HIQA notes long wait times in Letterkenny University Hospital emergency department

Long wait times in the emergency department and ongoing lengthy ambulance wait times were noted at Letterkenny University Hospital by inspectors.

Inspectors from Health Information and Quality Authority (HIQA) carried out an unannounced visit to the hospital in early November, 2023.

Two patients who spoke to inspectors were in the emergency department for 17 hours and 19 hours with one awaiting an inpatient bed and the other awaiting diagnostics.

The inspection was carried out to assess compliance with the National Standards for Safer Better Healthcare as part of HIQA's role to set and monitor standards in relation to the quality and safety of healthcare.

Inspectors spoke with service users, staff and management and observed care being administered and interactions as well as reviewing documents.

Patients told inspectors that they had been seen relatively quickly in triage, but waited for long periods of up to 12 hours to see a doctor or to wait for an x-ray of scan.

The average waiting time from registration to triage at 11am was 36 minutes, which was

not in line with the 15 minutes triage time recommended by the HSE’s emergency medicine

programme and longer than that observed during the previous inspection.

The average time from triage to medical assessment was 400 minutes (6.6 hours) and the average waiting time from medical assessment to admission was 418 minutes (6.9 hours).

While the ambulance turnaround time for the week prior to the inspection showed 'a notable improvement', the average time of 55.4 minutes was still outside the national target.

Inspectors said staff engaged with patients in a respectful and friendly manner and protecting patients' privacy and dignity and noted evidence of strong clinical and nursing leadership in the emergency department.

A physiotherapist and occupational therapist for the Frailty Intervention Team were on leave and not replaced at the time of inspection.

The HIQA report said: “Therefore the team was not functioning as intended to support patient care for the frail elderly attendee and to support patient flow through the ED.”

The absenteeism rate for September, 2023 was 7.8 per cent, which was above the HSE target of less than or equal to 4 per cent. This absence rate was the highest of all Saolta University Health Care Group hospitals.

The inspectors noted that the women’s and children’s services and the intensive care unit were without a clinical pharmacy service at the time of inspection and recommended that the hospital “should advance clinical pharmacy service to some of the clinical areas currently not covered considering the available resourcing”.

During the inspection, 24 patients in LUH were experiencing delayed transfers of care (DTOC) to the community – among the highest number of DTOC in comparison to similar model 3 hospitals.

The report said: “Hospital management outlined that patients complex discharge needs and shortage of community carers posed challenges to transferring patients to safe appropriate care in the community.”

Inspectors found that the hospital had formalised corporate and clinical governance arrangements

While the hospital was endeavouring to manage complaints in a timely manner, the response times still exceeded required timelines. The contribution of the PALS (Patient Advice and Liaison Service) - who was on leave when the inspectors visited - had been beneficial in supporting patients and managing their complaints.

“The hospital should seek to recommence this service if possible,” the HIQA report said.

HIQA said that it was satisfied with the governance and oversight of infection prevention and control practices at the hospital.