Patients’ dignity and privacy breached as inspectors find 19 people forced to lie on trolleys in corridor at UHL

This impacted the dignity and privacy for patients, the inspectors from the Health Information and Quality Authority, a new report says.

The inspectors were following up on previous inspections in March 2022 and February 2023 and found several improvements.

Despite improvement, the patient experience in the ED continued to fall significantly short of national targets

The hospital had made improvements in resourcing, supports and alternate pathways. It had established an Urgent and Emergency Care Directorate to coordinate the strategic and operational function of the emergency and urgent care services across the six hospital sites of hospital group.

The staffing complement for all disciplines in the emergency department had increased since the previous inspection.

Data provided by the hospital demonstrated increased activity in many services to support patient flow and better compliance with HSE performance metrics related to unscheduled care.

The inspection report comes after last week’s inquest into the death of Shannon teenager Aoife Johnston, who died of sepsis after waiting nearly 16 hours in the emergency department in December 2022, found she died due to medical misadventure.

The inspectors said the impact of corrective actions and controls applied to reduce overcrowding and mitigate potential and actual risks to patient safety were still not fully effective on the day of inspection. In addition to 32 inpatients accommodated in the department, there was an additional 50 inpatients in surge capacity.

Thirty five patients were accommodated on trolleys on wards averaging 1-3 per ward, with other patients accommodated in the day services area and cardiology day ward.

Half of patients at the emergency department were there for more than six hours after registration ─ not in line with the national target which requires that 70pc be admitted to a hospital bed or discharged within six hours.

Some 48pc were in the department for more than nine hours after registration ─ not in line with the national target of 85pc of attendees being admitted to a hospital bed or discharged within nine hours of registration in the department

Of all patients in the emergency department, 19 were aged 75 and over. 63pc of these patients were in the department for more than nine hours after registration ─ not in line with the national target that 99pc of patients aged 75 years and over are admitted to a hospital bed or discharged within nine hours of registration in the department.

More than one in five were aged 75 years and over were in the department for more than 24 hours after registration.

However, patients were complimentary about staff, describing them as ‘amazing’, ‘great’ and ‘so nice’. Patients also commented that staff were ‘so busy’.

One patient on a corridor off zone A, referred to the fact that they had no way to call nurses and had to wait until a staff member arrived.

The ongoing mismatch between the number of people attending the ED and the hospital’s capacity resulted in an overcrowded ED, with patients admitted to the hospital continuing to be accommodated in the ED.

At 10am on the day of inspection, 32 of the 82 patients in the ED were admitted and awaiting an inpatient bed. This overcrowding, albeit reduced since the previous inspection, impacted on meaningful promotion of dignity and privacy for patients, the report said.

The planned addition of extra inpatient bed capacity is to be welcomed, the Hiqa inspectors said, but noted that the intended gains may be limited if a significant proportion of this new stock is used as replacement stock.

This should be further considered in the context of the risks posed by overcrowding in the ED, they said.

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Minister for Health Stephen Donnelly recently said 71 new beds would be available next year in Limerick compared to the previous estimate of 49.

Many of the new initiatives and improvements introduced by the hospital will take time to be fully established to impact positively on hospital attendance, patient experience times (PETs) and admission rates. The underlying issue of ineffective patient flow has yet to be fully addressed but ongoing focus should be targeted at hospital avoidance measures and alternate pathways alongside the planned additional capacity, Hiqa said.

It added that management at the hospital should ensure that recruitment is progressed to ensure staffing meets the additional beds.

The inspectors’ report highlighted how the emergency medicine early warning system had not been implemented at the time of inspection and said this is essential to spot and respond to patients who are deteriorating.

Hiqa also published inspection reports on other hospitals today.

The report on Letterkenny Hospital in Donegal said: ”Hospital management implemented a range of measures on a daily basis to improve patient flow through the hospital and into the community.

"However, on the day of inspection these arrangements were not effective in the ED, resulting in non-compliance with PETs and delayed transfer of care. Uptake of mandatory and essential training required improvement, especially training on transmission-based precautions, basic life support and the Irish National and Paediatric Early Warning Systems.”

During an inspection of the Rotunda Hospital inspectors reported: “[There were] identified areas for improvement including shortfalls in the rostered complement of midwifery and nursing staff in the antenatal ward, delivery suite and gynaecology ward. In addition, refurbishment work was continuing within the hospital but the age and current footprint of the hospital’s building and physical environment presented many challenges to fully support the delivery of high-quality, safe, reliable healthcare services. Notwithstanding these areas for improvement, good overall compliance was identified on inspection.”

The inspection of the Coombe Hospital found management was progressing with the refurbishing and repurposing of some clinical areas to support the delivery of safe, quality care.

Notwithstanding this, the configuration of large multi-occupancy rooms did not always support high-quality, safe, and reliable maternity care and did not fully support the promotion of privacy and confidentiality for women and babies.

In addition, shortfalls in the rostered complement of midwifery and nursing staff in clinical areas needs to be addressed. Notwithstanding these areas for improvement, good overall compliance was identified on inspection.

A report on Nenagh Hospital, which is part of the University Hospital Limerick Group said: ”On the day of inspection, the hospital’s medical assessment unit and local injury unit were functioning well and were in line with HSE targets related to patient experience times (PETs).

“Inspectors found evidence of a person-centred approach to care, especially for vulnerable patients, such as patients with dementia. People who spoke with inspectors were positive about their experience of receiving care in the hospital and were very complimentary of staff. Improvement was needed to ensure that relevant staff had up-to-date basic life support and advanced cardiovascular life support training where needed.”