Risk to CUH patients due to overcrowding, watchdog finds

On the day the inspection took place, more than 190 people attended Cork University Hospital's emergency department and Hiqa noted a total of 52 patients had been admitted that were waiting for beds. File picture: Larry Cummins

Cork University Hospital’s (CUH) emergency department is overcrowded and relies on agency nursing staff to maintain staff levels, according to a report by the Health Information and Quality Authority (Hiqa).

The unannounced inspection found the emergency department remained overcrowded despite management efforts to alleviate risks. Staffing levels in the emergency department were another concern for Hiqa’s inspectors as they found a reliance on agency nursing staff to ensure safe and sustainable levels.

Hiqa found the hospital to be partially compliant with three standards and non-compliant with one standard assessed on the day of inspection in the Emergency Department.

The inspection raised concerns that the hospital was challenged to manage surge capacity, support effective patient flow and ensure that care supports the timely review and medical assessment of patients.

Hiqa found that a more sustainable approach was needed to enhance patient flow, in particular, a further need to focus on progressing clinical leadership arrangements across the hospital to strengthen interdisciplinary planning and patient flow.

The report found the waiting time from the decision to admit to actual admission in an inpatient ward ranged from two hours to more than 58 hours. On the day the inspection took place, more than 190 people attended the emergency department and Hiqa noted a total of 52 patients had been admitted that were waiting for beds.

It found that while CUH "had defined management arrangements in place to manage and oversee delivery of care in the emergency department", circumstances "impacted on the continuous and effective flow of patients through the emergency department".

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These included unprecedented high numbers of attendances to the department combined with issues of ineffective patient flow, limited surge capacity and reduced access to transitional, rehabilitation and step-down beds in the community.

Hiqa stated that CUH management were aware of the situation and had implemented a range of short-term and longer-term measures to improve the functioning of the department.

However, it noted that the measures implemented to date "were not fully effective in managing the potential patient safety risks associated with overcrowding of the department".

Other hospitals

In the same report, the physical environment at St Columcille’s Hospital was found to not adequately support the delivery of high-quality care while the emergency department in Cavan and Monaghan Hospital was challenged by the lack of space and effective flow of patients admitted to inpatient beds.

All three hospitals have submitted compliance plans to Hiqa in response to their inspection findings. Hiqa will continue to monitor the implementation of the compliance plans to address the areas in need of improvement identified in the inspections. The inspections were carried out in June and July.