‘Risks of harm to the patients’ at ED in Limerick hospital persists - warns HIQA report

DESPITE improvements in resourcing, supports and alternate pathways, on its latest HIQA inspection, University Hospital Limerick (UHL) was still found to have an overcrowded emergency department (ED), presenting a potential risk to anyone who attends there. 

This was the finding of an unannounced HIQA inspection of the ED in November 2023. This was a follow-up to an inspection of the ED in March, 2022 and of the whole hospital and ED in February, 2023.

HIQA’s inspection found the ED it to be partially or non-compliant in three of the four national standards assessed on inspection and substantially compliant in one standard.

“Patients felt they were kept informed of their plan of care, but commented on the ‘long wait’ for decisions to admit or discharge and the long waits for an inpatient bed,” the report said. 

During the inspection, there were 35 admitted patients in the ED and 19 of these were on trolleys in corridors, which the report said was “not consistent with the human rights-based approach to care supported and promoted by HIQA.” 

48% of those in the ED were waiting more than nine hours after they first came to the hospital, while 23% were waiting more than 24 hours. 

“Given the persistent overcrowding in the department, there still existed risks of harm to the patients in the emergency department, which were not fully managed by the hospital.”

The report went on to say that inspectors saw staff “promoting and protecting patients’ privacy and dignity, in so far as possible within the context of a very overcrowded environment.” 

The hospital set a priority target that all patients over the age of 75 would be admitted or discharged within 24 hours by June. 

Inspectors said that “significant gains” would need to be made by the hospital to meet this target. 

The report noted that “although the level of overcrowding was still unacceptable, the number of attendees on the day was an improvement on the previous two inspections.” 

The average waiting time for triage was 27 minutes, similar to average waiting times for triage at the previous inspection - showing that little had changed in the eight months that had passed. 

As part of the hospital’s escalation plan, an extra nurse would be allocated to triage when ten patients were waiting more than 20 minutes to be triaged. 

A consultant in emergency medicine was allocated to triage between 8am and 8pm Monday to Friday to support patient assessment. 

Between 2022 and November, 2023, average waiting times for patients were reduced by less than two hours for admitted patients. 

“Operationally, the department was functioning better than on previous inspections, but still has a way to go to match the best performing emergency departments inspected by HIQA,” the report said. 

The report highlighted the “mismatch” between the number of patients presenting at the hospital and the amount of available beds as being a “significant” contributor to the overcrowding. 

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In order to support patient flow through the ED, hospital management now hold meetings at 9am with an extra meeting at 2pm if escalation plans are in place. 

While the report acknowledged the new 96 bed block being built, it also highlighted that 44 of these beds will be replacements. 

“The full 96 bed complement will not be added to the bed stock at the hospital on the conclusion of this build,” the report said. 

If twenty or more category 2 patients are waiting more than 30 minutes for an ED doctor review, the emergency medicine consultant on call would be contacted to attend the hospital. 

The report acknowledged that staff were “committed and dedicated to promoting a person-centred approach to care.”