HIQA find mismatch of bed availability to meet demand at Tullamore hospital

An unannounced HIQA inspection of Midland Regional Hospital in Tullamore found staff and management at the hospital demonstrated an effective approach to patient care in the emergency department. However, there was also scope for improvement, in a number of areas.

On the day of inspection, the hospital’s emergency department was busy, relative to its intended capacity,'' but was functioning well overall,'' the inspectors reported.

They noted that there were a significant number of patients in the emergency department awaiting specialty review which was impacting PET (patient experience time).

They reported that it was clear that hospital management were working to optimise capacity within and outside of the hospital and had implemented a range of measures to improve the flow of patients through the emergency department by using surge capacity beds and extended rosters for emergency medicine consultants.

''The hospital was in escalation, indicating an overall mismatch between the availability and demand for inpatient beds at the time of inspection. The significant use of additional beds for surge capacity helped to maintain patient flow through the emergency department on the day of inspection. However, the use of surge capacity for prolonged lengths of time is not sustainable and places a significant additional demand on services, such as delays in elective procedures, redeployment of staff and higher reliance on agency and overtime,'' it was reported.

Further integration and collaboration with community services to increase availability options, was recommended.

There was a rostered six-day consultant presence in the emergency department. The unit was well staffed on the day of inspection although 14% of nursing posts and 47% of HCA (health care assistants) posts were vacant. Hospital management were working to actively recruit staff to fill vacant positions in the emergency department where possible but the hospital was subject to a national recruitment embargo at the time of inspection.

Patients who spoke to inspectors were complimentary of staff. Inspectors found that there were ''robust systems and processes in place to support care and protect patients in the emergency department from the risk of harm.'' However, the physical environment in the department ''did not support the delivery of high-quality, safe, reliable care. For example, there was insufficient physical distancing between trolleys located on the corridor, which was an infection risk.''

It was recommended that the hospital should explore opportunities to increase toilet facilities to reduce the potential risk of cross infection. Although the hospital had a number of complex delayed discharges, there was opportunity to avail of access to local step down beds and private rehabilitation beds to support access and egress within the service, inspectors said.

The inspectors concluded saying, ''while it is commendable to see that the hospital is consistently meeting most of the patient experience times, and no patients were waiting 24 hours or more to be admitted or discharged, there is some further work to do to consistently meet the six and nine hour targets. There was also scope for improvement of staffing and completion of environmental and equipment cleaning and this should be monitored closely to ensure that root causes are identified and areas for improvement continue to be identified and acted on promptly.''

The Midland Regional Hospital in Tullamore is a member of the Dublin Midlands Hospital Group (DMHG) and is the largest hospital in the midlands of Ireland. It serves a population within the four counties of Laois, Offaly, Longford and Westmeath and other surrounding counties. The hospital provides acute, emergency, general and tertiary specialist services, across a range of medical and surgical specialties.