IMPROVEMENTS in the delivery of care at the emergency department in University Hospital Limerick (UHL) has been noted in HIQA’s latest report which also found that overcrowding continues to impact patient dignity and privacy.
HIQA carried out an unannounced risk-based inspection at UHL over two days in February, reviewing the quality and safety of services at its ED, as well as services in the wider hospital. This inspection followed a damning report in June of last year in which HIQA found several worrying factors which were contributing to overcrowding.
These included the huge demand for services exceeding ED capacity, insufficient nurse staffing levels impacting safe quality patient care, and patient dignity and privacy compromised in these conditions. All of these factors led to ineffective patient flow measures and prolonged waiting times contributing further to the overcrowding problems.
This latest inspection found that there had been an improvement in nurse staffing levels in the ED compared to June 2022, along with enhanced consultant cover providing greater levels of onsite availability over each working day and throughout the week. The appointment of a senior manager to oversee the operational running of the hospital has meant better decision making around shorter treatment times and lengths of stay for patients in the ED.
However, notwithstanding these improvements, HIQA says the ED remained very busy on the day of the inspection with 72 patients on trolleys and chairs awaiting an impatient bed. This level of overcrowding continues to impact on the privacy and dignity of patients despite the best efforts of staff.
Elsewhere in the hospital, HIQA found that eight out of eleven national standards assessed were either compliant or substantially compliant with more private and dignified patient care available outside the ED. The report also highlighted that the hospital and the wider Health Service Executive fully acknowledged that improvement efforts to address ED overcrowding remains a work in progress, and additional measures are under way to improve the chronic congestion there.
These include the building of one 96-bed block, and the planning of a second block, which should add significant inpatient bed capacity. The first of these is due to be ready in late 2024 or early 2025, with the second 96-bed block not intended to be open until 2027.
HIQA also noted that recent improvements to the way work was organised in the ED and a commitment to utilise alternative care pathways, in particular for older patients who present at the ED. A need for a whole region plan for the midwest to include acute, community and general practice was further emphasised by HIQA to comprehensively address the continued overcrowding situation at UHL. HIQA will continue to monitor UHL’s short, medium and long term actions in its compliance plan to ensure patient safety risks are further reduced.
Responding to the report, a spokeswoman for the Mid-West Hospital Campaign stated, “The report failed to examine the implementation of the long term measures committed to by UHL management in the 2022 report and by doing so has not reported on progress in relation to their commitment to explore a model 3 hospital for the region. It is therefore unsurprising that there was no meaningful improvement to the situation of overcrowding. There was also no improvement to the grading of the effectiveness of the management team in the ED standard 5.5 remaining at partially compliant”.
“Our conclusion despite a more positive presentation of the HIQA Report there has been no significant change to the situation of overcrowding at UHL but in fairness we did not need another report to tell us what is the lived experience for many of us, our families and our communities. 420,000 people dependent on just one Emergency department is a major issue which can only be resolved by looking again at the upgrading and reopening Ennis, Nenagh and St. Johns Emergency Departments”.
