HIQA’s unannounced inspection of University Hospital Kerry found the hospital compliant or substantially compliant with four national standards, partially compliant with five national standards and non-compliant with two national standards. Inspectors indentified some improvement in the corporate and clinical governance structures at the hospital, but the expected efficiencies and effectiveness in the hospital’s governance arrangements had not yet been fully realised since HIQA’s previous inspection. 

There were significant improvements in the management and oversight of complaints and the processes for the recognition and management of the clinical deteriorating patient. While the arrangements to manage the service demand increases were more responsive, the hospital had not improved its performance with HSE targets for the six and nine hour patient experience times in the emergency department (ED) and continued to fall significantly short of HSE targets. 

While medical, nursing and midwifery staff resourcing had improved the hospital, hospital management continued to experience challenges in addressing resourcing deficits in quality and patient safety management and health and social care professionals. Efforts were underway to improve and strengthen the hospital’s quality and patient safety function but, similar to previous inspection findings, the staffing shortfalls in the quality and patient safety department significantly impacted on the ability to proactively monitor, improve and act on opportunities to continually improve healthcare services at the hospital. In addition, improvements in clinical governance and oversight in the ED outside core working hours had not progressed since the previous inspection which was of concern to HIQA. 

Following the inspection, these risks were escalated to the South/South West Hospital Group executive management and subsequent assurances were received in relation to updated clinical governance of the hospital’s emergency department 24/7. HIQA continues to engage with UHK to ensure compliance with the national standards. 

On this unannounced inspection of the ED at Midlands Regional Hospital, Tullamore, inspectors found the hospital to be compliant or substantially compliant with all of the four national standards for assessed on the day. 

Inspectors found the ED was busy, but hospital management was working to optimise patient flow and capacity within and outside of the hospital through the use of additional beds for surge capacity. 

Hospital management was planning, organising and managing staff in the ED to support the provision of high-quality, safe healthcare despite the ongoing vacancies. There were robust systems and processes in place to support care and protect patients in the ED from the risk of harm. 

HIQA found a person-centred approach to care was supported and promoted throughout the hospital. Inspectors were assured that patients’ dignity, privacy and autonomy were being respected and promoted on the day of inspection. Patients who spoke with inspectors were complimentary of staff in the ED.  

Overall, despite the additional pressures on the ED — such as delays in elective procedures, redeployment of staff and higher reliance on agency and overtime — staff and management at the hospital had demonstrated an effective approach to patient care in the ED which was supported by improving performance metrics.

HIQA’s unannounced inspection of Tallaght University Hospital found the hospital to be compliant or substantially compliant in seven standards and partially compliant in four of the 11 national standards assessed on inspection.

On the day of inspection, there were 41 patients registered in ED, which was low in comparison to the department’s usual activity level. The average waiting time from registration to triage was seven minutes, which was compliant with the 15 minutes triage time recommended by the HSE’s emergency medicine programme. However, the hospital was not compliant with the HSE’s key performance indicators for patient experience times. Due to a demand for inpatient beds, 16 admitted patients were accommodated in the ED under the care of a specialist consultant awaiting an inpatient hospital bed. 

There were opportunities to improve the physical environment to support the delivery of high-quality, safe, care which included the need for appropriate storage of supplies and equipment and cleaning of equipment. In addition, further work is required to address the number of isolation rooms in the hospital to accommodate patients with communicable infectious diseases. 

There was evidence that patients’ autonomy and independence was promoted in the wards visited by inspectors. For example, patients told inspectors that they were kept informed and updated about their plan of care. Patients’ privacy and dignity in the ED was supported by individual cubicles and single rooms; however, the use of trolleys compromised dignity and privacy and confidentially.

Workforce management arrangements had improved since the previous inspection. The hospital had systems and processes in place to respond promptly, openly and effectively to complaints and concerns raised by people using the service. 

Overall, further work is required to continue to improve patient experience time targets in the ED, and to implement early warning systems for pregnant women and emergency patients. 

HIQA’s announced inspection of Kilcreene Regional Orthopaedic Hospital found to be compliant or substantially compliant in 10 standards and partially compliant in one of the 11 national standards monitored.

The hospital had corporate and clinical governance arrangements in place appropriate to its size and scope, and there were plans in place to further evolve these governance structures.  

Hospital management and staff promoted a culture of kindness, consideration and respect for people accessing and receiving care at the hospital. Staff in the clinical areas visited by inspectors respected and promoted patients’ dignity, privacy and autonomy. Patients were very complimentary about the staff, and the care provided at the hospital. The hospital responded effectively to complaints and concerns raised by people using the service. The hospital had systems in place to identify and manage potential risks of harm and to identify, report, manage and respond to patient-safety incidents in relation to infection prevention and control, medication safety, the deteriorating patient and transitions of care.

Inspectors observed that the physical environment was overall very clean and well maintained and supported the delivery of high-quality, safe, reliable care and protected the health and welfare of people receiving care.

Good overall compliance was found with all the standards assessed on this inspection; however, further improvements were required in relation to pharmacy cover arrangements and attendance at mandatory and essential training.