HIQA carried out an unannounced inspection of the emergency department (ED) at Mercy University Hospital and its local injury unit on St. Mary’s campus in Gurranabraher on 9 March 2023. The service was found to be partially compliant with two national standards and non-compliant with two other national standards assessed on the day.

Inspectors found that corporate and clinical governance arrangements were not sufficient or effective in managing patient flow on the day of inspection when the ED was full and overcrowded. While the hospital had systems in place to monitor, analyse and respond to information relevant to the provision of care in the ED, HIQA was not assured that measures were effective to protect people attending the ED from risk of harm. Risks identified on inspection included gross overcrowding, which led to concerns on timely access and exit from the service in the event of an emergency situation.

HIQA conducted an unannounced inspection of the emergency department (ED) at St James’s Hospital on 29 March 2023 and found the service to be partially compliant with all four standards assessed. Hospital management had implemented a range of measures to improve the flow of patients through the emergency department and increase inpatient capacity at the hospital. However, there was a mismatch between demand for unscheduled and emergency care, ineffective patient flow and inpatient bed capacity.

The hospital was challenged by a high number of delayed transfers of care and length of stay for patients. Inspectors found shortfalls between the ED’s approved and actual rostered complement of nursing staff. Lengthy patient experience times increased the risk to patient safety and did not fully support the delivery of high-quality, safe, reliable care.

HIQA acknowledges that planned capital developments for St James’s Hospital will increase inpatient bed capacity and should improve the flow of patients through the hospital’s ED in the longer term however further interim improvements are needed in the short to medium term.

During an announced inspection at Portiuncula University Hospital on 9 and 10 May 2023, HIQA found the hospital to be compliant or substantially compliant with nine national standards, partially compliant with four national standards and non-compliant with one national standard assessed during inspection.

The hospital had an effective management arrangement in place to support and promote the delivery of care in the ED, but was challenged with capacity issues and lack of isolation facilities resulting in poor patient flow. There was a mismatch between demand for inpatient beds, especially isolation facilities, and the hospital’s overall capacity which resulted in 14 admitted patients being accommodated in an overcrowded ED environment while awaiting an inpatient bed.

It was evident that hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care at the hospital. Patients who spoke with inspectors were positive about their experience of care in the hospital.

The hospital had systematic monitoring arrangements in place to identify and act on opportunities to improve the quality and safety of healthcare services at the hospital. Hospital management was planning, organising and managing their nursing, medical and support staff in the ED and wider hospital to support the provision of high-quality, safe healthcare. The hospital was actively recruiting to fill vacant posts, such as pharmacy vacancies, which had been challenging to recruit.

HIQA carried out an announced inspection of South Infirmary Victoria University Hospital on 25 and 26 April 2023. The hospital was found to be compliant with one national standard, substantially compliant with eight standards and partially compliant with two standards.

HIQA was satisfied that the hospital had formalised corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare. Systematic monitoring arrangements were in place at the hospital for identifying and acting on opportunities to continually improve the quality and safety of all services.

It was evident that hospital management was planning, organising and managing staffing levels to support the provision of high-quality, safe healthcare. However, hospital management must progress with recruitment efforts to address the shortfall in staff vacancies and the reliance on locum medical staff to maintain the out-of-hours medical registrar roster.

Further opportunities for improvement noted by inspectors included the need to address environmental issues which had the potential to impact on infection prevention and control measures and to ensure required improvements in training is addressed at the hospital.

HIQA conducted an announced inspection of Midland Regional Hospital Portlaoise on 4 and 5 April 2023. The hospital was found to be compliant in two national standards, substantially compliant in five national standards and partially compliant in four national standards.

HIQA found the hospital had formalised corporate and clinical governance arrangements for assuring the quality and safety of healthcare. However, aspects of governance could be strengthened to further improve the effective oversight of the quality and safety of healthcare services provided at the hospital, for example, regular review of identified risks.

The ED was functioning effectively at the time of inspection, and patient experience times and average length of stays for medical and surgical patients on the days of inspection were amongst the better performing hospitals.

While effective workforce arrangements were in place to support and promote the delivery of healthcare, improvements were required to advance existing staff vacancies in the service and improvement of the uptake of training.