Hospital overcrowding: Patient waited 116 hours on trolley, report finds

In a first-time inspection against national standards, inspectors found overcrowding in emergency departments is a patient safety risk. They warned patients’ dignity, privacy and right to confidentiality are being compromised

Health watchdog Hiqa has warned patients are not protected from harm in three out of seven hospital emergency departments inspected with at least one patient waiting 116 hours on a trolley.

In a first-time inspection against national standards, inspectors found overcrowding in emergency departments is a patient safety risk. They warned patients’ dignity, privacy and right to confidentiality are being compromised.

Following the inspection of seven units including Cork University Hospital (CUH) and University Hospital Limerick (UHL), they found five over capacity and warned treatment is not in line with a human-rights approach to healthcare.

They identified patients waiting as long as 3 hours and 35 minutes for an initial triage assessment when this should be done within 15 minutes of registration. 

Additionally, they said waiting on a trolley for a hospital bed after admission for 80 to 90 hours is “not uncommon”. In at least one unit they found as many as 21% of patients spent more than 24 hours in the ED. 

Letters warning of “high risk” were issued to three hospitals.

They found “some hospitals cope better than others with the demands placed upon them” and urged that good management in successful hospitals be copied in struggling units.

In three units including CUH and UHL inspectors found failures to ensure “service providers protect service users from the risk of harm associated with the design and delivery of healthcare services.” 

In three units including UHL, inspectors found non-compliance with the need to ensure “dignity, privacy and autonomy are respected and promoted”.

Inspectors also found UHL and Mayo University Hospital were not compliant with the need to manage their workforce to deliver high-quality, safe and reliable healthcare.

They found the majority of the units had far more patients attending then they had space for on the day of inspection. They found personal medical information being talked about on corridors and that patients had no privacy.

In two hospitals, inspectors found patients who were dying were not always effectively removed from the busy emergency department to have more peaceful end-of-life care.

In two hospitals there was not even one metre between trolleys due to the over-crowding.

Director of healthcare Sean Egan said: "Findings from this new programme of inspections, continues to highlight that overcrowding in emergency departments compromises the dignity and respect of patients, and poses a risk to health and safety of patients.” 

Hiqa director of healthcare Sean Egan

He added: “Improvements are needed to ensure that there is a balanced approach to the daily operational management of patient flow, capacity and appropriate staffing, which is clearly linked to patient safety and activity."

The report highlights that recommendations made by the Department of Health in 2018 around increasing staffing and bed numbers have not been implemented. This is particularly an issue in areas outside of Dublin, the inspectors found.

Hiqa called for investment in additional supports for regional hospitals.

Among the patient comments in the report, one said: “The waiting is terrible but what can you do?” and another is quoted as saying: “There seems to be more patients here than I have seen before when I came to ED, there is no dignity in this.” 

However some patients highlighted the help they received from staff, while also pointing out there are not enough people on duty.

The Hiqa report also looks outside of the ED units, warning that gaps in community health are driving more patients into hospitals.

The seven units also include St Vincent’s University Hospital, Cavan and Monaghan Hospital and St Micheal’s Hospital.

The Irish Nurses and Midwives Organisation (INMO) is seeking an urgent meeting with the health minister in the wake of the report.

INMO General Secretary, Phil Ní Sheaghdha said: “The report published by Hiqa today compounds what the INMO has been consistently highlighting – our hospitals are under enormous pressure due to capacity issues and unsafe staffing.

“The report is particularly stark when it comes to safe staffing in our hospitals. According to Hiqa, of the seven emergency departments they inspected, only one hospital was properly staffed. This is unacceptable. We know that many nurses are leaving emergency departments because of the conditions that they are faced with. This phenomenon cannot continue into 2023.

“Over 70% of the hospitals that Hiqa inspected were over capacity. This is borne out in the INMO TrolleyWatch figures. Today alone over 638 patients were without a bed with many patients facing long waits before being admitted to a trolley. We know that excess time spent on a trolley or an inadequate bed has negative health implications for patients.

“We have sought an urgent meeting with the Minister for Health in the coming week to discuss how a more proactive approach can be taken to tackling the very serious challenges that exist in our emergency departments. Trade unions raised this issue as part of our engagements at the Labour Employer Economic Forum (LEEF). We are strongly of the view that emergency measures are now needed to prevent the unnecessary continuation of these inhumane and undignified conditions for patients and really unhealthy working conditions for nurses and midwives and other healthcare workers.”