Overcrowded hospitals should 'copy what Waterford is doing'

Hiqa found Beaumont and UHW had moved from a situation of persistent overcrowding in the emergency departments 'to one where such crowding was well managed or not present'

University Hospital Waterford regularly records zero patients waiting on trolleys, according to an INMO tally.

Hospitals and the HSE should copy the systems put in place at University Hospital Waterford which have helped it to slash overcrowding in its emergency department.

Health watchdog Hiqa made the call as it published an overview of inspections carried out between 2021 and 2023 in emergency departments across the country.

It found that Beaumont Hospital and University Hospital Waterford (UHW) "had managed to move from a situation of persistent overcrowding in the emergency departments to one where such crowding was well managed or not present". 

Sean Egan, director of healthcare regulation, said some hospitals have really got a grip on the problem of overcrowding.

Inspectors found that UHW has filled vacant posts, including for nurses in the emergency department. Staff had good access to consultants and managers, which ensured quicker decision-making around patients.

The hospital has also developed relations with community services. Inspectors found UWH has “good access” to step-down facilities where patients can be discharged after hospital care.

"These factors are very much reproducible in those services that are performing less well," said Mr Egan.

Hiqa's Sean Egan said factors that have allowed UHW to manage overcrowding are 'very much reproducible in those services that are performing less well'. 

He also said strong leadership at UWH has helped. “There is a better unity of purpose in addressing the specific issues that need to be addressed," he said.

Local leadership and management at national level in the HSE need to focus on these fixes, he told RTÉ.

“[These] have been shown to work in places like Waterford, Beaumont, Cavan, Connolly,” he said.

The watchdog stressed that overcrowding compromises patients' dignity and respect, but is not inevitable.

UHW regularly records zero patients waiting on trolleys, according to a separate tally by the Irish Nurses and Midwives Organisation, even as national numbers hovered around 700 this week.

In response to Hiqa's call, the HSE pointed to plans under way to create health areas, previously known as regional health areas. A spokeswoman said:

The new structures being implemented through the health regions will serve to enhance collective leadership across acute and community services at a regional level.

Some hospitals said rising patient numbers were one reason for overcrowding and GP shortages were leading to patients not getting early treatment.

Other hospitals pointed to a shortage of community services, which could include homecare or nursing home beds.