Hiqa finds UHL patient waiting for 116 hours and diagnoses being given in public corridors
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A Hiqa inspection of the emergency department at University Hospital Limerick identified one patient waiting 116 hours for treatment and found nurse shortages are significantly affecting the “delivery of safe care”.
The inspectors said patients on trolleys had “little to no privacy or dignity” due to the overcrowding with personal information regularly shared in areas where many others could hear.
Inspectors found 60 patients on the day they visited had been waiting “an especially long time”. This included one patient waiting 116 hours, a second waiting over 85 hours and another waiting 71 hours. Another patient waited 45 hours for an angiogram.
UHL is consistently one of the hospitals worst affected by the growing trolley crisis with the Irish Nurses and Midwives Organisation counting 99 people waiting for beds on Friday morning.
“Of the 139 attendees in the emergency department at 11.30am, 60 (43%) patients were boarding in the department while awaiting an inpatient bed,” inspectors found on the day they visited.
“The majority of these patients were being accommodated on trolleys in corridors with very limited space between each trolley, which impacted on patients’ privacy and confidentiality.” The inspectors on March 15 witnessed patients on trolleys being given medical diagnoses or updates on corridors where this was easily overheard.
“In this setting, it was not possible to maintain privacy and confidentiality when communicating and interacting with patients,” they wrote.
“There was a significant risk that others (patients, visitors and staff) could overhear patient-clinician conversations and personal information exchanged between patients, medical and nursing staff.”
Delayed access to scans was highlighted by staff and patients to the inspectors as one reason for long waits in the ED. One patient said they waited 45 hours in the ED for an angiogram and another 24 hours for a computed tomography scan.
The report also highlights efforts by UHL to address the problems for patients including the appointment in January 2020 of two dedicated people to act as patient advocates and provide support to patients, especially older people, attending the emergency department.
The inspectors found however that the “sheer volume of patients” attending the ED is causing delays throughout the hospital system. The hospital has 530 in-patient beds (98 were added in late 2020 and early 2021) and 149 day-case beds.
It provides the only emergency department in the region, and the Hiqa report states this caters for a population of 385,172 people. The hospital has nine emergency medicine consultants including eight registered as specialists with the Medical Council, Hiqa found.
However, despite having recruited almost 300 nurses last year, the inspectors found the hospital struggling to provide enough nurses to meet demand.
“Hiqa found that on the day of inspection the nurse staffing levels in the emergency department were insufficient to meet the needs of people attending the department,” the report states.
“This significantly impacted on the delivery of safe, quality care and on the timely triage and assessment of attendees to the department.”
On the day of the inspection, the emergency department had “a shortfall of 17% in the agreed number of nurses rostered on duty for the department”, the report found.
It states that the hospital has a policy of transferring patients to smaller hospitals in the UL Hospital Group as part of the escalation policy, and placing trolleys on wards when the ED becomes particularly overcrowded.
However, they found other escalation measures listed by the hospital were not in place on the day they visited including capping the number of attendances to ensure compliance with fire regulations.
On the day of the inspection, they found 51% of the attendees to the emergency department were in the department for more than nine hours after registration, contrary to guidelines.