University Hospital Limerick management said Friday it accepted the findings of a damning report by the Health and Information and Quality Authority (HIQA), which found “insufficient” nursing staff numbers at the hospital was “having an impact on the safe provision of care”, and the hospital’s “overcrowded and understaffed emergency department posed a significant risk” to patients.
Chief Clinical Director, UL Hospitals Group, Professor Brian Lenehan, apologised to patients and families and acknowledged UHL’s responses to overcrowding were “not sufficient to meet the unprecedented increase in demand on our service”.
Prof Lenehan said UHL has “fewer inpatient beds and fewer consultants and NCHDs to provide care than comparable hospitals, and serves a region with a higher frailty index and a city with a higher deprivation index”.
Prof Lenehan said “the growth in demand on our hospital since (the pandemic) has also been disproportionate and exceptional” when compared to other hospitals.
“The volume of self-referrals to our ED as outlined in the HIQA report is higher than elsewhere, and the people of the Mid West have fewer alternatives than elsewhere when it comes to accessing emergency care”.
“The case for an acceleration of Slaintecare in the MidWest is obvious,” Prof Lenehan said.
A UHL spokesman added “the long waits and poor care environment being experienced in our Emergency Department also adversely impacts on staff”.
HIQA said it conducted an unannounced inspection off UHL on March 12th this year and found the hospital to be “non-compliant” in three standards of patient care, and “partially-compliant” in one standard.
HIQA inspectors found that “demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding”.
They also found that “ineffective patient flow and decreased inpatient bed capacity significantly contributed to overcrowding”.
“Nurse staffing levels were insufficient, which was having an impact on the safe provision of care at the time of inspection. In addition, inadequate nurse staffing levels had been a regular problem over the preceding weeks,” stated the report, published Friday.
It also found that “the overcrowded and understaffed emergency department posed a significant risk to the provision of safe, quality, person-centred care and to the health and welfare of people receiving care in the department”, and, that “the dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised”.
For years prior to and in the months following HIQA’s inspection at UHL, the hospital has continued to experience record levels of patient overcrowding — On April 21st this year a record 126 patients languished on trolleys at UHL.
Hospital Response
In response to HIQA’s report UHL outlined a short to medium plan “to bring our service in the Emergency Department closer to compliance with the national standards, with actions to be taken within three months, six months and three years”.
In 2009 all Accident+Emergency units in the region were funneled to UHL resulting in Limerick ED been the only 24-hour service in the region with a catchment of around 400,000.
A UHL spokesman said overcrowding could be significantly reduced by “resourcing the heath service in the MidWest, including acute bed capacity, in line with the size and the health needs of the population it serves”.
The hospital is “redeploying additional staff” to the emergency department and triage area, conducting a “review of our escalation plans”, focusing on transferring patients to other hospitals in the region, and is consulting with the HSE to develop “hospital avoidance programmes” focusing on frail and elderly patients.
The hospital said it was also “awaiting” a report from a HSE expert team which the Minister for health, Stephen Donnelly ordered to conduct a review of unscheduled care and ED management at UHL last April which it said “will be a means of mitigating the risks to patient safety and addressing poor patient experiences in our ED, as highlighted by HIQA”.
The spokesman added there has been “an increase in staff of 37 per cent across UL Hospitals Group since December 2019, and an increase in bed capacity at UHL of 98 inpatient beds and 10 critical care beds since the start of the pandemic”.
The spokesman said the hospital regretted its triage times were “unacceptable” and that it was trying to address this.
