Damning UHL inspection report finds 116-hour wait times and patients at risk of harm


A damning inspection report on gross overcrowding at University Hospital Limerick’s emergency department has found patients at risk of harm.

he hospital is struggling with nurse shortages and long delays with people in some cases waiting up to five days for a bed.

The report following an unannounced inspection by Hiqa on March 15 found that patients were left with little or no privacy or dignity and their intimate medical details could be overheard by others.

One of the patients was waiting for 116 hours, another for 85 hours and a third patient for 71 hours.

The number of patients in the resuscitation area was twice that of its capacity. One patient waited 45 hours for an angiogram.

The Hiqa report found:

  • demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding;
  • ineffective patient flow and decreased inpatient bed capacity significantly contributed to overcrowding;
  • nurse staffing levels were insufficient, which was having an impact on the safe provision of care at the time of inspection. In addition, inadequate nurse staffing levels had been a regular problem over the preceding weeks;
  • the overcrowded and understaffed emergency department posed a significant risk to the provision of safe, quality, person-centred care and to the health and welfare of people receiving care in the department;
  • the dignity, privacy and confidentiality of patients attending and receiving care in the emergency department was compromised.

Hiqa was not assured that the hospital had enacted measures to sufficiently manage overcrowding in the emergency department and the related patient safety risks posed by overcrowding. It had adequate measures in place to address the issues of ineffective patient flow, insufficient nurse staffing levels and prolonged waiting times, all of which contributed to the overcrowding of the emergency department.

Following the inspection, Hiqa escalated its concerns to University Limerick Hospitals Group and the HSE. It sought assurances that the hospital and wider region would be effectively supported to enact substantive measures to address capacity deficits, including in acute and community service configuration, capacity and resourcing implementation.

The hospital has submitted a compliance plan in response to the inspection’s findings, outlining its short, medium and long-term actions to address the non-compliances. Hiqa will continue to monitor issues in the hospital’s emergency department and the implementation of the compliance plan to ensure patient safety risks are reduced.

In response, a spokeswoman for the hospital said today :”We acknowledge the findings of the Hiqa report. Our plan to bring our service in the emergency department closer to compliance with the national standards is included in the report.

“We have developed a detailed plan with actions to be taken within three months, six months and three years.

“Its success will depend, among other factors, on improvements in internal processes; additional patient flow pathways and hospital avoidance initiatives; closer integration with community services as set out in Sláintecare; and resourcing the heath service in the Mid-West, including acute bed capacity, in line with the size and the health needs of the population it serves.

“Among the short-term actions we are taking are the following: additional staff redeployment to the Emergency Department and triage; review of our escalation plans; ongoing focus on patient transfers to Ennis, Nenagh and St John’s hospitals; further development of hospital avoidance programmes with our colleagues in HSE Midwest Community Healthcare; and enhanced opportunities to increase patient access to community health services.

“As announced by the Minister for Health on April 27, we are currently working with a team of HSE experts on unscheduled care and ED management. This HSE support team has also been engaging with colleagues in HSE Mid-West Community Healthcare. We await the team’s report to include additional measures to improve patient streaming and hospital avoidance. This action plan will be a means of mitigating the risks to patient safety and addressing poor patient experiences in our ED, as highlighted by Hiqa.

In addition, the CEO of UL Hospitals Group has commissioned Deloitte to conduct an external review of patient flow at the hospital.

The spokesperson added: “We apologise to all patients for the long waits and poor care environment being experienced in our Emergency Department. This also adversely impacts on staff and it is encouraging to see the professionalism and kindness of staff, in the words of our patients, acknowledged in the Hiqa Report.”

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