Emergency care in the Mid-West to be reviewed by HIQA

THE HEALTH Information and Quality Authority (HIQA) has published the terms of reference for a review into urgent and emergency care in the Mid-West. 

The independent review will look at the whole region, with a primary focus on overcrowding in University Hospital Limerick (UHL) and it will consider the case for a second emergency department (ED) in the Mid-West. 

Six months on from when the review starts, the Minister for Health will be given a preliminary briefing on progress and findings. 

A full report will be published in the summer of 2025. 

A second emergency department for the region is being considered in light of consistent overcrowding at UHL, despite significant investment in increasing capacity, as well as population changes. 

As part of the review, HIQA was also asked to consider the recommendations of former Chief Justice Frank Clarke into the circumstances surrounding the death of 16-year-old Clare girl Aoife Johnston who died in December 2022, after contracting sepsis and experiencing significant delays in treatment at the ED in UHL. 

The terms of reference from HIQA states: “Overcrowding in the ED at UHL is not unique, with a number of other hospitals also experiencing overcrowding. 

“However, the scale of overcrowding at UHL has consistently been greater than that at other impacted hospitals. HIQA, through its national inspection programme, has identified the issue of overcrowding and noted that some hospitals have successfully worked to reduce or eliminate overcrowding. 

“Interventions that have contributed to sustained improvement in other sites include governance and operational grip, changes to process and work practices, allied to addition of resources and inclusive of extra bed capacity – either within the hospital or in step-down or non-acute facilities in each hospital’s respective region. 

“Many of these changes have not yet been fully realised in UHL, and while recent HIQA inspections there have noted some incremental progress, work on this reform agenda is continuing. Of relevance, UHL has routinely experienced the second highest number of presentations to the ED per annum compared to other hospitals, while also having the second lowest number of inpatient beds of the Model Four hospitals in the State.”

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In 2008, three ED’s in the Mid-West were closed in Ennis, Nenagh and St John’s and there have been campaigns since then to reopen these. 

Since 2019, staff levels at UHL have increased by 30% and there have been expansions in bed capacity, but despite this, the hospital still ranks as the most overcrowded almost daily in the trolley watch figures from the Irish Nurses and Midwives Organisation (INMO). 

Recent HIQA inspections have identified that UHL needs to improve management practices, reduce how long patients have to stay in the hospital and try to avoid people presenting to the ED where possible. 

A final report from this review will be given to the Minister for Health in summer of next year, 2025 and it will then be published on the HIQA website.