Letterkenny University Hospital welcomes publication of HIQA report following inspection

Letterkenny University Hospital welcomes the publication by Health Information Quality Authority (HIQA) of its report into its inspection of three areas at Letterkenny University Hospital (LUH). An announced inspection was carried out at the hospital on the 16th and 17th of November 2022. The areas assessed were the Emergency Department, Medical 2 Ward and the Gynaecology Ward.

The focus of the inspection was to monitor the National Standards for Safer Better Healthcare. HIQA’s core assessment focused on key standards relating to leadership, governance and management, workforce, person-centred care, safe care and support and effective care.

During this inspection, HIQA looked at 13 National Standards in relation to leadership, governance and management and workforce. Of these, Letterkenny University Hospital was substantially compliant with 3 National Standards, partially compliant with six National Standards and non-compliant with four National Standards.

Sean Murphy Hospital Manager at Letterkenny University Hospital said, “We welcome this report and recognise the important and valuable role of HIQA in promoting safety and quality in the healthcare services.  Urgent action has been taken to address the issues identified by HIQA and significant progress has been made by all staff to ensure that we provide our services safely.
“I would like to acknowledge the on-going commitment and dedication of our staff in providing a patient centred approach and we will work together to build on the good practice highlighted in this report.”

Significant work has been carried out on all areas where the hospital was found to be non-compliant or partially compliant. In a number of areas this work had commenced prior to the HIQA Inspection.

In the area of Overall Governance, the revision of the Clinical Handover Policy has been completed.

As part of the implementation of the National Healthcare communication programme, facilitator training is underway with five members of staff identified to undertake the training.

A programme of work to strengthen governance within Letterkenny University Hospital (LUH) has been identified. The LUH Hospital Executive Board (HEB) and the QPS service, working with the Change Implementation Manager and Saolta Executive will agree and implement changes to the governance structure at LUH to include updated terms of reference; membership; and reporting relationships.

The HIQA concerns regarding the governance of the Respiratory Receiving Unit (RRU) were in the process of being addressed at the time of inspection. Changes were implemented in December 2022 and full management of the service was transferred to the emergency medicine service in January.

The acute medical assessment unit was re-established at the hospital in February with the employment of Consultant AMAU Physician. This marked the cessation of a distinct RRU facility. With changes to Covid pathway guidance, the area is no longer utilised as a red ED stream. The AMAU is under the governance of the medical directorate.

In regards to access to diagnostics, a second CT scanner is now operational at the site with protected slots for AMAU each day. The MRI scanner at the hospital is scheduled for replacement later this year and the new scanner will increase both functionality and speed within the service.

In relation to the risk register internal audit, risk register meetings have increased from quarterly to monthly to ensure the timely implementation of all recommendations. 5 out of the 7 recommendations are fully implemented with the remaining 2 almost fully implemented.

Recruitment remains a top priority for LUH. Since November 2022 the hospital has recruited 140 new staff across all grades. A new electronic employment control tracker has been implemented in April to streamline the recruitment process between LUH and Saolta. LUH HR Department has carried out significant recruitment over the last number of years for the Pharmacy Department at LUH, with an increase of 12 WTE (pharmacists and technicians) approved for LUH in the last two years, however like many hospitals LUH faces significant challenges in recruiting senior pharmacists required to undertake clinical pharmacy roles.

In relation to Safe Care and Support, a further Assistant Director of Nursing was appointed to assist patient flow in February. The Saolta Group Unscheduled Care Lead is working very closely with the patient flow team in LUH ensuring all optimal patient flow processes are in place.

LUH has also received funding to employ four additional Consultant in Emergency Medicine.  This will allow the hospital to improve the availability of Senior Clinical Decision makers within the Emergency Department and extend their onsite presence.  LUH is seeking to fill of posts on a locum basis pending permanent filling of same.  A Consultant has been employed to cover AMAU which has direct responsibility for staff in AMAU under Medical Department governance.

The Pathfinder project commenced in LUH in April 2023 to support admission avoidance by providing assessment and treatment at home. An ambulance liaison person is also now based in the ED to support nursing staff in caring for patients in ambulances. The hospital has also recently appointed a GP Liaison Senior nurse to be the link between GPs throughout Donegal and the LUH Emergency Department

A Pathway stream has also been developed to fast track patients presenting with minor injuries through the Emergency Department.

LUH are working with HSE Estates colleagues to provide a modular building to relocate non clinical functions in the Emergency Department and convert the non-clinical accommodation into additional patient treatment areas for patients with potential transmissible diseases.

A Patient Advice and Liaison Service (PALS) Coordinator officer has been appointed to ensure patients receive communication and access to advice as required. The Patient Advice and Liaison Service Coordinator acts as a visible focal point for patients, families and carers and is often the main contact within the hospital. They help to resolve issues for patients and their families and work towards improving the patient experience at any available opportunity. A second PALS officer is currently being recruited.

Under the area of Effective Care and Support actions have also been introduced in response to high levels of C.Difficile. The hospital continues to advertise for antimicrobial pharmacist and Consultant Microbiology posts. In the interim there is a system in place to manage Infection Prevention and Control (IPC) issues and locums will be employed where possible.