HIQA inspection finds overcrowding and staff shortages at Louth hospital

An unannounced inspection by the Health Information and Quality Authority (HIQA) at Our Lady of Lourdes Hospital in Louth has revealed overcrowding and staffing issues in the Emergency Department (ED).

The inspectorate, which assessed the hospital against four national standards, found the hospital to be ‘substantially compliant’ in one area and ‘partially compliant’ in the remaining three.

Although the hospital has clear lines of responsibility for managing unplanned and emergency care, overcrowding remains a major problem. At the time of the inspection, there were 87 patients registered in the emergency department, well above the planned capacity. This resulted in longer wait times and patients spending more time in the emergency room than recommended.

On one of the inspection days at 11 a.m. it was noted that:

• 47% (41) of patients who attended the emergency department were in the department for more than six hours after registration.
• 42% (37) of patients who attended the emergency department were in the department for more than nine hours after registration.
• 1.2% (1) of the patients present in the emergency department were in the department for more than 24 hours after registration.
• Of the patients aged 75 or older, 60% (6 out of 10) were in the department for more than nine hours after registration.
• Of the patients aged 75 years and older in the department, 10% (1 in 10) were in the department for more than 24 hours.

The report noted that: “The hospital’s emergency department had performed poorly compared to other Model 3 hospitals in terms of 24-hour breaches for all attendees and nine-hour breaches for people aged 75 and over according to the year to date data.

“The average length of time a patient spent in the hospital emergency department so far in 2024 was 9.5 hours. This was the second highest of all Model 3 hospitals.”

Although triage times met national HSE emergency medicine program targets, the hospital struggled to meet targets for discharging or admitting patients within six to nine hours.

This was attributed to a shortage of available beds, which kept admitted patients in the emergency department, as well as in the acute medical and surgical assessment units, hindering the proper functioning of these areas.

The inspection found that hospital management is actively managing staff levels and maintaining a high standard of care, but that unfilled emergency medical roles presented additional challenges. Staff were committed to respecting patient dignity and privacy, but the presence of 19 inpatients in the emergency department further complicated efforts to maintain these standards.

HIQA called on the hospital to prioritize improvements, as set out in the compliance plan, to address the identified shortcomings and ensure better conditions for both patients and staff.

In a statement released upon the publication of the report, HIQA said:

“HIQA carried out an unannounced inspection of the emergency department at Our Lady of Lourdes Hospital and found that the hospital was largely compliant with one standard and partially compliant with three of the four national standards audited.

“The hospital had arrangements in place with defined lines of responsibility and accountability for the governance and management of unplanned and emergency care at the hospital.

“However, the hospital emergency department was overcrowded relative to planned capacity, with 87 registered patients in the emergency department, resulting in increased patient experience time. The time taken to triage patients was in line with the targets recommended by the HSE’s emergency medicine program.

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“On the first day of the inspection, patient waiting times and average lengths of stay for medical and surgical patients were in line with national targets, and there were no patients waiting to transfer care from hospital on the day of inspection.

“The hospital’s performance was not in line with PETs for the percentage of emergency department attendees who required discharge or admission within six and nine hours. There was a mismatch between bed demand and hospital capacity, with admitted patients continuing to be accommodated in the Emergency Department, Acute Medical Assessment Unit and Acute Surgical Assessment Unit, impacting on the effective running of these units.

“Hospital management was planning, organizing and managing their emergency nursing and medical staff to support the delivery of high-quality, safe healthcare. However, at the time of inspection, there were unfilled medical posts in the emergency department.

“Hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care in the emergency department. However, the accommodation of 19 inpatients in the emergency department on the day of inspection had implications for meaningfully promoting patient dignity, privacy, and autonomy.

“The work to progress, as set out in the compliance plan submitted to HIQA, must continue to address the shortfalls identified.”