HIQA found the hospital to be substantially compliant with two national standards, partially compliant with seven national standards and non-compliant with five national standards assessed on the days of inspection.
The hospital was substantially behind many other similar-sized hospitals in relation to its efforts to ensure compliance with the national standards, though HIQA acknowledges that the hospital management team was in transition at the time of inspection.
There were significant deficits in governance and management arrangements which impacted on the hospital’s ability to effectively and promptly manage any increase in service demand. For emergency care in particular, HIQA found gross overcrowding of the emergency department along with significant patient flow issues. The emergency department had a significant shortage of medical and nursing staff. At the time of inspection, there were no formalised arrangements in place to ensure consultant oversight in the emergency department 24/7. The emergency department also had a significant shortfall on the rostered complement of nursing staff.
HIQA found that there should be more responsive oversight and management of patient-safety incidents and of the implementation of learnings and recommendations from incident reviews. HIQA was also concerned with the apparent delay in fully implementing the learning and recommendations from the look-back of radiology services carried out in 2018, and the potential for patient safety risk associated with this delay.
The systems and processes in place at the hospital to respond to complaints and concerns raised by patients and their families were not as effective as they should be in promptly and effectively resolving complaints and concerns.
Significant further work, underpinned by effective leadership and support external to the hospital, is required to progress service quality and safety at the hospital and address many of the findings identified on this inspection. Following this inspection, HIQA escalated its concerns regarding the findings to regional and national HSE management to ensure that necessary supports are provided to the hospital to address the issues identified.