Inspectors carried out an unannounced inspection of Wexford General Hospital and found the hospital to be compliant or substantially compliant with eight national standards, partially compliant with two national standards and non-compliant with one national standard. On the days of inspection, the emergency department (ED), acute medical assessment unit and patient flow processes throughout the hospital were functioning well. Data on the patient experience times (PETs) in the ED showed that the hospital was compliant with the majority of the Health Service Executive (HSE) targets.  

Inspectors found that there was a person-centred approach to care provided by staff in the hospital, with a culture of kindness, consideration and respect evident in the areas inspected. Areas identified for improvement included availability of adequate facilities for patients requiring isolation and the need to produce time-bound action plans with individuals assigned actions in order to implement quality improvements.

Non-compliance was found in relation to management of nursing resources as there was an inadequate staffing of nurses in the special care baby unit. Hospital management submitted an urgent compliance assurance to address the deficits in the short term with additional resources planned to support the service in the medium term. 

HIQA’s unannounced inspection of St. Luke’s General Hospital Kilkenny found the hospital to be compliant or substantially compliant with 10 national standards and partially compliant with one national standard.

On the first day of inspection the ED was operating well relative to its intended capacity with 18 patients registered in the ED and six admitted patients in the ED cubicles awaiting an inpatient bed. The hospital had defined management arrangements in place to manage and oversee the delivery of care and the hospital was achieving most of the national targets for patient experience times (PETs) which is commendable. However there was scope for improving PETs for patients aged 75 years old or more. From the start of 2024 up to the week of inspection, the overall attendance rate at the hospital’s ED was 8% higher when compared to the same period in 2023. 

Risks related to staffing were documented by the hospital on the corporate risk register and ongoing recruitment and alternative strategies were in place to mitigate risks. Patients were generally complimentary about care received in the ED and wards visited but referenced how busy staff were. Inspectors noted that the physical environment broadly supported the delivery of high-quality, safe, reliable care and protected the health and welfare of patients; however, there were opportunities to further improve upkeep of the physical environment. The hospital had systems in place to monitor, evaluate and improve healthcare services. The hospital needs to make continuous improvements based on findings from previous audits. The hospital also had systems in place to identify and manage potential risk associated with the areas of known harm that were the focus of this inspection. Overall, good levels of compliance had been maintained since the previous inspection. 

HIQA’s announced inspection of Mercy University Hospital found the hospital to be compliant with three national standards, substantially compliant with five national standards and partially compliant with three national standards assessed.

The hospital had formalised integrated corporate and clinical governance arrangements in place, but at the time of the inspection, these structures were being reviewed by the executive management board. On the day of inspection, the hospital’s ED was busy and inspectors found that management needs to continue to work to improve its PETs. A person-centred approach to care was supported and promoted throughout the hospital, and people using the service were positive about their experience of receiving care in the ED and the wider hospital. 

Areas for improvement identified by HIQA included ensuring that the physical environment of all areas fully supports the delivery of high-quality, safe, reliable care. The hospital had systems in place to monitor, evaluate and improve its services; however, quality improvement initiatives were not always implemented when standards fell below acceptable levels. In addition, there was no change in improvement with compliance of the resourcing standard since the last inspection. Inspectors acknowledged that nursing staffing levels had increased in three of the four clinical areas visited, as a result of improvements from implementing recommendations from the Final Report and Recommendations by the Taskforce on Staffing and Skill Mix for Nursing from the Department of Health.

HIQA carried out an unannounced inspection of the ED of Our Lady of Lourdes Hospital and found the hospital to be substantially compliant in one standard and partially compliant in three of the four national standards monitored.

The hospital had arrangements in place with defined lines of responsibility and accountability for the governance and management of unscheduled and emergency care at the hospital. However, the hospital’s ED was overcrowded relative to its planned capacity with 87 patients registered in the ED, resulting in increased patient experience time. Time taken to triage patients were in line with targets recommended by the HSE’s emergency medicine programme. 

On the first day of inspection, the patient wait time and the average length of stay for medical and surgical patients were in line with national targets, and there were no patients awaiting transfer of care from the hospital on the day of inspection. Hospital performance was not in line with PETs for the percentage of attendees in the ED who should be discharged or admitted within six and nine hours. There was a mismatch between the demand for beds and hospital capacity, with admitted patients continuing to be accommodated in the ED, the acute medical assessment unit and the acute surgical assessment unit, which impacted the effective running of these units. The hospital management was planning, organising and managing their nursing and medical workforce in the ED to support the provision of high-quality, safe healthcare. However, there were unfilled medical posts in the ED at the time of inspection. 

Hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care in the ED. However, the accommodation of 19 admitted patients in the ED on the day of inspection, impacted on the meaningful promotion of the patients’ dignity, privacy and autonomy. Work to progress improvements as outlined in the compliance plan submitted to HIQA should be progressed to address the deficits found. 

Inspectors carried out an unannounced inspection of University Hospital Galway and found the hospital to be compliant or substantially compliant in four standards and partially compliant in seven of the 11 national standards monitored.

The hospital had formalised corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe and reliable healthcare. There were defined management arrangements in place at the hospital to manage and oversee the delivery of care. However, patient flow within the hospital was not functioning as it should. The mismatch between availability and demand for inpatient beds resulted in patients admitted into hospital continuing to be accommodated in the ED. Data on the PETs showed that the hospital was not in line with the majority of the HSE’s targets, although it had improved on the previous inspection. On the day of inspection, 31 patients had delayed transfers of care out of the hospital which was attributed to a deficit of community beds in the region. 

Nursing, medical and support staff in the hospital were well managed to support the provision of high-quality, safe healthcare. However, there was still a shortfall in the approved complement of nurses and consultants in emergency medicine. The attendance and oversight of mandatory and essential training required improvement in most ward areas. 

While hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care, staff were challenged to maintain privacy and dignity in large multi-occupancy rooms and in the overcrowded ED. 

The hospital had systems and processes in place to respond openly and effectively to complaints and concerns raised by people using the service. However, the response time for managing complaints was not in line with HSE guidance and there was a risk of transmission of communicable infectious diseases in some multi-occupancy rooms, en-suite bathrooms and showers. While the hospital was monitoring and evaluating healthcare services provided at the hospital to improve care, it was not clear what action had been taken as a result of this to address issues identified in areas such as medication safety, deteriorating patient, sepsis and clinical handover. 

HIQA’s unannounced inspection of University Hospital Waterford found the hospital to be compliant or substantially compliant with all national standards that were assessed.

The inspectors found that the hospital’s executive management team worked collaboratively to ensure the quality and safety of healthcare services was prioritised. There was evidence of good operational grip by the executive management team and devolved accountability and responsibility for the four areas of focus — infection prevention and control, medication safety, deteriorating patient including sepsis and transitions of care. Patients also spoke positively about their experiences of receiving care in the hospital.

Effective management systems were in place to manage identified risks and patient-safety incidents. Recommendations from the review of patient-safety incidents were implemented and learnings from patient-safety incidents were shared with staff.

Hospital management planned, organised and managed the workforce to ensure the delivery of high-quality, safe and reliable care. There were reported shortfalls in nursing and healthcare assistant staff that had the potential to impact on care delivery, but staffing shortfalls were limited in the areas visited on the days of inspection. 

HIQA conducted an announced inspection of the community rehabilitation unit in Our Lady’s Hospice and Care Services, Harold’s Cross and found the unit to be compliant or substantially compliant with 10 standards and partially compliant with one standard assessed. 

Inspectors found integrated corporate and clinical governance structures that focused on the quality and safety of healthcare services were in place. Monitoring arrangements were effective in identifying opportunities to improve healthcare services. Workforce arrangements were planned, organised and managed to ensure the delivery of high-quality and safe healthcare with good staff uptake of mandatory and essential training. 

Improvements were required in relation to gaps in the standard of environmental hygiene in the unit with further work to progress improvement plans. Notably, all patients that inspectors met were complimentary about the care. There were numerous initiatives in place to support social interactions and promote patients’ autonomy. Overall, the service was found to be a positive environment for those seeking care there.