University Hospital Galway welcomes publication of HIQA report following inspection

University Hospital Galway (UHG) welcomes the publication by Health Information Quality Authority (HIQA) of its report into an inspection of multiple clinical areas in the hospital. An unannounced inspection was carried out by HIQA on May 8th and 9th 2024, the focus of which was to monitor compliance with the National Standards for Safer Better Healthcare.

Over the two days HIQA inspected the emergency department including the acute medical assessment unit (AMAU), the acute surgical assessment unit (ASAU) and the ED Transitional Area. St Teresa’s ward, St Finbar’s ward and St Enda’s ward were also inspected.

The hospital was assessed on eleven standards and was found to be compliant in one standard, substantially compliant in three standards and partially compliant in seven standards.

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 healthcare services. Management and staff in UHG have worked extremely hard over recent years to improve the flow of patients within the hospital and it is great to see this progress acknowledged by HIQA.

“There is a marked improvement in HIQA’s assessment of our standards when compared to the 2023 report, with no non-compliance recorded in this report. Throughout the inspection our staff were observed “promoting a culture of kindness, consideration and respect for people accessing and receiving care at the hospital” and I want to thank all our teams for their constant commitment to patients.

“Detailed action plans are underway to address any areas highlighted for improvement in the report.”

In UHG we are fully committed to providing safe, person-centred care for all our patients however, our ability to deliver the highest standard of care in the ED is impacted by a number of factors including; sustained increases in attendances, inadequate physical infrastructure and recruitment challenges.

On 8th May, 264 people attended the ED which is higher than a 2024 daily average of 216. During this period we also were caring for high number of patients (31) classified as DTOC (delayed transfers of care) these are patients who are ready to leave hospital but still occupy a bed because the follow on care or home supports they require are not in place. 

The hospital was in full escalation at the time of inspection and we welcome the report’s findings that evidence of escalation actions as per the hospital’s escalation framework were seen to be implemented.

Regrettably, due to very high attendances some national targets for patient experience times (PET) and average length of stay were not met. We are however constantly striving to improve the care we give to patients and welcome HIQA’s findings of our progress in managing patient flow since the last inspection. The report notes “improvements to triage to support patient flow, additional staff had been employed for the patient flows teams resulting in expanded cover 7/7 with patient flow coordinators assigned to specific wards, there was cohorting of patients on wards to deliver an improved patient experience.”

We welcome the report’s findings that “there was evidence of strong clinical and nursing management in the emergency department to manage surges of people attending the emergency department.”

For patients aged 75 or older, UHG has an escalation area adjacent to the ED ensuring that patients can be accommodated there to provide dignity and ensure they are cared for in a dedicated area and not on corridors.

The patient cohorting project has moved to phase two. The focus is on all medical teams, with the commitment to fill the allocated base ward beds with the correct specialties. This pilot project in UHG has demonstrated improvements in the safety of discharges and in the average length of stay for patients.

The hospital has undertaken a Bed Utilisation Study and recommendations have been used to draft an action plan. The 15 actions are tracked over time, with a relevant responsible person appointed. 

The report finds that despite all the systems in place to support patient flow, the demand for inpatient beds outweighed the hospital’s bed capacity, noting that patient flow was not operating as efficiently and effectively as required to support the patients’ journey from the emergency department through the hospital and onto the community. The report also notes that staff were challenged to maintain privacy and dignity in large multi-occupancy rooms and in the overcrowded emergency department.

UHG acknowledges that a 222 bed deficit and over-crowded accommodation is a consistent and ongoing challenge.

There is an urgent need for a new Emergency Department and additional bed capacity at UHG, this development is crucial to address current suboptimal accommodation and associated patient risk issues at the hospital.

In terms of workforce management, there is an ongoing cycle of recruitment to fill any vacancies as per our WTE and an improvement plan for mandatory training for Doctors, Nurses and HCAs is being developed.

In relation to complaints and national response times not being met, the hospital has put in place additional resources to address the backlog and ensure timely management of complaints going forward.

A plan is in place for the roll out of EMEWS within the Emergency Department however this will require increased staffing level, a submission for additional staff will be made. A meeting with key stakeholders will take place in the coming months to discuss progression of same.

Galway University Hospitals is the only Model 4 Hospital in the HSE West and North West Region. It provides secondary care for Galway city and surrounds and tertiary care for the region (catchment population of circa 850,000).

Galway University Hospitals Capital Programme Oversight Board was established by the Saolta Group CEO in late 2023 with membership from Saolta, GUH, Estates, Community, National Acute Hospitals, University of Galway and patient representatives.

A design team has been appointed to develop the masterplan and a Project Manager for Major Capital Projects on the GUH Campus took up post in July 2024 to drive this ambitious development for the region.

The major requirement for healthcare in the region is the provision of protected Emergency Care, Elective Scheduled Care and Cancer Care and the associated increased bed capacity. This Capital Programme Board is now developing a masterplan which runs to 2048 and encompasses projects of significant scale on the campus. The key projects are:

New Emergency Department UHG

Women and Children’s Block UHG

Laboratory UHG

New Ward Block

Cancer Centre UHG

Additionally the Elective Hospital, Surgical Hub, Outpatients Department and Adult OPD Cystic Fibrosis Unit are in progress on our MPUH campus.

The Masterplan will play a pivotal role in delivering on National and Regional healthcare policies. It will be used to support capital submissions for priority capital projects and to secure investment.

The new plan will see elective, day surgery and ambulatory care move to the MPUH campus while complex acute elective and unscheduled inpatients and day cases, oncology and maternity and paediatric inpatient care remains in UHG. It will also provide the required bed capacity to address the demand for increased inpatient beds and additional day case requirements.

Work is also progressing in decanting some services to the Merlin Park site. The build for Phase One of the Outpatient Department block in MPUH has completed and is now at commissioning stage and the Adult CF OPD is also due to be handed over shortly to be commissioned. Phase Two Outpatients MPUH is currently at design stage and will then go to tender for construction. This will eventually facilitate the relocation of the majority of outpatient appointments to Merlin Park Hospital.

Plans for an elective hospital and surgical hub are also progressing for the MPUH campus with construction work now underway on the surgical.