Harmful UHL inspection report finds 116 hour wait time and risk of harm to patients

A harmful inspection report on heavy overcrowding in the emergency department of the University Hospital Limerick found patients at risk of harm.

That hospital is grappling with a shortage of nurses and in some cases people have to wait up to five days for beds.

Reports after an unannounced inspection by Hika on 15 March found that patients were left with little or no privacy or dignity and that their intimate medical details could be heard by others.

One patient was waiting for 116 hours, another for 85 hours and the third patient was waiting for 71 hours.

The number of patients in the resuscitation area was twice its capacity. One patient waited 45 hours for an angiogram.

The Hikka report found:

  • The demand for services exceeded the capacity of the emergency department and was a major contributing factor to overcrowding;
  • Ineffective patient flow and reduced patient bed capacity contributed significantly to overcrowding;
  • The level of nurse staff was inadequate, impacting on the safe provision of care at the time of inspection. In addition, inadequate nurse staffing levels have been a regular problem over the past weeks;
  • The overcrowded and under-staffed emergency department poses a significant risk to the provision of safe, quality, person-centred care and to the health and well-being of those receiving care in the department;
  • The dignity, privacy and confidentiality of patients seeking and receiving care in the emergency department were compromised.

Hika was not assured that the hospital had taken measures to adequately manage overcrowding in the emergency department and patient safety risks related to overcrowding. It had adequate measures in place to address the issues of ineffective patient flow, inadequate nurse staffing levels and long wait times, all of which contributed to emergency department overcrowding.

After the inspection, Hika expressed her concerns to the University Limerick Hospitals Group and HSE. It sought assurance that the hospital and the wider sector would be effectively supported to take adequate measures to address the capacity shortfall, including rapid and community service configuration, capacity and resource implementation.

The hospital has submitted a compliance plan in response to the findings of the inspection, outlining its short, medium and long-term actions to address non-compliances. Hiqa will continue to monitor issues in the hospital’s emergency department and ensure implementation of the compliance plan to reduce patient safety risks.

In response, a spokeswoman for the hospital said TODAY: “We accept the findings of the Hikka report. Our plan to bring our service in the emergency department closer to compliance with national standards is included in the report.”

“We have developed a detailed plan with actions within three months, six months and three years.

“Its success will depend on, among other factors, improvements to internal procedures; additional patient flow routes and hospital avoidance initiatives; closer integration with scheduled community services at SlantaCare; and realigning healthcare in the Midwest, including acute beds. Receiving capacity, commensurate with the size and health needs of the population that it meets.

“Short-term actions we are taking include: additional staff redeployment to the emergency department and triage; review of our growth plans; continued focus on patient transfers to Ennis, Nenagh and St. John’s hospitals; HSE Midwest Community Further development of hospital avoidance programs with our partners in healthcare; and increased opportunities to increase patient access to community health services.

“As announced by the Health Minister on April 27, we are currently working with a team of HSE experts on unscheduled care and ED management. This HSE support team has also been engaging with partners at HSE Mid-West Community Healthcare. We await the team’s report to include additional measures for patient streaming and hospital avoidance. This action plan will be a means to mitigate risks to patient safety and address poor patient experiences in our ED, as highlighted by Hika.

In addition, the CEO of UL Hospitals Group has appointed Deloitte to conduct an external review of patient flow to the hospital.

The spokesperson said: “We apologize to all patients for the long wait and poor care environment in our emergency department. It also adversely affects the staff and it is, in the words of our patients, to see the professionalism and kindness of the staff.” which is acknowledged in the Hika report.”