'Mismatch' between patients and beds a continuous struggle for UHL
Some 23% of emergency department patients in University Hospital Limerick were still there more than 24 hours after registration, when the HSE target is 3%. Picture: Dan Linehan
University Hospital Limerick (UHL) continues to struggle with an “ongoing mismatch” between patient and bed numbers, while improvements may not fully protect patients from harm, a report from the health watchdog shows.
Inspectors from the Health Information and Quality Authority (Hiqa) found changes included higher staffing levels than in February during an unannounced inspection in November, but they advised more reforms are needed.
They saw 35 patients on trolleys in the emergency department waiting for a bed, including 19 on corridors which they said “did not support or promote the dignity or privacy for those patients”.
A further 50 patients waited for a bed elsewhere in the hospital, placed on surge beds temporarily. This included 35 on trolleys in wards, and others staying in the day services area and cardiology day ward.
The Hiqa report said: “The ongoing mismatch between the number of people attending the emergency department and the hospital’s capacity, resulted in an overcrowded emergency department with admitted patients accommodated in the emergency department.”
Its report, published on Thursday, highlights changes in systems to protect patients, but said these “were still not fully effective” by November.
Inspectors said that, given the high patient numbers and challenges caused by overcrowding, “the processes in place may not be fully sufficient to protect people who use the service from the risk of harm".
They assessed performance against four standards, finding it non-compliant with a standard which states that patients’ “dignity, privacy, and autonomy are respected and promoted".
Overcrowding made it difficult to keep 1m between patients, which increases the chance of infections being passed on, the report cited as an example.
Some 23% of emergency department patients were still there more than 24 hours after registration, when the HSE target is 3% — with everyone else to be either admitted or sent home.
Among the patients, 19 were aged over 75. Inspectors saw 21% were in the emergency department more than 24 hours after registration, when the national target is 1% at most.
Inspectors noted expanded systems to tackle overcrowding, including services to support older people in the community, and reduce admissions such as the Pathfinder ambulance service and access to scans for GPs.
They said UHL uses the Irish National Early Warning System, but recommended an Emergency Medicine Early Warning System be used, noting training was already going on for its use with most staff trained up.
The hospital has worked with the fire officer to identify safe designated trolley spaces.
Despite this, Hiqa said overcrowding in the emergency department “remained a high-rated risk on UHL’s corporate risk register since the previous inspection”.
Overall, performance was found partially compliant with a standard indicating a hospital protects patients “from a risk of harm” and a standard indicating a hospital has “effective management arrangements” in place.
Staffing levels had improved, they said, leading to a finding of substantial compliance — but gaps remained.
The number of nurses and nurse managers was equivalent to 23.2 full-time nurses below the approved level, although previously the gap was equal to 34.6 staff.
There were 45 non-consultant hospital doctors with just one vacancy — compared to early last year when one in five such roles were vacant.
A senior clinical decision-maker at consultant level was in the emergency department Monday to Friday 8am to 8pm, weekends from 8am to 1pm, with a consultant on-call each night and at weekends.
Inspectors also found that staff "were observed to be kind and caring towards patients in the department", and also noted their assistance and information as reported by parents was provided in “a kind and caring manner”.
The report notes that UHL provides the only emergency department for a population of 410,000.
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