HIQA inspectors have expressed concern about the “sustainability” of medical staffing levels to provide 24/7 care in the emergency department (ED) at University Hospital Galway (UHG).
The Authority’s report, released in July, noted evidence of “strong” clinical and nursing leadership in the ED, but also highlighted deficits in consultant, NCHD, and nursing staffing levels.
At the time of the unannounced inspection in February, the hospital was approved for eight whole-time equivalent (WTE) consultants in emergency medicine. However, only 2.5 WTE positions were filled (two WTE appointed on a permanent basis and 0.5 WTE on a locum basis).
The number of actual consultants in post had decreased from four WTE to 2.5 since the previous inspection in April 2022. “This had a significant impact on the ED consultant on-call roster resulting in a 1:3 on-call rota for consultants in emergency medicine,” according to the inspection report.
“Hospital managers were aware of the potential risks with the low level of emergency medicine consultant cover and the limited contingency options in place in the event of change to capacity or workload and had recorded this on the risk register and escalated this to the Saolta Group.”
Hospital management “assured HIQA” that a senior clinical decision-maker at consultant or registrar grade was on-site in the ED 24/7. “Outside of core working hours, a consultant in emergency medicine was available off-site and staff confirmed that they were available and could be on-site within 30 minutes, if needed.”
The ED also has an approved complement of 43 WTE NCHDs comprising of 18 registrars and 25 SHOs. Nine of these posts (four registrars and five SHOs) were unfilled at the time of inspection. Inspectors were informed that the hospital was reliant on agency staff to fill vacant shifts.
“The use of agency staff is not a sustainable solution in the long-term for covering vacancies and needs to be reviewed by hospital management,” stated HIQA’s report.
The inspectors reported that at 11am on the day of the inspection, the ED was “grossly overcrowded and very busy relative to its intended capacity and function”. A new “temporary” ED was opened at the hospital last October as the previous infrastructure was not capable of providing the single cubicles and isolation facilities required. “Staff in the ED who spoke with inspectors were committed and constantly striving to provide the best experience to the patients who attended the ED in what was a very challenging environment, with admitted patients awaiting an inpatient bed and staffing shortages,” noted HIQA’s report.
Commenting on staffing deficits, a spokesperson for Saolta told the Medical Independent: “HIQA have noted a shortfall in medical and nursing staff, which impacted on the delivery of high-quality, safe, and reliable healthcare. The hospital is prioritising the recruitment of unfilled posts across all areas within the ED; we are using all tools, both locally and internationally, to recruit our full complement of staff.”
The spokesperson continued: “There are currently 3.5 WTE consultants in post in the ED of UHG. One additional post is filled, but the consultant is currently on maternity leave. The hospital has approval for 6.5 additional ED consultants, one of whom is due to take up post in September 2023 and one in January 2024. The remaining 4.5 WTE approved posts form part of an ongoing recruitment campaign. Medical workforce are [also] prioritising recruitment of the unfilled NCHD posts within the ED and a significant number of these have been filled in July 2023.”
Saolta said it welcomed HIQA’s “acknowledgement” that measures had been implemented to improve the flow of patients through the ED and to increase surge capacity. “However, despite these efforts, overcrowding will occur where an infrastructure deficit exists,” added the spokesperson. “We deeply regret that the privacy, dignity, and confidentiality of patients accommodated on trolleys and chairs is being compromised and that the ED is not functioning as effectively as it should be. In our ED we see 200-to-270 patients daily and there is an urgent need for a new emergency department at the hospital; this development is crucial to address current suboptimal accommodation and associated patient risk issues.”
Four “urgent” priority developments have been identified for UHG, according to Saolta. These developments are the ED with the women’s and children’s block; laboratory replacement facilities development; cancer centre and additional beds (200 beds); and an elective hospital on the Merlin Park site.
“These developments are fundamental to address the demands for Galway University Hospitals in providing both secondary care for the Galway catchment population and tertiary care for the entire west/north-west region.”