ED reports show progress can be made on crowding- IAEM

The Irish Association for Emergency Medicine (IAEM) has welcomed two new HIQA inspection reports that praise progress made at the emergency departments (EDs) of Beaumont Hospital, Dublin, and University Hospital Waterford (UHW).

The IAEM said the reports noted “significant progress” in both hospitals’ management of crowding in their EDs

“The reports… make clear the factors that have brought about such improvements and clearly show that where individual hospital managements adopt a more aggressive, zero tolerance approach to the holding of admitted inpatients on trolleys in the ED, substantial progress can be made,” the Association said in a statement.  

“Such a level of management commitment adds significantly to the shop-floor work done by consultants and other senior decision makers in EM to improve service provision which is noted in both reports.”

New inspections by HIQA have found that the EDs of Beaumont Hospital, Dublin, and UHW both demonstrated good overall levels of compliance with national standards.

The hospitals had been adequately resourced to provide a good standard of care, and had worked to reduce staff vacancy rates, according to the Authority.

Both hospitals had a full complement of nursing staff in the EDs at the time of inspection, and had established greater availability and access to consultants and senior decision-makers. Both hospitals also had good access to step-down facilities and beds which facilitated efficient patient flow within and from the hospitals.

Furthermore, HIQA found that in recent years both services had managed to move from a situation of persistent overcrowding in the EDs to one where such crowding was well managed or not present.

The unannounced inspection of the emergency department at UHW took place on 18 April 2023, finding compliance with three national standards and substantial compliance with one national standard. On the day of inspection, UHW’s ED was functioning effectively and efficiently. Although a total of 258 people attended the ED on the day of inspection, there were no patients on trolleys awaiting admission to an inpatient hospital bed at the time of inspection and all patients were receiving care in dedicated treatment areas. While 61 patients were registered in the ED at the time of inspection, care was being delivered in a calm and controlled environment.

The management of patient flow in the ED was further helped by the creation of additional capacity in UHW over the last number of years. For example, the hospital had added 72 additional beds in a new block which has been fully operational since 2019, leading to a current capacity of 510 inpatient and day beds.

HIQA carried out an unannounced inspection of the emergency department at Beaumont Hospital on 13 April 2023, finding substantial compliance with all four standards assessed. While the emergency department was found to be busy, it was functioning well. On the day of inspection, 69 patients were registered in the ED with eight patients on trolleys. While the hospital had further work to do to meet the six and nine-hour ED targets for admission or discharge set by the HSE, there were no patients waiting more than 24 hours to be admitted or discharged from the emergency department.

Beaumont Hospital consistently features in the top three better performing Irish hospitals in relation to maintaining a low number of admitted patients on trolleys in emergency departments.

The hospital had an escalation policy to manage delays in triage times which incorporated actions when registration to triage times surpassed 15 minutes. Furthermore, the hospital’s ‘Beaumont in the Home’ initiative supported the discharge home of patients awaiting a care package. The scheme involved a number of visits from a healthcare team to the patient until a care package was available through community care. This initiative was established under the governance of Beaumont Hospital, in conjunction with the HSE Community Health Organisation area 9 (CHO9). At the time of inspection, 100 patients had used the service since its establishment in April 2022.

HIQA’s Director of Healthcare, Mr Sean Egan, stated: “The inspections of the emergency departments in Beaumont Hospital and University Hospital Waterford show the positive impact of a well-managed service on patient care. Our findings demonstrate that management had implemented effective operational measures and oversight to support efficient functioning of their emergency departments to reduce overcrowding. A key element in both hospitals had been the increase in available bed capacity both in the hospital and in local step-down facilities – inclusive of those provided in the private sector – to enable patient flow.

“Of particular note is that the inspection of University Hospital Waterford took place seven weeks after the fire at Wexford General Hospital, when the hospital was providing emergency care cover for counties normally serviced by Wexford University Hospital. Despite the high level of patient presentations, the hospital continued to effectively manage its emergency department.”