University Hospital Galway welcomes publication of HIQA report following inspection

University Hospital Galway welcomes the publication by Health Information Quality Authority (HIQA) of its report into the inspection of the Emergency Department (ED) in the hospital. An unannounced inspection was carried out at the ED in UHG on 16 February 2023, the focus of which was to monitor compliance with the National Standards for Safer Better Healthcare.

The inspection focused on key issues that impact on the delivery of care in the ED including: effective management to support high-quality care, patient flow and inpatient bed capacity in the hospital, respect, dignity and privacy for people receiving care and staffing levels. The hospital was inspected on four standards and was found to be partially compliant in two areas and non-compliant in two areas. Work is underway to progress actions to address issues highlighted in the report.

Chris Kane, Hospital Manager at UHG said, “We welcome this report and recognise the important and valuable role of HIQA in promoting safety and quality in the healthcare services. We are working hard to address the issues highlighted and acknowledge the ongoing commitment of our ED staff who provide excellent person-centred care in a challenging physical environment.”

The hospital remains committed to improving patient flow with the ED with a focus on patients over 75 years old waiting >9 hours.  We have commenced a number of quality improvement projects in this area including appointing additional patient flow co-ordinators to support both admission to the correct specialty wards and also to support discharge and improve our streaming of patients to the wards in a more timely manner.

We commenced a patient cohorting pilot in three wards in May 2023. The wards are a geriatric specialty and two other medical specialities and our aim is to improve patient length of stay and ensure that there is a team based approach to care on these wards, reducing the incidence of patients spending over 24 hours on trollies for those over 75 years of age.  In addition, the Emergency Department Transit Area is now used for patients >75 years, providing cubicle spaces and privacy while the patients await a bed at ward level. We have recruited an additional Patient Advocacy Liaison Officer specifically for ED/Acute floor to further support ED patients.

To further improve patient flow and the safe transfer of patients within and from the hospital we have implemented a number of hospital admission avoidance pathways, including;

• Frailty at the front door initiative
• OPRAH – Older Persons Rehabilitation at Home Initiative
• Multi-allied Response Service (MARS)
• Pathfinder – Pre-hospital rapid response service for older people

Other person-centred initiatives implemented by the hospital to improve the experiences of older persons attending the ED included engaging with community initiatives, such as the Community Intervention Team and the Integrated Care Programme for Older Persons (ICPOP).

A number of steps have been taken to improve patient’s privacy and dignity within the current limitations of the ED. The Age Friendly Cubicles in Zone A have been recently completed. The Irish National Dementia Strategy and the Irish National Audit of Dementia Care in Acute Hospitals identified the importance of good design for supporting people with Dementia. An assessment was completed by the frailty team members, ED nursing and Medical, Alzheimer’s Society representatives and the Clinical Nurse Specialist Dementia Nurse. Changes included: pictures and murals on the walls, painting of back wall of cubicles, clocks, coloured handrails / toilet seats.

During the course of the inspection, HIQA observed staff being kind and caring towards people using the service and the majority of patients who spoke to inspectors were complimentary of staff. We acknowledge and appreciate the dedication of our wonderful staff who were noted in the report as “committed and constantly striving to provide the best experience to the patients who attended the ED in what was a very challenging environment”.

HIQA have noted a shortfall in medical and nursing staff which impacted on the delivery of high-quality, safe and reliable healthcare. The hospital is prioritising the recruitment of unfilled posts across all areas within the ED, we are using all tools both locally and internationally to recruit our full complement of staff.  The Acute Oncology Nursing Service is in place to help cancer patients avoice having to wait in the ED, we have one CNS in post in ED, a second post is being recruited. We have appointed a Clinical Facilitator CNM1 and CNS Orthopaedics and additional international nurses are being recruited and expected to be in post in September.

Four ED Consultant posts are currently being processed and one is expected to commence in September and a further two consultants expected in 2024, and a further two are being interviews and selected. Medical workforce are prioritising recruitment of the unfilled NCHD posts within ED and a significant number of these have been filled in July 2023.

HIQA found that not all measures to protect service users from the risk of harm were being effectively implemented, particularly in relation to infection prevention and control measures. Cleaning was highlighted as particular risk and the hospital has moved immediately to remedy this. A Quality Improvement Plan has been created to address issues by the Services department in collaboration with the contracted cleaning service vendor, a regular programme of cleaning audits is in now place to ensure that hygiene standards are maintained.

The Terms of Reference for various committees have been updated and also education on incident reporting and quality improvement plans is ongoing.

We welcome HIQA’s acknowledgement that a range of measures have been implemented to improve the flow of patients through the ED and to increase surge capacity. However, despite these efforts, over-crowding will occur where an infrastructure deficit exists. We deeply regret that the privacy, dignity and confidentiality of patients accommodated on trolleys and chairs is being compromised and that the ED is not functioning as effectively as it should be. In our ED we see 200 – 270 patients daily and there is an urgent need for a new Emergency Department at the hospital, this development is crucial to address current suboptimal accommodation and associated patient risk issues.

Four urgent priority developments have been identified for UHG and need to be progressed to address the current deficient infrastructure and provide the required bed capacity for the identified demand of 222 inpatient beds and additional day-case requirements. They are;

1. The Emergency Department with Women’s & Children’s Block
2. Laboratory Replacement facilities Development
3. Cancer Centre and additional beds (200 no of beds)
4. Elective Hospital on the Merlin Park site

These developments are fundamental to address the demands for Galway University Hospitals in providing both secondary care for the Galway catchment population and tertiary care for the entire West / North West region.