Sligo University Hospital welcomes publication of HIQA report following inspection

Sligo University Hospital (SUH) welcomes the publication by Health Information Quality Authority (HIQA) of its report into its inspection of three areas at the hospital. An unannounced inspection was carried out at the hospital on the 12th and 13th of July 2023.

The three clinical areas assessed were the Emergency Department, Medical South and Surgical North.

The focus of the inspection was to monitor compliance with the National Standards for Safer Better Healthcare.

As part of the assessment, HIQA focused on key standards relating to Capacity and Capability and Quality and Safety.

The inspection focused in particular, on four key areas; infection prevention and control, medication safety, the deteriorating patient (including sepsis) and transitions of care.

The hospital was found to be compliant in one area, substantially compliant in four areas, partially compliant in six areas and non-compliant in two areas of the standards.

Grainne McCann, Hospital Manager at Sligo University Hospital said: “We welcome this report and recognise the important and valuable role of HIQA in assessing and promoting safety and quality in the healthcare services. Action has been taken to address issues identified by HIQA and staff are continuously improving our services 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.”

The report found that the hospital had formalised corporate and clinical government arrangements in place that monitored performance against key performance indicators to improve the quality and safety of the hospital. There was clear evidence that the hospital management and staff were aware of the need to respect and promote the dignity, privacy, and autonomy of people receiving care of the hospital, promoting a culture of kindness, consideration and respect. Overall HIQA were satisfied that the hospital had a system in place to identify, report, manage and respond to patient safety incidents. 

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.

To improve the environment for patients, SUH has extended the ED waiting area, which now opens up into the reception area thus improving visibility of patients. The security office is now located in the waiting / reception area improving safety for patients. Mobile phone charging points are now in place in the waiting area. To utilise all areas in ED to maximise patient space and open remaining zone once staffing are in place.

SUH has recruited patient flow co-ordinators to improve operational oversight and management of patient flow. The hospital has also recruited an ED Phlebotomy post triage nurse to improve diagnostics, treatment and patient experience times.

A mapping exercise in relation to ED patient flow and Patient Experience Time (PET) was also undertaken at SUH in July ‘23 as part of a review of the ED patient pathway to ensure data is captured consistently.

A weekly report highlighting long stay patients is reviewed to ensure all efforts are made to minimise delayed transfers of care and a new KPI has been introduced to monitor the release of ambulances / handover timing of patients.

An audit of all hygiene practices in ED to ensure compliance with hospital policy is underway and expected to be completed in Q2, 2024.

A number of training plans have been implemented including the monitoring of ED training records, a hand hygiene training plan and the introduction of new nursing documentation to improve patient safety and outcomes. Protected time is also being provided to staff for mandatory training.

Electronic information has been made available for patients and visitors via QR Codes and leaflets covering areas such as Emergency Dept, Patient Liaison information and how to make a formal complaint.

A standard operating practice has been put in place to address patients that leave the Emergency department before treatment has commenced / completed whereby the post call Consultant may contact the patient if there are immediate concerns. GPs are advised of all patients who leave before being seen.

The hospital has incorporated any patient complaints and feedback into the agenda of the Patient Engagement Forum and Patient Experience Survey committee. The complaints department are in the process of introducing a track & trending of complaints and will provide this information to all hospital departments. Targeted training is underway with relevant departments to increase the awareness of the timeframe for responding to complaints and the expectation to meet that timeframe.

Essential maintenance issues on the Medical South area have been progressed and the hospital has improved IPC signage (signage on doors and back of bed) for ward areas and has reintroduced the green tagging system to identify what equipment is clean in all wards. An IPC educational drive with staff on wards was carried out to heighten awareness of Standard of IPC/Hygiene.