Patients still at risk from ‘gross overcrowding’ in Limerick emergency department

Significant risks to patient safety remain at University Hospital Limerick due to “gross overcrowding” in its emergency department, according to an inspection report by the State’s health watchdog.

Despite some improvement since the hospital was last inspected in 2022, the report describes the gains achieved as marginal, due to a continuing mismatch between demand and capacity.

The emergency department at UHL was not in compliance with any of the key national performance indicators and Hiqa said there was no significant change to the environment where patients were boarded, or in the promotion of their privacy and dignity, since last year. One patient had been waiting for a bed for over five days, inspectors found.

The report is based on an unannounced inspection of UHL on two days last February, in which Hiqa reviewed the quality and safety of services in the emergency department and also the wider hospital.

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As in last year’s inspection, the hospital’s ED was found to be grossly overcrowded with 121 patients registered, over 50 per cent more than planned capacity.

Almost half of these patients were “boarding” in the ED while waiting for a bed in the main hospital.

While complimentary of the efforts of staff, patients who spoke to the inspectors described the unit as noisy, uncomfortable and understaffed. One patient had been waiting four days for an MRI scan; another was waiting seven days for an EEG.

Inspectors found the average wait time from a decision to admit a patient to admission was 30 hours and 44 minutes. One patient had been waiting 132 hours.

“When compared to Hiqa’s last inspection, there was an improvement in the waiting times for triage and medical review, which demonstrated the operational efficiencies gained in the emergency department as a result of the increased supports and resourcing of UHL.

“However, on the whole, the gains were marginal because the mismatch between demand and capacity for inpatient beds remained, which resulted in a substantive number of patients boarding in the emergency department and continued to be a key casual factor of the prevailing overcrowding of the department.”

UHL is the second busiest hospital in the country and one of the most overcrowded. Last year’s critical Hiqa result prompted the HSE to send in a high-level team to address the hospital’s patient flow issues. Additional Government funding has enabled the recruitment of additional doctors and nurses.

Despite these measures, the hospital was forced to declare a major incident last January when overcrowding hit new record levels.

In the ED, Hiqa found the hospital to be non-compliant with one national standard – relating to the promotion of patients’ dignity and privacy – and partially compliant with three.

It says this represents “some improvement” on the last inspection in 2022, when the hospital was non-compliant with three out of four national standards.

Among the improvements it found were changes to local management, including the appointment of a senior manager assigned on site responsible for the overall daily running of the hospital; and better nurse staffing.

There were also more consultants working in emergency medicine and changes to work practices to ensure greater levels of on-site availability over the working day and week.

Hiqa says improvements to the way services are organised and managed, to enable faster treatment and decision-making around care, have begun to yield shorter treatment times and lengths of stay for patients in the emergency department.

Inspectors found the ED was very overcrowded when they visited, with 72 patients on trolleys and chairs waiting for a bed. “This level of overcrowding continued to impact on the privacy and dignity of patients despite the best efforts of staff,” Hiqa concluded.

While the hospital and the HSE have acknowledged that improvement efforts at UHL remain “a work in progress”, Hiqa points to further planned measures that are intended to tackle overcrowding. A new 96-bed block is due to open in late 2024 or early 2025, and a second such block is planned for 2027. Further efforts are being made to enhance efficiency, including greater use of alternative care pathways for older patients presenting to the ED.