No one was accountable for patients who were left lying on trolleys in corridors for long periods in Tallaght Hospital, a watchdog found.
A Health Information and Quality Authority report also revealed patients were at risk while the State failed to hold the hospital to account for the quality and safety of services it provided.
HIQA launched an inquiry into the emergency department in Tallaght last summer after a patient died on a trolley.
Tracey Cooper, Hiqa chief executive, said the investigation found a history of long-standing challenges in leadership, governance, performance and management at board and executive level of the hospital.
There was also a failure of the State to hold the hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided.
“The findings of this investigation reflect a history of longstanding challenges in leadership, governance, performance and management at Board and Executive level of the Hospital, and a failure of the State to hold the Hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided,” said Ms Cooper.
“These challenges resulted in the persistent, and generally accepted, tolerance of patients lying on trolleys in corridors for long periods of time with a lack of clarity as to who was accountable for patients. This puts patients at risk, is not acceptable and should not be tolerated in any hospital in Ireland.”
“This puts patients at risk, is not acceptable and should not be tolerated in any hospital in Ireland.”
HIQA launched its first investigation into safety standards at a hospital emergency department amid concerns over care provided to patients and “a patient safety incident”.
The A&E department regularly had a high number of patients on trolleys waiting for admission to wards.
A coroner warned that Tallaght Hospital sounded like a “very dangerous” place after a 65-year-old man died in a “virtual ward” – a name given to corridors and alcoves where patients are left while awaiting a bed in a ward.
During the investigation, Hiqa analysed all hospitals providing emergency department services nationally over a 24-hour hour period in August 2011.
This identified some significant concerns in relation to the waiting time for patients in some hospitals and the quality of the data and the amount of absent information with which to manage the performance of an emergency department.
The investigation also found the board did not have adequate arrangements in place to direct and govern the hospital, nor did it function in a sufficiently effective way to assure itself that the hospital was providing safe care to patients – including patients receiving care in the Emergency Department.
The report made 76 recommendations aimed at improving Tallaght Hospital and similar hospitals nationally, as well as proposals to improve the accountability in the health system.
“Following on from this investigation, the Authority recommends that the Department of Health establishes a clearly defined ‘Operating Framework’ for the State that establishes the key levers and drivers for the effective oversight, governance and delivery of a high quality, safe and reliable health and social care system which is designed to deliver the most accessible service in the most cost and clinically effective way for our population,” said Ms Cooper.
Following the approval by the Minister for Health of the National Standards for Safer Better Healthcare, and the subsequent commencement of a monitoring programme against the Standards, the Authority will monitor service providers against the implementation of these recommendations as part of that process.
“These standards will be the first step towards the introduction of a licensing system in the Irish healthcare system. The establishment of a licensing system in Ireland will accelerate the requirement for these recommendations to be implemented by all service providers,” said Ms Cooper.
“It is crucial that in Tallaght Hospital, and in all healthcare providers, the behaviours and practices that result in unacceptable care for patients are simply not tolerated.
“We must make a choice to actively drive our health system, from patient to policymaker, and to ensure that a culture of patient safety, openness, accountability and improvement is led, managed and embedded into our services,” Tracey Cooper concluded.
In 2010, Tallaght was at the centre of a scandal involving unreported x-rays and unprocessed referral letters.
Despite assurances that governance and administration at the hospital would be streamlined, nine months later the publication of the Hayes report on the scandal found the hospital has not yet fully implemented its recommendation to restructure the board to a smaller size.