HIQA inspections identify good management of emergency departments in Beaumont Hospital and University Hospital Waterford

Date of publication:

The Health Information and Quality Authority (HIQA) has published two reports on inspections of the emergency departments of Beaumont Hospital and University Hospital Waterford, which were conducted in April 2023.

The inspections found that the emergency departments of Beaumont Hospital and University Hospital Waterford (UHW) both demonstrated good overall levels of compliance with the National Standards for Safer Better Healthcare. The hospitals had been adequately resourced to provide a good standard of care, and had worked to reduce staff vacancy rates. Both hospitals had a full complement of nursing staff in the emergency departments at the time of inspection, and had established greater availability and access to consultants and senior decision-makers. Both hospitals also had good access to step-down facilities and beds which facilitated efficient patient flow within and from the hospitals. Furthermore, HIQA found that in recent years both services had managed to move from a situation of persistent overcrowding in the emergency departments to one where such crowding was well managed or not present.

The announced inspection of the emergency department at UHW took place on 18 April 2023, finding compliance with three national standards and substantial compliance with one national standard. On the day of inspection, UHW’s emergency department (ED) was functioning effectively and efficiently. Although a total of 258 people attended the ED on the day of inspection, there were no patients on trolleys awaiting admission to an inpatient hospital bed at the time of inspection and all patients were receiving care in dedicated treatment areas. While 61 patients were registered in the ED at the time of inspection, care was being delivered in a calm and controlled environment.

The management of patient flow in the ED was further helped by the creation of additional capacity in UHW over the last number of years. For example, the hospital had added 72 additional beds in a new block which has been fully operational since 2019, leading to a current capacity of 510 inpatient and day beds.

HIQA carried out an unannounced inspection of the emergency department at Beaumont Hospital on 13 April 2023, finding substantial compliance with all four standards assessed. While the emergency department was found to be busy, it was functioning well. On the day of inspection, 69 patients were registered in the ED with eight patients on trolleys. While the hospital had further work to do to meet the six and nine-hour ED targets for admission or discharge set by the Health Service Executive, there were no patients waiting more than 24 hours to be admitted or discharged from the emergency department.

Beaumont Hospital consistently features in the top three better performing Irish hospitals in relation to maintaining a low number of admitted patients on trolleys in emergency departments.

The hospital had an escalation policy to manage delays in triage times which incorporated actions when registration to triage times surpassed 15 minutes. Furthermore, the hospital’s ‘Beaumont in the Home’ initiative supported the discharge home of patients awaiting a care package. The scheme involved a number of visits from a healthcare team to the patient until a care package was available through community care. This initiative was established under the governance of Beaumont Hospital, in conjunction with the HSE Community Health Organisation area 9 (CHO9). At the time of inspection, 100 patients had used the service since its establishment in April 2022.

HIQA’s Director of Healthcare, Sean Egan, stated that: “The inspections of the emergency departments in Beaumont Hospital and University Hospital Waterford show the positive impact of a well-managed service on patient care. Our findings demonstrate that management had implemented effective operational measures and oversight to support efficient functioning of their emergency departments to reduce overcrowding. A key element in both hospitals had been the increase in available bed capacity both in the hospital and in local step-down facilities – inclusive of those provided in the private sector - to enable patient flow.

“Of particular note is that the inspection of University Hospital Waterford took place seven weeks after the fire at Wexford General Hospital, when the hospital was providing emergency care cover for counties normally serviced by Wexford University Hospital. Despite the high level of patient presentations, the hospital continued to effectively manage its emergency department.”

Read the two inspection reports by following the link below. 


Further Information:

Zoe Forde, Communications Manager, HIQA, 085 802 1469, zforde@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.
  • In December 2022, HIQA published an overview of its first inspections of emergency departments in Ireland, highlighting key areas for both immediate and longer-term attention to address safety issues in our emergency departments. Read it here.