Despite notable improvements at the University Hospital Limerick’s emergency department, substantial patient safety risks endure, as per the most recent assessment of the persistently congested unit. Patient danger continues to be high at the emergency department (ED) due to ongoing overcrowding, a situation that the hospital has not fully rectified, concluded the healthcare watchdog in its inspection report. The length of time patients wait to be seen and treated significantly lags behind national targets, elevating the jeopardy for patients left in the ED for extended durations, states the Health Information and Quality Authority (Hiqa).
The report’s publication comes on the heels of last week’s inquiry into the demise of a 16-year-old, Aoife Johnston, in the ED in December 2022. Evidence was provided by staff members describing the department as a ‘death trap’ due to its ‘excessively overcrowded’ state. The verdict of medical misadventure highlighted systemic shortcomings, overlooked chances, and miscommunications in the period leading up to her death, as her sepsis remained untreated.
The young girl’s death transpired nine months after Hiqa’s previous, highly negative inspection report on the ED. The current report stems from an unscheduled inspection following her death in November 2023. The watchdog also criticised the hospital’s management in a February 2023 report on the broader hospital facility.
During the most recent visit, of the 82 patients in the ED, 32 had been admitted yet were awaiting a bed. “This reduction in overcrowding from the previous review still impacts the crucial promotion of patient dignity and privacy,” was the comment in the report.
Over half of the patients treated (52%) had self-referred rather than being recommended by a GP. They found the ED lacked compliance with three out of four national standards.
Nearly 50% of patients observed in the study had to wait over nine hours after registering, surpassing the nationally accepted standard of serving 85% within that time frame. In fact, 23% and 21% of individuals who are 75 years old or above had to wait for more than a day.
The Health Information and Quality Authority (Hiqa) acknowledged that a substantial discrepancy between the number of people using the emergency services of University Hospital Limerick (UHL) and its bed strength was leading to severe overcrowding.
The department saw nearly 80,000 patients converging on its emergency, ranking it second across all hospitals for 2022. Despite this, UHL’s capacity stands at a mere 536 beds, a number prominently deficient amongst large (model 4) hospitals.
Since the time of Hiqa’s last evaluation, the hospital has made strides in the areas of resource allocation, support systems and alternate routes for patient admission. The staffing metrics have seen an improvement in all areas; nevertheless, the emergency department continues to report a deficiency of 23 nurses.
In conclusion, the hospital has introduced several new initiatives and improvements, but these will require time before they can effectively alleviate issues related to hospital attendance, Patient Experience Times (PETs) and admission rates. The persistent problem of inefficient patient movement demands further attention. Efforts should be consistently directed towards averting hospital admissions where possible and providing alternate treatment routes, in tandem with a planned increase in overall capacity.
In the past week, the Health Service Executive (HSE) initiated a support team in its latest endeavour to combat the ongoing issue of overcrowding in UHL.
Further inspection reports regarding other medical facilities such as the Letterkenny University Hospital, Rotunda Hospital, Belmullet Community Hospital, Coombe hospital and Nenagh Hospital were made public by Hiqa on Thursday.