Monitoring inspections in public acute hospitals publication statement 22 February 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 September and October 2022 at University Hospital Kerry, Cork University Maternity Hospital and Tallaght University Hospital.

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:

University Hospital Kerry, 20 and 21 September 2022

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

The hospital was substantially behind many other similar-sized hospitals in relation to its efforts to ensure compliance with the national standards, though HIQA acknowledges that the hospital management team was in transition at the time of inspection.

There were significant deficits in governance and management arrangements which impacted on the hospital’s ability to effectively and promptly manage any increase in service demand. For emergency care in particular, HIQA found gross overcrowding of the emergency department along with significant patient flow issues. The emergency department had a significant shortage of medical and nursing staff. At the time of inspection, there were no formalised arrangements in place to ensure consultant oversight in the emergency department 24/7. The emergency department also had a significant shortfall on the rostered complement of nursing staff.

HIQA found that there should be more responsive oversight and management of patient-safety incidents and of the implementation of learnings and recommendations from incident reviews. HIQA was also concerned with the apparent delay in fully implementing the learning and recommendations from the look-back of radiology services carried out in 2018, and the potential for patient safety risk associated with this delay.

The systems and processes in place at the hospital to respond to complaints and concerns raised by patients and their families were not as effective as they should be in promptly and effectively resolving complaints and concerns.

Significant further work, underpinned by effective leadership and support external to the hospital, is required to progress service quality and safety at the hospital and address many of the findings identified on this inspection. Following this inspection, HIQA escalated its concerns regarding the findings to regional and national HSE management to ensure that necessary supports are provided to the hospital to address the issues identified.

Cork University Maternity Hospital, 26 and 27 October 2022

On this inspection, HIQA found the hospital to be compliant with two national standards, substantially compliant with seven national standards and partially compliant with one national standard.  

HIQA found that there were effective formalised corporate and clinical governance for assuring the delivery of high-quality, safe and reliable healthcare, with effective oversight from the South/Southwest Hospital Group which had progressed since the previous HIQA inspection. There were effective systems in place to proactively identify, manage and minimise unnecessary or potential risk of harm to women and babies. There were also systematic monitoring arrangements used to identify and act on opportunities to continually improve the quality, safety and reliability of maternity services in the hospital.

There were shortages in the levels of medical, midwifery and nursing staff found at the time of inspection. Hospital management were aware of these shortages and were working to address the issue through reassignment of exisiting staff. While targeted measures are required to address this risk, HIQA found good overall levels of compliance with the national standards assessed during inspection.

Tallaght University Hospital, 27 October 2022

HIQA conducted a risk-based unannounced inspection of the emergency department of Tallaght University Hospital on 27 October 2022. The hospital was partially compliant with three national standards and non-compliant with one national standard.

While Tallaght University Hospital had management arrangements in place to support and promote the delivery of healthcare services, 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.

Emergency department staff were striving to provide safe, quality care to the high number of patients presenting to the emergency department. The hospital was challenged with capacity issues, insufficient isolation facilities and management reported a deficit in the numbers of community facilities and services to support transfer of care to the community. The practice of admitted patients awaiting inpatient beds on trolleys in the emergency department contributed to overcrowding. The environment in which care was provided to patients on the day of inspection did not promote dignity, privacy and confidentiality for these patients.

At the time of inspection, the hospital had made progress in recruiting medical staff for the emergency department, but unfilled nursing and healthcare assistant posts were impacting the ability of the department to be fully functional.
The hospital had also identified opportunities for improvement within the emergency department under the themes of communication, triage, staff shortages and patient flow. Overall, significant improvements were necessary to enhance the capacity, capability, quality and safety of emergency services at Tallaght University Hospital.

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.
  • University Hospital Kerry is a Model 3 acute teaching hospital. It is a member of and is managed by the South/Southwest Hospital Group on behalf of the Health Service Executive (HSE).
  • Cork University Maternity Hospital is a statutory hospital, and a member of and is managed by the South/Southwest Hospital Group on behalf of the HSE. The hospital provides obstetrics, gynaecology and neonatal services to the population of the South/Southwest Hospital Group.
  • Tallaght University Hospital is a voluntary, model 4 acute teaching hospital and is part of the Dublin Midlands Hospital Group.