Critically ill hospital patients were put at risk by inadequate out-of-hours staffing levels at a Co Cork hospital, a report published today has found.
The Health Information and Quality Authority (Hiqa) said Mallow General Hospital did not have round-the-clock on-site expertise and facilities to safely manage patients with complex clinical needs.
The Mallow inquiry was opened last August after a tip-off that patients with major or complex conditions were being treated in the emergency department. The hospital did not have an intensive care unit, with critically ill patients cared for in a four-bed coronary/high dependency unit.
Hiqa was also informed that acutely ill patients were undergoing major surgery in a hospital with few similar procedures and without round-the-clock critical aftercare.
This went against recommendations published by the watchdog some 14 months earlier after a review of a similar-sized hospital in Ennis, Co Clare. It found such services could pose a serious risk to the health and welfare of acutely ill patients receiving emergency, major surgery and critical care.
Jon Billings, Hiqa’s director of health-care quality and safety, said services in Mallow were based on historic practices, with insufficient action at a local, regional or hospital group level to identify and anticipate risks to acutely ill patients.
He said: “The investigation found that the seniority of medical staff available on site outside core hours in Mallow General Hospital was not adequate for a hospital open to emergencies 24 hours a day. This has subsequently been addressed by the Health Service Executive (HSE).
"In short, the safety and quality of the service provided to patients was dependent on the willingness of local clinical staff at MGH, rather than a resilient and reliable system of care." The authority highlighted a number of immediate patient safety concerns that came to its attention during the course of the investigation and requested the HSE take immediate steps.
The HSE has since introduced a mandatory policy for Cork University Hospital to accept critically ill patients from Mallow General Hospital.
Speaking at the publication of the report, Mr Billings said that although the inquiry found longer-term improvements were in train, "the response of the HSE to key recommendations from the authority’s investigation report into Mid-Western Regional Hospital Ennis, published in April 2009, has been slow and inconsistent, with certain actions only happening relatively recently in response to enquiry from the authority.
“In Mallow General Hospital, this has resulted in a service based on historic practices continuing with insufficient action at a local, regional or hospital group level to identify and anticipate any clinical risks to acutely ill patients and manage these in advance of planned longer-term change," he said.
However, Mr Billings said the hospital should have an important future serving its community.
Minister for Health James Reilly said the report's conclusions would further improve acute hospital services. “This report underlines the need for the HSE to recognise the implications in the previous Hiqa Ennis report, for all hospitals of a similar size," he said. "Both reports deal in particular with the type of services that can safely be provided in smaller hospitals, and with the structures required for good governance and accountability.
"The HSE must ensure that this happens and I will be monitoring the situation closely in conjunction with Hiqa.”
Mr Reilly repeated his support for expanding the services that could be provided in smaller hospitals.
"Local hospitals can and should be a vibrant element of local health services, providing treatment and care at the appropriate level of complexity to the patients in their area. Patients should only have to travel to the larger hospitals for more complex services. Hiqa’s report on the situation at Mallow is entirely in keeping with this approach."
In April 2009, a Hiqa review found patients at the Mid-Western Regional Hospital in Ennis would be exposed to “potential harm” by the continuation of acute services in their current form, including emergency services, cancer surgery and critical care.
The independent inquiry said “change for safety” must happen at the hospital and that some services, including the 24-hour emergency service and acute services must be discontinued "as soon as practicable".
Local Labour TD Sean Sherlock said the report showed an under-investment and shortage of resources at the hospital for more than a decade, but that it vindicated doctors and staff.
Additional reporting PA