HIQA says ‘system-wide problems’ at St Luke’s General Hospital in Kilkenny

Patients of St Luke’s General Hospital emergency Department are exposed to ‘risks of harm and increased morbidity and mortality’ because of ‘ineffective patient flow’ and ‘limited surge capacity’ according to HIQA.

A lack of staff in the Emergency Department, from consultant level to nursing numbers, must also be addressed ‘as a matter of importance’.

The ED’s limited capacity to respond to unplanned medical staff leave or a surge in patients was also a concern to HIQA.
The inspection body said the problems highlighted in its report were signs of ‘system-wide problems’.

HIQA’s unannounced inspection took place in January, and the report was published this week. St Luke’s was measured in relation to national standards.
The standards body says that while hospital management had implemented a number of measures to support ‘effective patient flow’ in the emergency department and wider hospital, the measures were ‘not fully effective in managing the potential patient safety risks associated with long patient waiting times for triage and medical review, and the long patient wait times in ED for an inpatient bed’.

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However, HIQA did acknowledge that hospital management is ‘striving to plan, organise and manage’ the workforce to achieve high-quality care.

Consultants
St Luke’s General Hospital is approved for four emergency medicine consultant posts. At the time of inspection there were only two posts filled.

HIQA said this ‘had a significant impact on the consultant on-call roster for the ED and the hospital’s inability to provide 7/7 on-call consultant in emergency medicine cover’.

Hospital management told the inspectors recruitment was planned but there are ‘challenges in recruiting consultant staff to the hospital given the geographical location and competing appeal’ of larger hospitals.

Inspectors reviewed rosters for the four weeks preceding the inspection. They found that while all NCHD (non consultant hospital doctors) posts were filled, 30% of SHO (senior house officer) shifts and 11% of registrar’s shifts were unfilled.

“Hospital management must, as a priority, ensure that there is sufficient resource capacity and contingency for the demand of the emergency department service at the hospital.”

The emergency department at St Luke’s had 44,693 attendees in 2022, an increase of 13% on 2021 but similar to pre-Covid.
On the day of inspection there was an average waiting time in the ED of 37 minutes, above the HSE’s recommended 15 minutes.

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“Delays in triage can seriously affect the timelines of patients’ diagnosis and treatment and should be reviewed by the hospital,” the HIQA report says.
Overcrowding in the ED was ‘compounded by the ineffective patient flow through the department’.

On the day of inspection the hospital had 24 patients more than its capacity of 241.
Trolleys in the corridor ‘did not fully promote the dignity, privacy and confidentiality’ of patients.

Caring Staff
However, the report notes, patients who spoke to the inspectors, on the day, recognised staff were very busy but still had time for patients and ‘everyone was lovely’.
The inspectors also observed staff actively engaging with patients in a respectful and kind manner.

All ED nursing posts were filled, however the inspectors found that for the four weeks prior to their visit 39% of days had one unfilled shift and 36% of nights had an unfilled shift. Agency staff and the reallocation of staff from other areas covered short term absences.

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On the day, due to unplanned leave, a nurse from the overcapacity area was allocated to the ED and as a result the overcapacity area was closed, resulting in patients being accommodated on a corridor.

An additional 8.5 posts had been approved and HIQA noted the ‘uplift in staffing level would have a positive impact on patient care in the acute floor area’.
The full report can be read on: https://www.hiqa.ie/reports-and-publications