Significant risks to patient safety remain in the emergency department of University Hospital Limerick, despite some improvements, according to the latest report on the chronically overcrowded facility.
Patients are still at risk of harm in the emergency department (ED) given the persistent overcrowding, which is not fully managed by the hospital, the health watchdog concluded in an inspection report.
The time it takes patients to be seen and treated falls “significantly short” of national targets, “creating a higher level of risk of harm for patients in the ED for prolonged periods of time,” according to the Health Information and Quality Authority (Hiqa).
Publication of the report follows last week’s inquest into the death of 16-year-old Aoife Johnston in the ED in December 2022, which heard evidence from staff that the department was a “death trap” due to “gargantuanly overcrowded” conditions. Delivering a verdict of medical misadventure, the coroner highlighted systemic failures, missed opportunities and communication breakdowns in the period leading up to her death, as her sepsis went untreated.
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The teenager’s death occurred nine months after a previous, highly critical inspection report by Hiqa into the ED. This latest report dates from an unannounced inspection after her death, in November 2023; the watchdog also criticised the running of UHL in a report on the wider hospital in February 2023.
On the day of the latest inspection, 32 out of 82 patients in the ED had been admitted but were waiting on a bed. “This overcrowding, albeit reduced since the previous inspection, impacted on meaningful promotion of dignity and privacy for patients.”
Over half of the patients attending (52 per cent) were self-referred rather than being sent by a GP.
The ED was found to be non-compliant with three of four national standards.
Almost half of attendees were waiting over nine hours after registration – the national standard is for 85 per cent to be dealt with in this period. One-quarter (23 per cent) – and 21 per cent of over-75s – had been waiting more than 24 hours.
The mismatch between the number of people attending UHL’s emergency department and its bed capacity “significantly contributed” to overcrowding in the hospital, Hiqa acknowledged.
Almost 80,000 people attended the ED in 2022 – the second highest of all hospitals – and the hospital’s capacity is 536 beds, among the lowest of all big (model 4) hospitals, it noted.
Since the last inspection, the hospital has made improvements in resourcing, supports and alternate patient pathways, Hiqa said. Staffing in all disciplines increased, though the ED was still 23 nurses short of complement.
“In summary, many of the new initiatives and improvements introduced by the hospital will take time to be fully established to impact positively on hospital attendance, 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.”
Earlier this week, in its latest attempt to tackle the overcrowding problem in UHL, the HSE set up a support team to address pressures on health services in the midwest.
Hiqa on Thursday also published inspection reports on Letterkenny University Hospital, Rotunda Hospital, Belmullet Community Hospital, Coombe hospital and Nenagh Hospital.
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