HIQA puts pressure on hospital to overhaul A&E
The pressure on Tallaght Hospital to overhaul its ED increased this week after the health watchdog gave management until next Thursday to end the practice of placing patients due to be admitted on trolleys.
The Health Information and Quality Authority (HIQA) issued its warning in the wake of an unannounced inspection of the hospital last Wednesday which found:
- One patient with tuberculosis had spent more than three days in a room which was not an isolation room and which opened onto a corridor where other patients were being cared for.
- There were 20 patients in corridors or in the ED waiting for a bed, five for more than 24 hours.
- At the time of inspection there was a cardiac patient who had not been assessed or admitted by any in-house clinical team.
The latest criticism of patient care at the ED suggests little has changed since last June when Dublin County Coroner Dr Kieran Geraghty said it sounded like a dangerous place. This followed an inquest into the death of 65-year-old Thomas Walsh from Kilnamanagh who had been moved away from the ED to a so-called “virtual ward”, a corridor area with no oxygen, monitors or equipment.
It emerged that last year in the ED a patient suffered a cardiac arrest on a chair while awaiting admission and three TB cases were put on the corridor posing risk of infection.
HIQA announced a statutory inquiry into the quality, safety and governance of care at the ED in the wake of the inquest into the death of Mr Walsh, part of which was last Wednesday’s inspection.
HIQA is not commenting because its investigation is ongoing. Neither is Tallaght Hospital, with the exception of a pledge from Eilísh Hardiman, chief executive, to co-operate fully with HIQA. Health Minister James Reilly expects the hospital to address without delay immediate safety issues identified by HIQA.
President of the Irish Association of Emergency Medicine Fergal Hickey said HIQA’s criticism of placing patients on trolleys was in keeping with international studies, which show patients suffer worse outcomes and are at greater risk of dying if detained in EDs after the decision is made to admit them.
Mr Hickey, a consultant in emergency medicine, said HIQA had effectively given Tallaght a mandate to stop placing patients on trolleys in the ED that logically had to extend to other hospitals.
The Irish Nurses and Midwives Organisation (INMO) said HIQA’s findings should be used to end ED overcrowding. In relation to Tallaght, it called for the re-opening of 28 closed beds to take the pressure off the ED and it called on the HSE to find long-term care for 63 patients who remain in the hospital despite being fit for discharge.
The INMO remains opposed to additional beds on in-patient wards as part of the solution to ED overcrowding. However, Mr Hickey said it was safer to have one or two patients extra on in-patient wards then “lodged on trolleys” in EDs.
- March 2010: It emerges a patient died when their diagnosis was delayed at Tallaght Hospital because X-rays were not reviewed by a consultant radiologist. More than 57,000 X-rays taken at the hospital between 2005 and the end of 2009 were not reviewed by a consultant radiologist.
- March 2010: The hospital admits there was a backlog in October 2009 of almost 3,500 GP referral letters that were not reviewed by a consultant.
- June 2011: HIQA announces an inquiry into quality of care at the hospital after remarks at an inquest by Dublin county coroner Dr Kieran Geraghty that the emergency department sounded like a very dangerous place.
- July 2011: The Data Protection Commissioner confirms he has received a preliminary verbal report from Tallaght Hospital concerning a potential data security breach.
- August 2011: The hospital admits that patient medical records have been the subject of unauthorised access and disclosure. The hospital had been using a private firm to transcribe some medical reports and letters for GPs — and this material was being sent to the Philippines.
- August 2011: HIQA inspects the ED and finds continuing risk to patients on trolleys. Tallaght is given until September 1 to end the practice.
