Overcrowding at Cork University Hospital putting patients at risk, report finds

Overcrowding at Cork University Hospital (CUH) is exposing patients to heightened risk and increasing the risk of infection, according to a report from the State’s health watchdog.

Referring specifically to the risk of patient deaths, the Health Information and Quality Authority (Hiqa) said the level of crowding in the hospital’s emergency department, ineffective patient flow and long waiting times have the potential to impact on patient safety.

Hiqa inspectors who made an unannounced visit to CUH last June found over 50 patients waiting on trolleys for admission to the hospital, for periods ranging up to 58 hours.

The Emergency Department is one of the busiest departments in Ireland with 62,974 attendances in 2020, equivalent to about 190 attendances daily.

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On the day of the inspection, the ED was very busy and overcrowded, according to the report, with 196 people attending the department.

At 11am on the day, there were 108 patients present, 21 per cent above intended capacity. At that time, 52 patients had been admitted and were waiting for a bed in the hospital. Of these, 38 were “boarded” in the ED and 14 were placed in other areas of the hospital.

Eighteen of these patients had been waiting for six to nine hours; 12 were waiting nine to 24 hours and eight were waiting over 24 hours.

Only one of the patients was in a corridor; the rest were in the triage area, the ED or single cubicles.

The average time from registration of patients to triage was 25 minutes. It then took from 20 minutes to eight hours for a patient to be medically reviewed. The waiting time from a decision to admit to actual admission ranged from two hours to 58 hours and 28 minutes.

Patients who spoke with inspectors were complimentary about the staff, describing them as “fantastic and very helpful” and “doing their best”.

Two patients, who had been waiting for 18 hours and 16 hours respectively, said they had been triaged and medically reviewed, and their treatment had begun relatively quickly, but they had received no updates since then.

Two-thirds of patients had been in the department for over nine hours since registration, and 25 per cent were there for over 24 hours. Over one-third of patients aged over 75 years had been waiting for more than 24 hours.

On the day of inspection, the hospital had 15 Covid-positive patients with two clinical wards closed to new admissions because of outbreaks. In addition, there were 44 patients with delayed discharges from the hospital; most were waiting for residential and rehabilitation care in the community.

Hiqa found the hospital had good clinical leadership and there were clear lines of accountability with devolved autonomy and decision-making. The hospital was also attempting to address the challenges posed by ED overcrowding.

It says CUH should appointed a lead clinical director for the hospital to provide greater clarity for overall leadership.

A separate inspection report on Cavan and Monaghan Hospital found it was largely compliant with standards. No patients in the hospital’s ED were waiting for longer than 24 hours.

Inspectors found the ED was challenged by a lack of space and a lack of effective flow for admitted patients.