HIQA report on a Tipperary hospital finds that staff operate in ‘challenging environment'

Tipperary University Hospital has received a positive inspection from the Health Information and Quality Authority (HIQA), despite its Emergency Department staff being under pressure due to staffing issues, according to a report published earlier this month.

HIQA carried out a one-day unannounced visit to Tipperary University Hospital, and the report was published on Friday, December 15 last.

The report was on an inspection of the National Standards for Safer Healthcare and the inspection focused on key issues that impact the delivery of care in the Emergency Department at the busy Tipperary hospital.

These included effective management to support high-quality care, patient flow and inpatient bed capacity in the hospital, respect, dignity and privacy for people receiving care, and staffing levels. Overall, Tipperary UH was judged to be substantially compliant in two national standards, and partially compliant in two national standards.

Tipperary UH is a Model 3 public acute hospital. It is managed by the South/South West Hospital Group on behalf of the HSE. The hospital provides a range of services to emergency and elective patients on an inpatient, outpatient, and day-patient basis. It has 210 inpatient beds, with 15 surgery beds, plus 22 day beds. The total capacity of the ED was for 19 patients.

“There was one toilet and shower for patient use within the ED,” stated the report.

“Management informed inspectors that there would be additional toilet and shower facilities available for patient use on completion of the Acute Medical Assessment Unit (AMAU) refurbishment works.

“The AMAU was originally an 8-bedded unit, which had been reduced by four beds at the time of inspection due to refurbishment works. On the day of inspection four beds were operational, due to overcrowding in the ED.

“On the day of inspection, the ED was overcrowded with 27 patients present at 11am,” according to the report.

“Patients were accommodated on trolleys on corridors - designated corridor A, corridor B, and corridor C. Inspectors observed that not all trolleys were adhering to the one-metre physical distancing requirement in line with national guidance.

“On the day of inspection, inspectors spoke with patients about the care they received in the ED. Feedback was positive and patients reported that they were treated with dignity and respect.

“Patients who spoke with inspectors were complimentary of staff, noting that they had been seen by medical and nursing staff, with some awaiting test results. Patients reported ‘staff was very busy, but attentive’ and that they were ‘very happy with the care’ provided to them.

“Inspectors observed that staff engaged with patients in a kind and respectful manner and it was evident from inspectors communication with and observation of staff, that staff were committed and constantly striving to provide the best experience to the patients who attended the ED, in what was a very challenging environment.

“Overall, there was consistency in what patients told inspectors about their experiences of the care they received in the ED and what inspectors observed on the day.”

TippUH had defined lines of responsibility and accountability for the governance and management of unscheduled and emergency care at the hospital, stated the inspector.

According to the report, the hospital had systems and processes in place to identify, evaluate, and manage immediate and potential risks to people attending the ED. In its conclusion, HIQA noted that TippUH had “defined corporate and clinical governance arrangements in place for assuring the delivery of high-quality, safe, and reliable healthcare in the ED.”