The Health Information and Quality Authority (HIQA) has published seven inspection reports on compliance with the National Standards for Safer Better Healthcare. Inspections were carried out in seven public acute hospitals and rehabilitation and community inpatient health services between December 2022 and March 2023.

This included inspections at:

• Connolly Hospital, Blanchardstown 
• St. Luke’s Hospital, Kilkenny 
• Wexford General Hospital 
• University Hospital Galway
• Mallow General Hospital, Cork
• Roscommon University Hospital
• St. Camillus Hospital, Limerick.

Overall, generally good levels of compliance were found in Connolly Hospital, Mallow General Hospital, Roscommon University Hospital and St. Camillus Hospital, Limerick. Inspectors found that these hospitals had formalised governance structures and monitoring systems in place to identify and act on opportunities to improve the quality and safety of services provided.

Some examples of good practice found on inspection included:

• In Connolly Hospital, inspectors found that there were systems and processes in place to respond promptly, openly and effectively to complaints and concerns raised by people using the service.
• Mallow General Hospital had systems in place to monitor and evaluate the quality and safety of services provided at the hospital and information from monitoring activities was being used to improve practices.
• People who spoke with inspectors at Roscommon University Hospital were positive about their experience of care received in the hospital, and were complimentary about the staff. 
• At St. Camillus Hospital, staff recorded verbal and written complaints locally, implemented quality-improvement plans and shared learning from complaints. 

Partial compliance was found in the emergency department (ED) at St Luke’s Hospital, Kilkenny, with mixed levels of non-compliance found in both Wexford General Hospital ED and University Hospital Galway ED. Although there was mixed compliance levels in the EDs inspected, inspections carried out in wider hospitals and rehabilitation and community inpatient healthcare services found generally good compliance with the national standards assessed.

St. Luke’s Hospital, Kilkenny had systems and processes in place to identify, evaluate and manage risks to people attending the ED; however, while risks outlined to inspectors by staff during the inspection were escalated, they were not all recorded on the risk register in line with effective risk-management processes. Hospital management had implemented a number of measures to support effective patient flow in the ED and wider hospital. However, these were not fully effective in managing long waiting times for triage and medical review, and long wait times by admitted patients in the ED awaiting an inpatient bed.

In Wexford General Hospital, although formalised corporate and clinical governance arrangements were in place for assuring the delivery of high-quality, safe and reliable healthcare, the ED was busy, relative to its intended capacity on the day of inspection. Inspectors also observed that while patients in cubicles were afforded privacy and dignity, this was not the same for patients being cared for on trolleys and chairs in the open corridors of the department.

Since HIQA’s previous inspection at University Hospital Galway, hospital management had implemented a range of measures to improve the flow of patients and increase surge capacity since the opening of the new temporary ED in October 2022. However, despite management efforts, it was evident on the day of inspection that the ED was not functioning as effectively as it should be. The ED was overcrowded, had significant issues with patient flow, and was compromising the privacy, dignity and confidentiality of patients accommodated on trolleys and chairs.

Other opportunities for improvement were also identified across a number of areas. There were notable deficits in the hospital’s approved and actual rostered complement of medical and nursing for the ED. Inspectors found that the increasingly routine use of the hospital’s escalation plan demonstrated that the hospital, and in particular the ED, will continue to be challenged by the mismatch between demand and capacity. The hospital should, with support from the Saolta University Health Care Group and HSE, address the effectiveness of short-term measures to address overcrowding at the hospital.

HIQA continues to engage with the services that were found to have non-compliance to ensure compliance with the regulations.

Read all seven inspection reports at the link below.

Notes to Editors:

• Under Section 8 of the Health Act 2007 (as amended), HIQA is responsible for monitoring compliance with national standards. Using these powers, HIQA may make recommendations for improvement of care, but under current legislation HIQA cannot enforce their implementation.
• Three weeks following the inspection of Wexford General Hospital, a fire at Wexford General Hospital on 1 March 2023, forced the evacuation and transfer of services, including the emergency department, from the hospital. At the time of writing this report, the emergency department had yet to re-open in the hospital.