HIQA inspection finds UHL ‘very overcrowded’ and ‘partially compliant’ with standards

A doctor working in the overcrowded emergency department at UHL.

THE EMERGENCY Department at University Hospital Limerick (UHL) is still massively overcrowded and in breach of national standards covering patient privacy and dignity, according to the findings of a flash inspection carried out earlier this year by the Health Information and Quality Authority (HIQA).

In a report published this morning (Friday), health watchdog HIQA said that the unannounced inspection carried out at the Emergency Department (ED) at UHL over February 21 and 22 this year found improvements in three out of four national standards, compared to a previous inspection in 2022.

“Notwithstanding these findings, the Emergency Department remained very overcrowded with 72 patients on trolleys and chairs awaiting an inpatient bed,” the report states.

“This level of overcrowding continued to impact on the privacy and dignity of patients despite the best efforts of staff – albeit a number of the risk issues HIQA found in 2022 had been addressed.”

The report on the February inspection outlines how HIQA conducted a risk-based, unannounced inspection at the UHL ED, as well as the wider hospital, including a review of the quality and safety of services provided.

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The inspection of the Emergency Department aimed to review and assess the effectiveness of improvements following HIQA’s prior risk-based inspection in March 2022. HIQA also engaged with local community healthcare services and local General Practitioners (GPs) as part of the inspection to inform overall findings.

During the inspection, HIQA assessed compliance with four key national standards from the National Standards for Safer Better Healthcare under the themes of leadership, governance and management; workforce; safe care and support; and person-centred care and support in the ED and a total of 11 national standards under the same themes in the wider hospital.

In the ED, HIQA found the hospital to be “partially compliant” with three national standards and non-compliant with one national standard assessed on the days of inspection.

“This represented some improvement on HIQA’s findings in 2022, where three of the four national standards assessed were found to be non-compliant, with the remainder found to be partially compliant.

“Recent findings indicating improvement included: changes to local management arrangements at the hospital, including the appointment of a senior manager assigned on site for the overall daily operational running of the hospital;

“An improvement in the level of nurse staffing levels in the Emergency Department compared to 2022 findings, coupled with an enhancement in the number of consultants in emergency medicine and a change to consultant work practices to ensure greater levels of onsite availability over the working day and week;

“Improvements to the way services are organised and managed to enable more timely treatment and decision-making around patient care.”

HIQA noted that the implemented changes had begun to yield shorter treatment times and lengths of stay for patients in the ED.

Findings from the inspection for other areas throughout the hospital were more positive, with eight out of 11 national standards assessed found to be either “compliant” or “substantially compliant”.

In particular, the ability to provide care in a more private and dignified way was described as being better enabled outside of the ED. Identified areas for required improvement included in hospital infrastructure, staffing levels, and better use of audit to drive improvement.

The hospital and wider HSE also fully acknowledged that improvement efforts to address ED overcrowding remain a work in progress, HIQA said.

Following the inspection HIQA says it continues to make representations for greater investment in UHL and the wider community healthcare in the region.