Persistent overcrowding in the emergency department of University Hospital Limerick is putting patients and staff at serious risk, according to a report published today by the State’s health watchdog.
The Health Information and Quality Authority (Hiqa) says the conditions experienced by patients attending the emergency department are unacceptable.
“The department is overcrowded and not fit for purpose; this has resulted in significant compromises in maintaining adequate levels of environmental cleanliness, and increased risk of healthcare associated infections, impeded access to patients for care and observation, and severely reduced patients’ privacy and dignity,” said Hiqa’s director of regulation, Phelim Quinn.
The report is also critical of delays in admitting children to the emergency department, and their accommodation in adult surroundings. Inspectors are critical of the hospital’s definition of an adult patient as anyone aged over 14 years. It points out that a new children’s area has been developed, but remains unopened.
At one point during Hiqa’s assessment, 37 patients were on trolleys in the hospital. “Space within the ED was limited, making it difficult for staff to move patient trolleys, or even to move around the area easily. Several ill patients were cared for on trolleys in the communal areas and corridors of the ED as there were no patient treatment bays available. Ill patients were placed close together with little or no privacy or dignity. Adequate cleaning of the ED environment was impossible as floor space was largely taken up with trolleys, hindering access to horizontal surfaces and floors.”
With no single rooms available, patients with communicable infections were cared for in the main emergency department. There is only one toilet for all patients, both paediatric and adult, including those with communicable diseases.
Inspectors looked at how the hospital treated hip fractures as a barometer of its performance. They found that the mean length of time patients with a hip fracture waited in the emergency department was 15 hours and five minutes, and less than one-quarter were admitted within the target time for four hours from presentation. Some 22 per cent of patients’ hip surgery was cancelled because of an overrun on operating theatre lists.
The report, which examines all six hospitals in the University of Limerick hospital group, points out that while University Hospital Limerick’s emergency department is overcrowded, the local injuries units in the other, smaller hospitals are under-used.
It says there are delays in transferring patients from the emergency department to intensive care and the high dependency unit, and these are made worse by the absence of a single clinical structure for governing these units.
In 2009, Hiqa published a highly critical report on one of the hospitals in the group, in Ennis. This latest report follows on from the earlier study and is the result of an “interaction” between the authority and the hospitals group since 2011.
Hiqa says all public hospitals must consider the findings from its report and benchmark their own services against the progress and challenges reported in it.
The report says progress has been made in the way in which services are organised within the University of Limerick hospitals group, with a “clear willingness” to change and improve services for the public.
However, the absence of a statutory governance framework is hindering the development of strong governance and patient safety functions and a number of patient safety risks in the group need to be addressed as a priority.