HIQA’s unannounced inspection of the emergency department (ED) of University Hospital Limerick found it to be substantially compliant in one standard and partially or non-compliant in three of the four national standards assessed on inspection. 

Since the last inspection, the hospital had made improvements in resourcing, supports and alternate pathways. It had established an Urgent and Emergency Care Directorate to coordinate the strategic and operational function of the emergency and urgent care services across the six hospital sites of the UL Hospitals Group. The staffing complement for all disciplines in the ED had increased since the previous inspection. Data provided by the hospital demonstrated increased activity in many services to support patient flow and better compliance with HSE performance metrics related to unscheduled care. Despite improvement, the patient experience times (PET) for patients in the ED continued to fall significantly short of national targets.  

The ongoing mismatch between the number of people attending the ED and the hospital’s capacity resulted in an overcrowded ED, with patients admitted to the hospital continuing to be accommodated in the ED. At 10am on the day of inspection, 32 of the 82 patients in the ED were admitted and awaiting an inpatient bed. This overcrowding, albeit reduced since the previous inspection, impacted on meaningful promotion of dignity and privacy for patients. 

The planned addition of extra inpatient bed capacity is to be welcomed, but HIQA notes that the intended gains may be limited if a significant proportion of this new stock is used as replacement stock. This should be further considered in the context of the risks posed by overcrowding in the ED. 

In summary, many of the new initiatives and improvements introduced by the hospital will take time to be fully established to impact positively on hospital attendance, PETs and admission rates. The underlying issue of ineffective patient flow has yet to be fully addressed but ongoing focus should be targeted at hospital avoidance measures and alternate pathways alongside the planned additional capacity.

Furthermore, in anticipation of finalising additional capacity, management at UHL should ensure that recruitment is progressed to ensure staffing meets the additional capacity.  

HIQA’s unannounced inspection of Letterkenny University Hospital found the hospital to be compliant or substantially compliant in five standards and partially compliant in six national standards assessed. 

The hospital had formalised corporate and clinical governance arrangements with defined management arrangements in place to manage and oversee delivery of care at the hospital. Hospital management implemented a range of measures on a daily basis to improve patient flow through the hospital and into the community. However, on the day of inspection these arrangements were not effective in the ED, resulting in non-compliance with PETs and delayed transfer of care. Uptake of mandatory and essential training required improvement, especially training on transmission-based precautions, basic life support and the Irish National and Paediatric Early Warning Systems.

The hospital had systematic monitoring arrangements in place for identifying and acting on opportunities to improve the quality, safety and reliability of healthcare services. Risk management structures were in place and patient-safety incidents, complaints and performance data were monitored and analysed. Quality improvement initiatives were implemented in response to audit findings, patient safety incidents and feedback from people using the service.  

There was evidence that hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care in the ED. However, patients were accommodated on corridors of wards where their dignity, privacy and confidentially were compromised. 

At the time of inspection, the hospital continued to have additional support in place from Saolta Hospital Group to coordinate, monitor and oversee a change plan at the hospital. The impact of this support will only be fully measurable when the hospital management is functioning effectively without support from the hospital group, and the planned changes are embedded.

HIQA’s announced inspection of the Rotunda Hospital found the hospital to be fully or substantially compliant with nine standards and partially or non-compliant with two national standards assessed. 

Inspectors found there were effective and robust integrated corporate and clinical governance arrangements in the Rotunda Hospital, with effective oversight from the Board and the Royal College of Surgeons in Ireland Hospital Group. In addition, there were effective systems in place to monitor and evaluate healthcare services and to identify and manage the risks for women and babies. There was also a strong culture of auditing and quality improvement aimed at identifying and acting on opportunities to improve the service. 

HIQA identified areas for improvement including shortfalls in the rostered complement of midwifery and nursing staff in the antenatal ward, delivery suite and gynaecology ward. In addition, refurbishment work was continuing within the hospital but the age and current footprint of the hospital’s building and physical environment presented many challenges to fully support the delivery of high-quality, safe, reliable healthcare services. Notwithstanding these areas for improvement, good overall compliance was identified on inspection. 

HIQA’s announced inspection of Belmullet Community Hospital found the hospital to be compliant or substantially compliant in four standards and partially compliant in seven of the national standards assessed. 

Opportunities were identified to strengthen the corporate and clinical governance arrangements in Belmullet Community Hospital and to improve the feedback mechanism from community hospitals to and from HSE community health organisation (CHO) level in CHO2. The hospital had adequate workforce arrangements in place but staff attendance at and uptake of mandatory training could be improved. Furthermore, the hospital’s physical environment did not fully support the delivery of high-quality, safe, and reliable care to protect people using the service. Infrastructural issues identified at a previous HIQA inspection were still being progressed by hospital management.

There were systems in place at the hospital to identify, report, manage and respond to patient-safety incidents. Staff were observed being kind and caring towards people using the service, and people who spoke with inspectors were positive about their experience of receiving care in the unit and were very complimentary of staff.

HIQA’s announced inspection of The Coombe Hospital found the hospital to be compliant or substantially compliant with eight standards and partially or non-compliant with three national standards assessed during the inspection. 

Inspectors found effective formalised corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare. There were effective systems in place to monitor and evaluate, and to respond to risk and improve the healthcare services provided at the hospital. 

Hospital management was progressing with the refurbishing and repurposing of some clinical areas to support the delivery of safe, quality care. Notwithstanding this, the configuration of large multi-occupancy rooms did not always support high-quality, safe, and reliable maternity care and did not fully support the promotion of privacy and confidentiality for women and babies. In addition, shortfalls in the rostered complement of midwifery and nursing staff in clinical areas needs to be addressed. Notwithstanding these areas for improvement, good overall compliance was identified on inspection.

A good overall level of compliance was demonstrated in Nenagh Hospital with the hospital found to be compliant or substantially compliant with 10 national standards and partially compliant with one national standard assessed during inspection. The hospital had effective management arrangements in place to support and promote the safe delivery of high-quality healthcare services. On the day of inspection, the hospital’s medical assessment unit and local injury unit were functioning well and were in line with HSE targets related to patient experience times (PETs). 

Inspectors found evidence of a person-centred approach to care, especially for vulnerable patients, such as patients with dementia. People who spoke with inspectors were positive about their experience of receiving care in the hospital and were very complimentary of staff. Improvement was needed to ensure that relevant staff had up-to-date basic life support and advanced cardiovascular life support training where needed.