Patient waited almost five days for bed in UHL, HIQA reveals

ONE of the 60 patients in the Emergency Department at UHL was waiting more than 116 hours for a hospital bed, an inspection report completed by the Health Information and Equality Authority has found.

Inspectors who visited UHL unannounced on March 15 found a second was waiting over 85 hours and a third was waiting 71 hours.

Hospital management told inspectors that all three patients were awaiting suitable in-patient isolation facilities.

Performance data on the patient experience time collected on the day of HIQA’s inspection
was poor.

The data showed that at 11.30am the hospital was not compliant with any of the national key performance indicators for the emergency department set by the HSE.

At that time 76 patients (55%) attendees to the emergency department were in the department for more than six hours after registration.

Over half (51%) of the attendees to the emergency department were in the department for more than nine hours after registration.

Just over one in five (21%) attendees to the emergency department were in the department for more than 24 hours after registration.

In total, 28 attendees to the emergency department were aged 75 years and over.

None were admitted or discharged within nine hours of registration, which was not in line with the national target of 99% of patients aged 75 years and over being admitted to a hospital bed or discharged within nine hours of registration.

Half of the attendees to the emergency department aged 75 years and over were not discharged or admitted within 24 hours of registration. The national target for this indicator was 99%, of which the department again fell significantly short.

The hospital used the Manchester Triage System to allocate patients to the most appropriate category of urgency for review which is in line with best practice.

However, at 11.30am on the day of inspection, HIQA found that eight people were waiting in excess of 60 minutes to be triaged, with one person waiting over 180 minutes.

This is an excessively long period of time, and was a significant concern to HIQA given the potential risk this presented to the health and welfare of patients.

Staff who spoke with inspectors identified shortages in the rostered number of nurses for the emergency department as being a key causal factor for the delay in triage.

HIQA was also concerned about the number of patients boarding in the emergency department while awaiting an inpatient bed. Of the 139 attendees in the emergency department at 11.30am, 60 (43%) patients were boarding in the department while awaiting an in-patient bed.

The majority of these patients were being accommodated on trolleys in corridors with very limited space between each trolley, which impacted on patients’ privacy and confidentiality.

Staff and hospital management who spoke with inspectors described how attendance and the acuity of patients presenting to the emergency department had increased since the onset of Covid-19.

This increase in acuity resulted in some patients needing a prolonged hospital stay which impacted on the patients’ average length of stay in a medical or surgical bed.

This in turn negatively affected in-patient bed availability and capacity, thereby contributing to the boarding of patients and overcrowding in the hospital’s emergency department.

Hospital management had developed a plan comprising short, medium and long-term measures to address the issue of overcrowding in the hospital’s emergency department.

However, evidence collected during HIQA’s inspection of the hospital’s emergency department showed that the short-term measures enacted by management had limited impact on the day-to-day workings of the emergency department.

On the day of inspection, overcrowding, poor patient flow and limited inpatient bed capacity all contributed to the ineffective functioning of the department — and indeed the rest of the hospital, which was equally impacted by this situation.

Furthermore, this environment posed a significant risk to the safety and quality of healthcare provided and to the health and welfare of patients attending the emergency department.

While the appointment of patient advocates to the hospital’s emergency department is commendable, the overcrowding in the department experienced on the day of HIQA’s inspection impacted negatively on any meaningful promotion of the patients’ human rights.