Monitoring inspections in public acute hospitals publication statement 25 April 2023

Date of publication:

Three inspection reports on monitoring in public acute hospitals have been published today by the Health Information and Quality Authority (HIQA). 

Inspections were carried out in November and December 2022 at Letterkenny University Hospital, Naas General Hospital and Midland Regional Hospital, Mullingar.

All three hospitals have submitted compliance plans to HIQA in response to their respective inspection findings. HIQA will continue to monitor the implementation of the compliance plans to address the areas in need of improvement identified on inspection. 

A summary of findings from each inspection is outlined below.

HIQA found the hospital to be substantially compliant in three national standards, partially compliant in six national standards and non-compliant in four national standards on the days of inspection.

Although the hospital was meeting some Health Service Executive (HSE) key performance indicators for the management of patient waiting times in the emergency department, the emergency department remained overcrowded, particularly on the second day of inspection. HIQA also found that immediate improvements were needed to address clinical governance and medical staffing levels in the emergency department. There was also limited evidence that comprehensive processes were in place to fully manage and respond to certain patient safety incidents as effectively as required, or that sufficient and timely learning was being shared and integrated into practice.

In relation to follow-up of the HIQA review of the governance arrangements of gynaecology services at Letterkenny University Hospital which was published in 2021, inspectors found there was good evidence from audit, patient satisfaction surveys and from meeting with staff that improvements have been progressed in the service. It is important that improvements identified on inspection are sustained over the medium to long term.

HIQA found several initiatives in the wards visited on inspection which demonstrated the respect and kindness shown by staff to patients in these wards. 

While HIQA found examples of a number of positive initiatives designed to enhance patient care, further immediate work was required to address deficits in a number of areas, namely: the comprehensive infection screening programme for patients; to improve learning from patient incidents; to fully implement the clinical handover of patients; and to and fully integrate safe processes to manage emergency department patient attendances at the hospital. 

On this inspection, HIQA found the hospital to be compliant or substantially compliant with eight national standards, partially compliant with three national standards and non-compliant with two national standards assessed during inspection. The two non-compliant findings related to standards assessed in the emergency department, which was overcrowded on the day of the inspection.

The hospital had defined management arrangements in place to manage, support and oversee the delivery of healthcare and had implemented a range of measures to improve the flow of patients through the emergency department. However, HIQA was not fully assured that these arrangements were effective in addressing the issues with overcrowding and patient flow issues found in the emergency department on the first day of inspection. In addition, the hospital was reliant on agency staff to maintain the medical roster. The hospital should ensure that there is sufficient continuity and contingency in staff resourcing to manage patients presenting at the emergency department at Naas General Hospital. 

People who spoke with HIQA inspectors were positive about their experience of receiving care in the hospital and were very complimentary of staff. The hospital was aware of the need to support and protect vulnerable patients and had developed a plan to act on findings from the National Inpatient Experience Survey related to these patients. 

While findings related to the emergency department require attention from hospital management, HIQA found generally good levels of compliance in the wider hospital and inpatient clinical areas visited on inspection. 

HIQA found the hospital to be substantially compliant in three national standards, partially compliant in nine standards, and non-compliant with two national standards assessed during the inspection. The two non-compliant findings related to standards assessed in the emergency department, which was overcrowded on the day of the inspection.

HIQA found the hospital had defined corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare. In addition, the hospital had systems in place to monitor and evaluate the quality and safety of services provided at the hospital but further work is required to ensure that all information from monitoring activities is being used to improve practices. Opportunities for improvement were also identified in relation to the management and oversight of risks, learning and improving services from patient safety incidents and outbreak management. HIQA found that hospital management were planning, organising and managing their nursing, medical and support staff in the emergency department, but were reliant on agency staff to maintain the non-consultant hospital doctor staff roster, which is not sustainable in the long-term. Furthermore, attendance at and uptake of mandatory and essential training for nursing staff in the emergency department was not at the required level and needs significant improvement. 

Notwithstanding this, inspectors found that compliance was generally better in the wards visited on inspection when compared to emergency department findings, and patients met with there spoke of a more positive experience. 

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.
  • The National Acute Medicine Programme model of hospitals describes four levels of hospitals as follows:
    • Model 1 hospitals: are community and or district hospitals and do not have surgery, emergency care, acute medicine (other than for a select group of low risk patients) or critical care.
    • Model 2 hospitals: can provide the majority of hospital activity including extended day surgery, selected acute medicine, treatment of local injuries, specialist rehabilitation medicine and palliative care plus a large range of diagnostic services including endoscopy, laboratory medicine, point-of-care testing and radiology-computed tomography (CT), ultrasound and plain-film X-ray.
    • Model 3 hospitals: admit undifferentiated acute medical patients, provide 24/7 acute surgery, acute medicine and critical care.
    • Model 4 hospitals: are tertiary hospitals and are similar to Model-3 hospitals but also provide tertiary care and in certain locations, supra-regional care.
  • Letterkenny University Hospital is a model 3 public acute general hospital and is managed by the Saolta Hospital Group on behalf of the Health Service Executive (HSE). 
  • Naas General Hospital is a Model 3 public acute hospital. It is a member of and is managed by the Dublin Midlands Hospital Group on behalf of the HSE. 
  • Midland Regional Hospital, Mullingar is a Model 3 acute teaching hospital. It is a member of and is managed by Ireland East Hospital Group on behalf of the HSE.