The Health Information and Quality Authority (HIQA) has today published a report of its inspection of the emergency department at University Hospital Limerick. 

On 15 March 2022, HIQA conducted a risk-based unannounced inspection of the emergency department at University Hospital Limerick to follow-up on issues of overcrowding and to assess preparations for the risk of additional severe crowding over the upcoming bank holiday weekend of 17 to 20 March 2022. 

During the inspection, HIQA assessed:

• compliance with four key standards from the National Standards for Safer Better Healthcare under the themes of Leadership, governance and management; Workforce; Safe care and support; and Person-centred care and support 
• contingency measures in place to mitigate the impacts of crowding in the emergency department. 

HIQA found the hospital to be partially compliant with one standard and non-compliant with three standards assessed on the day of inspection. Findings included:

• demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding
• ineffective patient flow and decreased inpatient bed capacity significantly contributed to overcrowding 
• nurse staffing levels were insufficient, which was having an impact on the safe provision of care at the time of inspection. In addition, inadequate nurse staffing levels had been a regular problem over the preceding weeks
• the overcrowded and understaffed emergency department posed a significant risk to the provision of safe, quality, person-centred care and to the health and welfare of people receiving care in the department
• the dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised.

HIQA was not assured that the hospital:

• had enacted measures to sufficiently manage overcrowding in the emergency department and the related patient safety risks posed by overcrowding
• had adequate measures in place to address the issues of ineffective patient flow, insufficient nurse staffing levels and prolonged waiting times, all of which contributed to the overcrowding of the emergency department.

Following the inspection, HIQA escalated concerns to University Limerick Hospitals Group and the HSE. HIQA sought assurances that the hospital and wider region would be effectively supported to enact substantive measures to address capacity deficits, including in acute and community service configuration, capacity and resourcing implementation.

The hospital has submitted a compliance plan in response to the inspection findings, outlining its short, medium and long-term actions to address the non-compliances. HIQA will continue to monitor issues in the hospital’s emergency department and implementation of the compliance plan to ensure patient safety risks are reduced. 

The report and compliance plan are available on www.hiqa.ie. 

Notes to Editors:

• Under Section 8 of the Health Act 2007 (as amended), HIQA is responsible for monitoring compliance with national standards. Using these powers, HIQA may make recommendations for improvement of care, but under current legislation HIQA cannot enforce their implementation.