSPECTION by HIQA has found that conditions in the emergency department at University Hospital Limerick pose a significant risk to the provision of care and to the health and welfare of people receiving care.

The report by the health watchdog, published today, found UHL’s emergency department to be non-compliant in three key indicators from the National Standards for safer better healthcare. It was only partially compliant with the other key standard.

Excessive demand on services, ineffective patient flow and insufficient nurse staffing levels were all highlighted in the report of an inspection that took place at the hospital on March 15 of this year.

On that date HIQA conducted a risk-based unannounced inspection of the ED at UHL to follow up on issues of overcrowding and to assess preparations for the risk of additional severe crowding over the upcoming bank holiday weekend of March 17 to 20.

During the inspection, HIQA assessed compliance with four key standards under the themes of Leadership, governance and management; Workforce; Safe care and support; and Person-centred care and support.

The hospital was non-compliant with three standards assessed on the day of inspection. Findings of the inspection included:

Demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding.

Ineffective patient flow and decreased inpatient bed capacity significantly contributed to overcrowding.

Nurse staffing levels were insufficient, which was having an impact on the safe provision of care at the time of inspection. In addition, inadequate nurse staffing levels had been a regular problem over the preceding weeks.

The overcrowded and understaffed emergency department posed a significant risk to the provision of safe, quality, person-centred care and to the health and welfare of people receiving care in the department.

It also found the dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised.

HIQA stated it was not assured that the hospital had enacted measures to sufficiently manage overcrowding in the emergency department and the related patient safety risks posed by overcrowding

Neither was it satisfied the hospital had adequate measures in place to address the issues of ineffective patient flow, insufficient nurse staffing levels and prolonged waiting times, all of which contributed to the overcrowding of the emergency department.

Following the inspection, HIQA escalated concerns to University Limerick Hospitals Group and the HSE. HIQA sought assurances that the hospital and wider region would be effectively supported to enact substantive measures to address capacity deficits, including in acute and community service configuration, capacity and resourcing implementation.

The hospital has submitted a compliance plan in response to the inspection findings, outlining its short, medium and long-term actions to address the non-compliances. HIQA will continue to monitor issues in the hospital’s emergency department and implementation of the compliance plan to ensure patient safety risks are reduced.

The report and compliance plan are available on www.hiqa.ie.

A spokesperson for UL Hospitals Group said, “We acknowledge the findings of the HIQA Report. Our plan to bring our service in the Emergency Department closer to compliance with the national standards is included in the report. We have developed a detailed plan with actions to be taken within three months, six months and three years.

“Its success will depend, among other factors, on improvements in internal processes; additional patient flow pathways and hospital avoidance initiatives; closer integration with community services as set out in Slaintecare; and resourcing the heath service in the MidWest, including acute bed capacity, in line with the size and the health needs of the population it serves.”

Among the short-term actions we are taking are the following:
Additional staff redeployment to the Emergency Department and triage
Review of our escalation plans
Ongoing focus on patient transfers to Ennis, Nenagh and St John’s hospitals
Further development of hospital avoidance programmes with our colleagues in HSE Midwest Community Healthcare
Enhanced opportunities to increase patient access to community health services

Commenting on the publication of the HIQA Report, Prof Brian Lenehan, Chief Clinical Director, UL Hospitals Group, said, “We have closely examined the findings of the HIQA Report and we are working with HIQA and with the HSE on short, medium and long-term plans to improve the experience of patients in our ED.

“We acknowledge that the measures in our escalation plan are not sufficient to meet the unprecedented increase in demand on our service. This is not for want of effort or commitment on the part of management and staff.

“While we are committed to taking the actions we can to bring about improvement, we hope that publication of this report today results in a wider acknowledgement that many of the solutions to this persistent problem in Limerick are to be found outside of the Emergency Department and outside of the hospital.

“The Mid-West and UHL has many unique challenges. We have fewer inpatient beds and fewer consultants and NCHDs to provide care than comparable hospitals. We serve a region with a higher frailty index and a city with a higher deprivation index.

“Over the course of the pandemic, our ED did not see the scale of reduction in presentations seen around the country and the growth in demand on our hospital since has also been disproportionate and exceptional. The volume of self-referrals to our ED as outlined in the HIQA report is higher than elsewhere.

“People of the Mid-West have fewer alternatives than elsewhere when it comes to accessing emergency care. We look forward to the fulfilment of the promise of Slaintecare that healthcare resources will be distributed more equitably in future in line with population need. The case for an acceleration of Slaintecare in the Mid-West is obvious,” Prof Lenehan said.

“I would like to apologise to each and every patient who faces excessive wait times in our ED. It is essential that people who need it continue to attend our Emergency Department.

“We are committed to working with all stakeholders on improving our processes and how we work to meet this challenge. We acknowledge the significant investment we have received in recent years in improving our infrastructure.

“Lack of bed capacity remains our primary constraint and we hope that publication of this report today redoubles the efforts of all to ensure that the MidWest catches up with the rest of the country in terms of bed numbers and staffing resources,” Prof Lenehan said.