The Health Information and Quality Authority has found that gross overcrowding, shortages of medical and nursing staff and significant issues with patient flow posed a risk to patient safety at the emergency department of University Hospital Kerry.
During a two-day inspection, HIQA inspectors also found that the dignity, privacy and confidentiality of patients had been compromised.
University Hospital Kerry is a model three teaching hospital in Tralee offering 24/7 acute surgery, critical care and maternity services.
It has more than 250 in-patient and day-case beds and caters for a population of around 150,000 people in Kerry, west Limerick and north Cork.
In a report published today, they said their findings were a cause of concern to HIQA.
The authority found poor and ineffective management arrangements at the hospital which resulted in both overcrowding and understaffing in the emergency department, as well as concerns about the quality and safety of services more generally.
In particular, HIQA identified concerns about the hospital's approach to the review of patient safety incidents and the hospital's effectiveness in acting on the lessons from such reviews where they were conducted.
HIQA found the hospital failed to meet national standards in five areas, representing a significant risk to people using its services.
The inspectors found the hospital's emergency department grossly overcrowded, with a significant shortage of medical and nursing staff.
There were no formalised arrangements for consultant oversight, and there were also significant patient flow issues.
Collectively, HIQA says, these conditions posed a risk to patient safety in the emergency department.
HIQA says it has communicated its concerns to HSE management regionally and nationally.
Four HIQA inspectors spent two days at the hospital last September and the hospital had advance notice of the inspection.
University Hospital Kerry said it welcomes the HIQA report.
It said it is committed as a hospital to "protecting the safety and welfare of our patients".
"Immediately following the inspection, urgent actions were implemented to address key issues identified by HIQA," it said.
HIQA's Director of Healthcare Regulation said they found that the hospital was "quite significantly behind" what they would expect to see in terms of the effectiveness of management arrangements.
Speaking to RTÉ's News at One, Sean Egan said there were "gaps in terms of compliance with the national standards" and "an issue in terms of the hospital’s ability to address recommendations from incidents and reviews".
"One of the areas that we tested during our inspection was the response that had been implemented by the hospital to the very significant and serious recommendations that had been made on foot of issues that occurred in radiology services back as far as 2018," he said
"Unfortunately, we found a scenario where there were still deficits."
Mr Egan said the HSE would need to take a rounded approach to address all issues identified in the inspection.
Cork and Tallaght
HIQA has also published inspection reports relating to Cork University Maternity Hospital and Tallaght University Hopsital.
Cork University Maternity Hospital was inspected on 26-27 October last.
HIQA said there was good overall levels of compliance with the national standards assessed during inspection.
However, the report found there were shortages in the levels of medical, midwifery and nursing staff at the time of inspection.
The authority said hospital management were aware of these shortages and were working to address the issue through reassignment of existing staff.
HIQA conducted what it described as a risk-based unannounced inspection of the emergency department of Tallaght University Hospital on 27 October last.
HIQA said 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.
Mr Egan also said an unannounced inspection had commenced at Limerick University Hospital to "identify whether the assurances that have been provided to us by the HSE have been implemented" and that the findings would be released in due course.
