LAST UPDATE | 17 Jun 2022
THE DIGNITY AND privacy of patients in the emergency department of University Hospital Limerick is being compromised due to severe overcrowding, an inspection has found.
HIQA, the state’s health service watchdog, has today published a searing report of its inspection of the hospital’s emergency department, which found that the “overcrowded and understaffed” emergency department posed a significant risk to the provision of safe, person-centred care.
The health and welfare of people receiving care in the department was at risk, the report said.
Demand for services exceeded capacity on the day of the inspection, which was a major factor in overcrowding there.
UL Hospitals Group has acknowledged the findings of the report and has outlined a plan “to bring our service in the emergency department closer to compliance with the national standards”, with actions to be taken within three months, six months and three years.
It also apologised to patients for the failings identified in the report.
Media Statement
— UL Hospitals (@ULHospitals) June 17, 2022
re @HIQA report published today on unannounced inspection of the Emergency Department at University Hospital Limerick on March 15th, 2022. pic.twitter.com/qjKNUskbkD
Brian Lenehan, the chief clinical director of UL Hospitals Group, told RTÉ News that bed capacity was “far short” of what was required.
In 2009, when we reconfigured the whole service in the Midwest, the recommended number of inpatient beds at that stage was 600. We had 98 new beds came on stream last year. We still only have 530 beds in University Hospital Limerick so we’re still far short of the bed capacity we need.
Staffing levels were an issue as well, he said: “We make every effort on a daily basis to redeploy staff into the ED, to support the ED, but you can only roster and deploy the staff that you have available to you.”
The unannounced inspection took place on 15 March this year, to follow up on issues of overcrowding and to assess preparations for the risk of additional severe crowding over the bank holiday weekend of 17 to 20 March 2022, HIQA said in a statement.
HIQA said in a statement that “the dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised.
HIQA 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.
Moreover, HIQA was not assured that the department 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, seeking assurances that the hospital and wider region would be supported to address the issues raised in the report.
Hospital plan
In a statement this afternoon, UL Hospitals Group said: “As announced by the Minister for Health on 27 April, we are currently working with a team of HSE experts on unscheduled care and ED management. This HSE support team has also been engaging with colleagues in HSE MidWest Community Healthcare.
“We await the team’s report to include additional measures to improve patient streaming and hospital avoidance. This action plan will be a means of mitigating the risks to patient safety and addressing poor patient experiences in our ED, as highlighted by HIQA.”
The hospital outlined a number of short-term measures it intends to implement, which included additional staff redeployment to the emergency department and triage, a review of its escalation plans and ongoing focus on patient transfers to Ennis, Nenagh and St John’s hospitals.
The statement said the scale of the challenge faced by “the only emergency department in the MidWest must not be underestimated”.
“In 2021, the ED at UHL saw a record 76,473 attendances, an increase of 17% on the previous year. In the first four months of this year, we have seen a further 26,548 ED attendances, an increase of another 20% on the corresponding period for 2021. The number of over 75s attending our ED has risen by an even greater proportion,” it said.
It said patients have been attending the emergency department in record numbers over the last 15 months, and that it is “essential” that seriously ill or injured patients continue to do so.
It encouraged people to consider attending injury units, GPs, GP out-of-hours and pharmacy services before attending the hospital’s emergency department.
We apologise to all patients for the long waits and poor care environment being experienced in our emergency department. This also adversely impacts on staff and it is encouraging to see the professionalism and kindness of staff, in the words of our patients, acknowledged in the HIQA Report.
It also said an escalation plan has been put in place to address triage times and that it is addressing staffing issues.
Professor Brian Lenehan, Chief Clinical Director at UL Hospitals Group, said he hopes the publication of the HIQA report 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”.
He said the hospital is committed to working with all stakeholders on improving its processes and how it will work to meet the 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.”
Earlier this week, the Irish Nurses and Midwives Organisation said the HSE was not doing enough to combat persistent overcrowding in hospitals, citing UHL as a particularly bad case.
There are 78 patients on trolleys in UHL today, according to the INMO’s trolley watch – 41 in the emergency department and 37 elsewhere in the hospital.
UHL is the only 24/7 emergency department in the midwest.
In a statement today, the INMO said the report reflected its concerns on overcrowding in the hospital.
INMO Assistant Director of Industrial Relations Mary Fogarty said: “The report is a fair analysis of the situation our members are facing on the ground. However, it needs to be noted that when things are this bad it becomes harder to keep nurses in their jobs, which makes it harder to ensure safe staffing numbers.
“The report shows that nursing staff are doing everything they can in a desperate situation, but that it’s not possible to keep patients safe in these conditions.
“Our members have been drawing attention to these issues for years and we requested that HIQA investigate the situation in UHL and they welcome the publication of the report as a first step, but it’s important that it leads to action.
“It would be wrong to wait for a winter surge or the next healthcare emergency to act on this. The report’s recommendations must be implemented urgently or the crisis in the mid-west is only going to get worse.”
Additional reporting by Jane Moore
To embed this post, copy the code below on your site
have your say