The Health Information and Quality Authority (HIQA) has today published a report of its unannounced inspection at University Hospital Limerick.

On 21 and 22 February 2023, HIQA conducted a risk-based unannounced inspection at University Hospital Limerick. This inspection included a review of the quality and safety of services in the emergency department, and also the wider hospital. The inspection of the emergency department aimed to review and assess the effectiveness of improvements following HIQA’s prior risk-based inspection in March 2022. HIQA also engaged with local community healthcare services and local General Practitioners (GPs) as part of the inspection to inform overall findings.

During the inspection, HIQA assessed compliance with:

• four key national standards from the National Standards for Safer Better Healthcare under the themes of Leadership, Governance and Management; Workforce; Safe Care and Support; and Person-centred Care and Support in the emergency department
• a total of 11 national standard under the same themes in the wider hospital. 

In the emergency department, HIQA found the hospital to be partially compliant with three national standards and non-compliant with one national standard assessed on the days of inspection. This represented some improvement on HIQA’s findings in 2022, where three of the four national standards assessed were found to be non-compliant, with the remainder found to be partially compliant. Recent findings indicating improvement included:

• changes to local management arrangements at the hospital including the appointment of a senior manager assigned on site for the overall daily operational running of the hospital 
• an improvement in the level of nurse staffing levels in the emergency department compared to 2022 findings, coupled with an enhancement in the number of consultants in emergency medicine and a change to consultant work practices to ensure greater levels of onsite availability over the working day and week 
• improvements to the way services are organised and managed to enable more timely treatment and decision-making around patient care – these changes had begun to yield shorter treatment times and lengths of stay for patients in the emergency department.

Notwithstanding these findings, the emergency department remained very overcrowded with 72 patients on trolleys and chairs awaiting an inpatient bed. This level of overcrowding continued to impact on the privacy and dignity of patients despite the best efforts of staff – albeit a number of the risk issues HIQA found in 2022 had been addressed. 

Findings from the inspection for areas in the hospital other than the emergency department were more positive, with eight out of 11 national standards assessed found to be either compliant or substantially compliant. In particular, the ability to provide care in a more private and dignified way was better enabled outside of the emergency department. Identified areas for required improvement included in hospital infrastructure, staffing levels, and better use of audit to drive improvement.

The hospital and wider HSE also fully acknowledged that improvement efforts to address ED overcrowding remain a work in progress. HIQA identified the following additional planned measures that are intended to further address continued overcrowding at the hospital’s emergency department. These included:

• that the hospital is in the process of building or planning the development of two additional 96-bed blocks to add significant extra inpatient bed capacity. The first of these blocks is intended to be opened in late 2024 or early 2025, with the second intended to open in 2027

• efforts were planned to build on recent improvements to the way work was organised to enhance efficiency in the unit, allied to a commitment to further utilise initiatives to provide alternate care pathways for in particular some older patients who present to the emergency department

• efforts to enhance the approach to workforce planning and vacancy filling.

It is imperative that these gains are built on and further efficiencies are achieved.

Following the inspection, HIQA also engaged with senior management within the HSE to further triangulate findings and confirm inputs from a national level to support the hospital. HIQA sought further assurances that the hospital and wider region would be effectively supported to enact substantive measures to address capacity deficits, including in acute and community service configuration, capacity and resourcing implementation. A need for a whole-region plan for the Mid-west region – to include acute, community and general practice – was further emphasised by HIQA to comprehensively address the continued overcrowding situation at UHL.

The hospital has submitted a follow-up compliance plan in response to the inspection findings, outlining its short, medium and long-term actions to address the non-compliances. HIQA will continue to monitor implementation of the compliance plan to ensure patient safety risks are further reduced.

The report and compliance plan are available here.

For further information please contact:

Cormac Farrell, Digital Media Manager

cfarrell@hiqa.ie