The damning report on the state of the emergency department at University Hospital Limerick by the State’s health service watchdog should be a wake-up call. Concerned about severe overcrowding at the hospital last winter, the Health Information and Quality Authority (Hiqa) sent three inspectors on an unannounced visit to its emergency department on March 15th to see how it would cope over the St Patrick’s Day holiday weekend.
This is a hospital with the only 24-7 emergency department in the midwest, serving a population of 385,000 people. It regularly tops the list of patients-on-trolleys that has become a proxy measure for gauging stress across the Irish hospital system. What the Hiqa inspectors found should not just put the Limerick hospital top of the HSE’s emergency fix-it list, but should make addressing problems there a critical Cabinet agenda item.
The regulator found a “grossly overcrowded” emergency department treating twice as many patients as it was designed to manage. The overcrowding was so bad that it was putting people at risk of harm, jeopardising the quality of care and compromising patient dignity and privacy. The issues were not just down to insufficient capacity but poor management. The hospital was found to have inadequate measures in place to address “ineffective patient flow, insufficient nurse staffing levels and prolonged waiting times, all of which contributed to the overcrowding.”
One patient was waiting on a trolley in a corridor for almost five days; another was waiting for a trolley, spending 14 hours in a wheelchair. These findings would be shocking on their own if a previous report, carried out more than two years ago, had not identified similar shortcomings. That report – carried out by Prof Frank Keane, the former president of the Royal College of Surgeons Ireland, in late 2019 into the emergency departments at nine hospitals – found “unsafe” and “unacceptable” practices caused by overcrowding and staff shortages in emergency departments across the hospitals.
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Both the Keane report and the Hiqa inspection report into UHL – published 30 months apart – found that resuscitation areas in the emergency departments were being used as additional capacity to “board” patients and these critical areas were not kept clear to deal with emergencies. As recently as early April, the Irish Association of Emergency Medicine accused the HSE of burying the 2019 report over its decision not to publish Prof Keane’s findings. The HSE said at the time that many of the issues in the Keane report had been addressed by changes introduced during the Covid-19 pandemic and that the report now had “little, if any, material benefit”. Hiqa’s report drives a coach and horses through the HSE statement. Corrective action is long overdue. UHL set a new overcrowding record just two months ago.