HIQA has found some improvements in the delivery of care in the Emergency Department at University Hospital Limerick in the past year, with more nursing staff and better consultant cover.
Despite improvements, the Health Information and Quality authority found that overcrowding in the ED continues to impact patient dignity and privacy.
HIQA carried out an unannounced risk-based inspection at UHL over two days in February, reviewing the quality and safety of services at its ED, as well as services in the wider hospital.
This inspection followed a damning report in June of last year in which HIQA found several worrying factors which were contributing to overcrowding.
These included the huge demand for services exceeding ED capacity, insufficient nurse staffing levels impacting safe quality patient care, and patient dignity and privacy compromised in these conditions.
All of these factors led to ineffective patient flow measures and prolonged waiting times contributing further to the overcrowding problems.
This latest inspection found that there had been an improvement in nurse staffing levels in the ED compared to June 2022, along with enhanced consultant cover providing greater levels of onsite availability over each working day and throughout the week.
The appointment of a senior manager to oversee the operational running of the hospital has meant better decision making around shorter treatment times and lengths of stay for patients in the ED.
However, notwithstanding these improvements, HIQA says the ED remained very busy on the day of the inspection with 72 patients on trolleys and chairs awaiting an impatient bed.
This level of overcrowding continues to impact on the privacy and dignity of patients despite the best efforts of staff.
Elsewhere in the hospital, HIQA found that eight out of eleven national standards assessed were either compliant or substantially compliant with more private and dignified patient care available outside the ED.
The report also highlighted that the hospital and the wider Health Service Executive fully acknowledged that improvement efforts to address ED overcrowding remains a work in progress, and additional measures are under way to improve the chronic congestion there.
These include the building of one 96-bed block, and the planning of a second block, which should add significant inpatient bed capacity.
The first of these is due to be ready in late 2024 or early 2025, with the second 96-bed block not intended to be open until 2027.
HIQA also noted that recent improvements to the way work was organised in the ED and a commitment to utilise alternative care pathways, in particular for older patients who present at the ED.
A need for a whole region plan for the midwest to include acute, community and general practice was further emphasised by HIQA to comprehensively address the continued overcrowding situation at UHL.
HIQA will continue to monitor UHL's short, medium and long term actions in its compliance plan to ensure patient safety risks are further reduced.
The Irish Nurses and Midwives Organisation (INMO) has welcomed the publication of the HIQA report.
INMO Deputy General Secretary, Dr Edward Mathews said: "Today's report as a follow on from last year’s damning inspection into the hospital is very welcome."
He said the report paints a very bleak picture of what patients face on a daily basis and the conditions nurses are working in in the Ireland’s most overcrowded hospital.
He said the report noted that on the day of inspection that the ED was over capacity by over three times the recommended number of patients that can be treated there safely.
"This comes as no surprise to our union whose trolley figures regularly point out to the chaotic levels of overcrowding that occur in UHL every single day.
"UHL has once again been found non-compliant when it comes to protecting the dignity and privacy of patients. This is not the fault of our members who are doing everything they can in a desperate situation."
He also said there needs to be a laser-like focus from the Government and the HSE to tackle the overcrowding crisis in UHL once and for all.
In its response, the University of Limerick Hospital Group said publication of the report provides some assurance that measures introduced to improve flow in the hospital and in the community are having a positive impact on patient care.
It said: "We also welcome the explicit acknowledgement in the report that overcrowding in our Emergency Department will remain the unfortunate reality until the fundamental mismatch between the demand on our services and our inpatient bed capacity is addressed.
"The report reflects an overall increase in compliance with the national standards since the previous inspection.
"Of the 15 standards assessed in the ED and across the hospital, UHL was found to be compliant in one instance, substantially compliant in seven, partially compliant in five and non-compliant in two.
"The areas of non-compliance relate in the main to physical infrastructure in our older nightingale wards and to patient dignity and respect in our Emergency Department."
The statement added: "Overall, the report is positive about management and governance structures; patient safety and risk management arrangements; workforce planning and the kindness and professionalism of our staff.
"It is significant that every one of the patients who spoke to the HIQA inspectors during their two-day visit spoke positively of the staff at University Hospital Limerick."
