IRELAND: Out of bounds; Understaffing and 'gross overcrowding' emergency department lacks 24/7 consultant: Irish Health Watchdog

Inspections of hospitals in Cork, Kerry and Tala found significant understaffing and "gross overcrowding", the health quality watchdog revealed.

The Health Information and Quality Authority (HIQA) inspected University Hospital Kerry, Cork University Maternity Hospital and Tala University Hospital in September and October 2022. All three hospitals were found to be struggling with current levels of staffing, with Kerry and Tala experiencing overcrowding.

In Kerry, HIQA found it was "significantly" behind other hospitals in its efforts to meet national standards. The inspection found significant deficiencies in governance and management arrangements at the hospital, affecting the ability to deal quickly and effectively with any increase in demand for services. In particular, HIQA found emergency department "overcrowding" and significant patient flow problems, indicating that the department has significant shortages of medical and nursing staff. At the time of the inspection there were no formal systems in place to ensure 24/7 consultant supervision in the emergency department and the department was significantly short of its rostered complement of nursing staff.

The Cork inspection found "good overall levels" of compliance with national standards. However, it identified a shortage of medical, midwifery and nursing staff, and the hospital noted that the hospital management was aware of the problem and was trying to address it by redeploying existing staff.

In Tala, the inspection found emergency department staff "doing their best" to provide safe, quality care to its high number of patients, but capacity issues, inadequate isolation facilities and limited options to transfer patient care to community facilities pose challenges. HIQA realized that admitted patients waiting on emergency department trolleys caused overcrowding and that the environment in which patients were cared for on the day of examination did not promote dignity, privacy and confidentiality.

HIQA said the hospital had made progress in recruiting medical staff to the emergency department, but nursing and healthcare assistant roles were impacting the department's ability to fully function.

INMO general secretary Phil Ni Shegda said in a statement that HIQA's reports on University Hospital Kerry and Tala University Hospital "paint a bleak picture of the realities of unsafe nurse staffing".

In the case of both hospitals, unsafe nursing staffing levels meant medical assessment units had to close or operate at reduced capacity. She said the situation at University Hospital Kerry was "of particular concern" to the union. It has called for urgent meetings with the hospital management on how to achieve safe staffing.

"HIQA's report on Cork University Maternity Hospital highlights the crisis in midwifery staff that exists in many maternity units across the country," said Ní Sheaghdha, "and it is unacceptable that they cannot provide a support for working women".

Of the ten HIQA reports carried out on hospitals over the past eleven months, not a single hospital was found to be fully compliant in terms of staffing. This is completely unacceptable and does not surprise the union. INMO has long sounded the alarm about the real human impact of unsafe staffing on nurses and the patients they try to care for.

Reports are not meant to sit on a shelf or in an inbox. They must be the catalyst for change when making safe employees a reality. The Irish Nurses and Midwives Organization (INMO) is calling for more unannounced inspections, citing the "very real human impact" of unsafe staffing levels.