Failings 'not acceptable' and cannot be tolerated

AN INVESTIGATION into patient care and governance at Tallaght hospital has revealed serious concerns over the safety of patients lying on trolleys in corridors for long periods.

The report by the Health Information and Quality Authority (Hiqa) also highlighted major deficiencies in the governance of the hospital and a failure by the State to hold the board to account for spending taxpayers’ money.

During the course of its investigation, the performance of all hospitals providing emergency department services nationally over a 24-hour period in August 2011 was also analysed.

This identified significant concerns regarding waiting times for patients in several hospitals. However, a total of nine hospitals were unable to provide any information.

The report says the hospital entered a consultancy contract with PricewaterhouseCoopers costing up to €1.8 million, without any evidence of quotations being sought from interested parties.

This contract – for a review of clinical governance and organisational change – was signed off when the hospital was forecasting a deficit of over €7 million and had a carry-over deficit of more than €20 million.

The report found there was no evidence in board minutes relating to the pay of the chief executive and management team. It was also unclear how decisions were made to provide additional payments to senior staff taking on extra roles. In one case a staff member received more than €150,000 for additional duties. In other cases, senior members of staff received up to €50,000 each in top-up payments.

Hiqa’s chief executive, Tracey Cooper, said these issues underlined the need for effective governance to ensure there was greater transparency over how money was spent.

Overall, the authority’s investigation found that the hospital’s board did not have adequate arrangements in place to govern the hospital. Neither did it function in an effective way to ensure it was providing safe care to patients, including those receiving care in the emergency department.

The report makes 76 recommendations, including that the current interim Tallaght board be dissolved and its charter be replaced with a new substantive board.

It says new accountability legislation is needed to deal with all hospitals where there is persistent poor performance of the board and/or the executive management team, which get public funds.

Following the approval by the Minister for Health of national standards for safer healthcare, Hiqa will be able to monitor service providers in the same way as it inspects nursing homes.

The patient safety watchdog conducted a year-long investigation into the running of the Dublin hospital’s emergency department, after an inquest into the death of Thomas Walsh raised serious concerns about overcrowding and risk management. He died in March 2011 in a corridor in the hospital.

The review of documentation by Hiqa at the hospital identified that in 2010, a total of 331 patient clinical incidents were reported in relation to the emergency department, 27 of these occurring in the corridor adjacent to the department. The most frequent type of clinical incidents reported were related to treatment (48 per cent), slips, trips and falls (16 per cent), absconded patient (10 per cent) and medication (7 per cent).

“In 2011, two unexpected patient deaths occurred within the emergency department, one in March and the second in July.

“As reported by the review commissioned by the Hospital’s Forum for Adverse Incident Review of the incident in March, the contributing factors centred on the sub-optimal environment of the corridor adjacent to the emergency department for the accommodation of patients, a lack of an early warning system to rapidly identify a patient whose clinical condition is deteriorating, lack of a structured communication process between hospital teams and limited nursing documentation and care plans for admitted patients while awaiting admission to an inpatient ward,” the report said.

In 2010, Tallaght hospital was subject to another investigation after it emerged that thousands of X-rays had gone unreported to consultants while many referral letters from GPs had not been processed.

MAIN POINTS

* Patients were put at risk due to a “persistent and generally accepted” tolerance of patients lying on trolleys in corridors for long periods of time.

* More than 80 per cent of patients who needed admission were kept on a trolley in a corridor next to the emergency department, where they waited a further 13 hours for an inpatient bed.

* In other hospitals, 24 out of 25 emergency departments that provided figures failed to meet targets for waiting times.

* A further nine hospitals failed to provide any data.

* Some patients were waiting very long periods on trolleys – in one case up to 137 hours – before admission.

* There was a lack of clarity over who was clinically responsible for patients left in corridors.

* The hospital paid €1.8 million for a consultant’s report, with no evidence quotations were sought from other interested parties, at a time when it was carrying over a deficit of more than €20 million.

* No evidence of how the board decided to authorise supplementary payments worth up to €150,000 for senior staff taking on additional roles. This pay totalled almost €740,000 for five people over five years.

* Report recommends accountability legislation to deal with all hospitals in receipt of public funds where there is persistent poor performance of the board of management.

* Urges all hospitals to ensure ultimately that patients spend no longer than six hours in an emergency department.