‘Improvements needed’ in Sligo and Mayo EDs – HIQA

New inspection reports by HIQA have found continued deficiencies in the emergency departments (EDs) of Sligo University Hospital (SUH) and Mayo University Hospital (MUH).

An unannounced inspection of SUH, which took place on 12 and 13 July last year, found the hospital to be compliant or substantially compliant in five national standards and partially or non-compliant in eight of the 13 national standards inspected.

The hospital had systematic monitoring arrangements in place for identifying and acting on opportunities to continually improve the quality and safety of all services. However, recommendations and areas for improvement identified by audit and monitoring activity required implementation to ensure improvements in practice occurred. The hospital had improved medical staffing levels in the ED which will have a significant positive impact.

“However, shortfalls in the nurse staffing in [the] ED were having an impact on optimal staffing complement for day and night shifts, and inspectors found limited improvement from the last inspection in September 2022,” according to the Authority.

HIQA identified further opportunity for improvement of the operational oversight and management of patient flow issues through the ED. While inspectors found that there were no patients aged 75 years or more in the ED over nine hours, none of the other HSE targets in relation to time taken for patients to progress through the ED were met on the day of inspection.

Patients who spoke with inspectors were positive about their experience of receiving care in the ED and wider hospital and were “very complimentary” of staff.

“Despite staff efforts to maintain patients’ dignity and respect, the practice of accommodating inpatients on trolleys on the ED corridor and on ward corridors and or treatment rooms impacted on patients’ dignity and privacy,” HIQA stated.

“While the hospital management team had committed to make improvements, there was limited progress on the hospital’s compliance with the national standards since the last inspection and this needs to be progressed.”

The unannounced inspection of MUH found the hospital to be compliant or substantially compliant in eight national standards and partially compliant in five of the 13 national standards assessed. The inspection took place on 21 and 22 June 2023.

Several improvements were noted since the last inspection, such as the reconfiguration of the quality and safety department, recruitment of quality and patient safety personnel, and the introduction of a patient advisory liaison service. While the times for patients to progress through the ED had improved since the last inspection, they remained outside of HSE targets.

Hospital management was identifying and acting on opportunities to continually improve the quality and safety of healthcare services at the hospital, according to the Authority.

There had been a significant increase in medical staffing at junior and consultant level in the ED since HIQA’s last inspection. However, there continued to be vacancy rates above 10 per cent in the healthcare assistant, nursing and health and social care professional roles.

HIQA was satisfied that the hospital had systems and processes in place to respond promptly, and effectively to complaints and concerns raised by people using the service and noted good practice in relation to in-house patient satisfaction surveys.

The hospital had increased ED capacity since the last inspection and inspectors found that patient privacy and dignity was supported for patients accommodated in individual cubicles and multi-occupancy rooms.

“However, for patients placed on trolleys along the corridor, the promotion of privacy and dignity was limited,” according to the Authority.

“While HIQA notes the improvements made since the last inspection across the hospital, further improvements were needed to improve patient experience in the ED.”

The reports were two of six inspection reports on compliance with the National Standards for Safer Better Healthcare published by HIQA on 27 March. Inspections were carried out in six public hospitals between June and September 2023. The other reports concerned:  The Rehabilitation Unit, St Mary’s Care Centre, Regional Hospital Mullingar, Co Westmeath; Clontarf Hospital, Dublin; Carlow District Hospital; and the National Rehabilitation Hospital, Dublin.