HIQA report finds overcrowding continues to impact privacy and dignity of patients at UHL

UNIVERSITY Hospital Limerick has once again come under scrutiny as a report from the Health Information and Quality Authority (HIQA) highlights persistent overcrowding issues in the hospital's emergency department, which is persisting to impact patient privacy and dignity.

The report, published this Friday, reveals that despite some improvements since last year's inspection, the emergency department remains severely overcrowded, with 72 patients waiting for inpatient beds on trolleys and chairs.

HIQA conducted an unannounced inspection at University Hospital Limerick on February 21 and February 22 2023, focusing on the quality and safety of services in the emergency department and the wider hospital. The inspection aimed to assess the effectiveness of improvements made following HIQA's previous inspection in March 2022.

In the emergency department, the hospital was found to be partially compliant with three out of four national standards assessed during the inspection. This indicates some progress compared to the previous year's findings, where only one standard was partially compliant.

UHL was found to be 'non-compliant' in one area - relating to the privacy, dignity and autonomy of service users.

"There were limited isolation facilities in the hospital and the shortfall in these facilities will not be addressed under current plans until such time as the new bed block is built and operational in late 2024. Adequate physical distancing between beds in ‘nightingale’ wards was difficult to maintain," states the report.

"Doors of rooms were left open where patients requiring transmission-based precautions were cohorted, which is not consistent with effective infection prevention and control practices. Inadequate storage facilities was an issue in all clinical areas visited. Collectively, these issues presented a potential risk to patient safety on the day of inspection," it adds.

Read the full report here. 

Positive changes included improved management arrangements, increased nurse staffing levels, and better organisation and management of services, resulting in shorter treatment times and lengths of stay for patients.

However, despite these improvements, the overcrowding issue remains. The 72 patients waiting for inpatient beds continue to experience a lack of privacy and dignity, despite the dedicated efforts of the hospital staff. Although some of the risk issues identified in the 2022 inspection have been addressed, the hospital must find sustainable solutions to tackle the ongoing problem.

The inspection findings for areas other than the emergency department were more positive, with eight out of 11 national standards assessed found to be compliant or substantially compliant. Care provided in these areas demonstrated better privacy and dignity for patients. Nevertheless, the report highlighted the need for improvements in hospital infrastructure, staffing levels, and the use of audits to drive further enhancements.

To address the persistent overcrowding, the hospital has outlined several planned measures. These include the development of two additional 96-bed blocks to increase inpatient bed capacity, the first of these blocks is intended to be opened in late 2024 or early 2025, with the second intended to open in 2027. Also included are efforts made to enhance work organisation and efficiency, initiatives to provide alternate care pathways for older patients, and improved workforce planning and vacancy filling. 

Following the inspection, HIQA engaged with senior management within the Health Service Executive (HSE) to support the hospital and confirm the report's findings. HIQA emphasised the need for comprehensive support at a regional level, including acute, community, and general practice services, to address the overcrowding situation in University Hospital Limerick.

The hospital has submitted a compliance plan in response to the inspection findings, outlining short, medium, and long-term actions to address the identified issues.