HIQA found the hospital to be compliant with two national standards, substantially compliant with ten national standards and partially compliant with two national standards assessed on the days of inspection. 

HIQA found that there were formalised governance structures and monitoring systems in place to identify and act on opportunities to improve the quality and safety of services provided at the hospital. The hospital supported and promoted a person-centred approach to care. There were systems and processes in place to respond promptly, openly and effectively to complaints and concerns raised by people using the service. There was also good collaboration and integration between the hospital and St Vincent’s University Hospital to ensure that patients attending for emergency care were provided with the right care, in the right place, based on their assessed needs. 

Areas for improvement included the need to address aspects of the hospital’s physical environment, which did not adequately support the delivery of high-quality care or the security of vulnerable patients using the service. Oversight, attendance at, and staff uptake of, mandatory and essential training also required improvement.

On this inspection, HIQA found the hospital to be compliant with three, substantially compliant with four, partially compliant with four and non-compliant with three national standards. 

There was considerable overcrowding in the emergency department which impacted on waiting times and the effective flow of patients. The resultant emergency department overcrowding challenged the promotion of the dignity, privacy and autonomy of people using the service. The overcrowding also posed infection prevention and control risks, where the minimum social distancing was not being achieved in all areas. Screening for COVID-19 on arrival at the hospital was not found to be fully in line with national guidance at the time, but this was addressed on inspection. Once allocated a bed space on the ward, there was evidence that the overall experience reported by patients improved. Despite challenges posed by overcrowding in particular, people using the services said that staff were kind, respectful and considerate of people using the services. 

Overall, HIQA acknowledges management’s efforts to address the issues identified. However, more effective measures are required to address overcrowding, staffing and patient flow issues to ensure the care delivered, in the emergency department in particular, complies with the National Standards for Safer Better Healthcare. 

HIQA conducted a risk-based announced inspection of St Vincent’s University Hospital on the 30 and 31 August 2022. The hospital was compliant with four national standards, substantially compliant with five national standards and partially compliant with six national standards assessed on the days of inspection. 

The hospital had formalised governance and systematic monitoring arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare services. There was good levels of compliance in the inpatient clinical areas visited on inspection. On the days of inspection, the hospital’s emergency department was challenged by the high numbers of attendances and limited capacity, which affected the continuous and effective flow of patients and negatively impacted on patient experiences. Nurse staffing levels were found to be inadequate based on the volume of patient presentations and there was a reliance on agency and existing nursing staff to fill rosters. The resulting deficit of staffing impacted the delivery of high-quality, safe care in the clinical areas visited, and posed a patient safety risk, especially in the emergency department. 

HIQA conducted a risk-based unannounced inspection of Sligo University Hospital emergency department on the 20 September 2022. The hospital was partially compliant with three national standards and non compliant with one standard assessed on the day of inspection. 

Although the emergency department had well-established pathways in place to expedite assessment and treatment, there were long waits for medical assessment and patients were subsequently managed in the emergency department while awaiting beds due to inpatient bed capacity issues and delayed discharges from the hospital. The management team were attempting to implement measures to improve patient flow through the emergency department, the hospital and onwards to the community. However, HIQA found that these measures were not fully effective in ensuring delivery of high-quality, safe and reliable healthcare services to the people who used the hospital's emergency services. Staff were striving to provide safe, quality care to the increasing number of patients attending the emergency department in a challenging and overcrowded environment. 

The hospital was making progress towards planning and organising the workforce, but further improvement was required to maintain nursing staffing levels in the emergency department. Despite staff efforts in the emergency department, the environment in which care was provided to patients, the patient experience time and the delays in accessing an inpatient bed, did not promote dignity, privacy and confidentiality for the patients in the emergency department.