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Report finds emergency patients at risk of harm in Limerick


University Hospital Limerick. Photo: Stock

University Hospital Limerick. Photo: Stock

University Hospital Limerick. Photo: Stock

Moves are under way to treat more people in the community nearer their own homes as a damning inspection report at the emergency department at University Hospital Limerick found patients were at risk of harm from overcrowding.

Following an unannounced inspection by Hiqa on March 15, the report found that patients were left with little or no privacy or dignity and their intimate medical details could be overheard by others.

One of the patients was waiting for 116 hours, another for 85 hours and a third patient for 71 hours.

The number of patients in the resuscitation area was twice that of its capacity. One patient waited 45 hours for an angiogram. As well as nurse shortages, there were long delays for beds with some people waiting up to five days in some cases.

The HSE said in response it wants to divert more care to the community such as looking after older people with frailty outside if hospital.

The Hiqa report found :

• Demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding.

•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. 

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•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.

•The dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised.

Hiqa was not assured that the hospital had enacted measures to sufficiently manage overcrowding in the emergency department and the related patient safety risks posed by overcrowding. It had inadequate measures in place to address the issues of ineffective patient flow, insufficient nurse staffing levels and prolonged waiting times, all of which contributed to the overcrowding of the emergency department.

The hospital has submitted a compliance plan in response to the inspection findings, outlining its short, medium and long-term actions to address the non-compliances. Hiqa will continue to monitor issues in the hospital’s emergency department and implementation of the compliance plan to ensure patient safety risks are reduced.

In response a spokeswoman for the hospital said: “Our plan to bring our service in the emergency department closer to compliance with the national standards is included in the report. We have developed a detailed plan with actions to be taken within three months, six months and three years.

“Its success will depend, among other factors, on improvements in internal processes; additional patient flow pathways and hospital avoidance initiatives; closer integration with community services as set out in Sláintecare; and resourcing the health service in the mid-west, including acute bed capacity, in line with the size and the health needs of the population it serves.”

Professor Brian Lenehan, chief clinical director of UL Hospitals Group, said many of the solutions to this persistent problem in Limerick are to be found outside of the emergency department and outside of the hospital.

“We have fewer inpatient beds and fewer consultants and junior doctors to provide care than comparable hospitals. We serve a region with a higher frailty index and a city with a higher deprivation index,” he said.

“The volume of self-referrals to our department is higher than elsewhere.

“Lack of bed capacity remains our primary constraint and we hope this report redoubles the efforts of all to ensure that the midwest catches up in terms of bed numbers and staffing.”

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