Letterkenny hospital manager says recruitment is 'top priority'

Sean Murphy, the manager of Letterkenny University Hospital, says that recruitment is a ‘top priority’ at the facility.

Mr Murphy was speaking after inspections by Health Information Quality Authority (HIQA) last year found that immediate improvements were needed to address clinical governance and medical staffing levels in the emergency department.

HIQA examined the Emergency Department, Medical 2 Ward and the Gynaecology Ward on two dates in November.

Since November 2022, when the inspections were carried out, LUH has recruited 140 new staff across all grades.

'Immediate' work needed to address staffing at Letterkenny hospital

HIQA inspectors visited the hospital on two dates in November and found the facility's emergency department overcrowded

A new electronic employment control tracker has been introduced in recent weeks. While the Pharmacy Department has been increased and 12 pharmacists and technicians have been approved, LUH says it ‘faces significant challenges in recruiting senior pharmacists required to undertake clinical pharmacy roles’.

An Assistant Director of Nursing was appointed to assist patient flow in February and funding has been sourced to employ four additional consultants in emergency medicine. 

LUH is seeking to fill of posts on a locum basis pending permanent filling of same.  A Consultant has been employed to cover AMAU which has direct responsibility for staff in AMAU under Medical Department governance.

HIQUA found ‘limited evidence that comprehensive processes were in place to fully manage and respond to certain patient safety incidents as effectively as required, or that sufficient and timely learning was being shared and integrated into practice’.

In relation to gynaecology services at LUH, inspectors found there was good evidence from audit, patient satisfaction surveys and from meeting with staff that improvements have been progressed in the service.

While HIQA found examples of a number of positive initiatives designed to enhance patient care, further immediate work was required to address deficits in a number of areas, namely: the comprehensive infection screening programme for patients; to improve learning from patient incidents; to fully implement the clinical handover of patients; and to and fully integrate safe processes to manage emergency department patient attendances at the hospital.

“Urgent action has been taken to address the issues identified by HIQA and significant progress has been made by all staff to ensure that we provide our services safely,” Mr Murphy said.

“I would like to acknowledge the on-going commitment and dedication of our staff in providing a patient centred approach and we will work together to build on the good practice highlighted in this report.”

HIQA looked at 13 national standards in relation to leadership, governance and management and workforce. Of these, LUH was substantially compliant with three, partially compliant with six and non-compliant with four.

LUH says that ‘significant work’ has been carried out on all areas where it was found to be either non-compliant or partially compliant.

In the area of overall governance, LUH says that the revision of the Clinical Handover Policy has been completed.

As part of the implementation of the National Healthcare communication programme, facilitator training is underway with five members of staff identified to undertake the training.

A programme of work to strengthen governance within LUH has been identified.

A statement said: “The LUH Hospital Executive Board (HEB) and the QPS service, working with the Change Implementation Manager and Saolta Executive will agree and implement changes to the governance structure at LUH to include updated terms of reference; membership; and reporting relationships.

“The HIQA concerns regarding the governance of the Respiratory Receiving Unit (RRU) were in the process of being addressed at the time of inspection. Changes were implemented in December 2022 and full management of the service was transferred to the emergency medicine service in January.”

The acute medical assessment unit was re-established at the hospital in February with the employment of Consultant AMAU Physician.

This marked the cessation of a distinct RRU facility. With changes to Covid pathway guidance, the area is no longer utilised as a red ED stream.

A second CT scanner is now operational with protected slots for AMAU each day and the MRI scanner at the hospital is scheduled for replacement later this year.

In relation to the risk register internal audit, risk register meetings have increased from quarterly to monthly to ensure the timely implementation of all recommendations.

“Five out of the seven recommendations are fully implemented with the remaining two almost fully implemented,” a statement said.

A pathfinder project began this month to support admission avoidance by providing assessment and treatment at home.

An ambulance liaison person is also now based in the ED to support nursing staff in caring for patients in ambulances. The hospital has also recently appointed a GP Liaison Senior nurse to be the link between GPs throughout Donegal and the LUH Emergency Department

A Pathway stream has also been developed to fast track patients presenting with minor injuries through the Emergency Department.

A Patient Advice and Liaison Service (PALS) Coordinator officer has been appointed to ensure patients receive communication and access to advice as required.