67-hour wait on trolley for one patient in Mercy University Hospital

A PATIENT admitted to Cork’s Mercy University Hospital (MUH) this year waited 67 hours in the emergency department for a bed, a Health Information and Quality Authority (Hiqa) report has found.

An inspection was carried out to assess compliance with four national standards from the National Standards for Safer Better Healthcare as part of Hiqa’s role to set and monitor standards in the quality and safety of healthcare.

The report found the hospital to be non-compliant with two of these national standards: 1.6 — that service users’ dignity, privacy and autonomy are respected and promoted; and 3.1 — that service providers protect service users from the risk of harm associated with the design and delivery of healthcare services, in the unannounced inspection on March 9, 2023.

On the day of inspection, the emergency department was full, relative to its intended capacity and function, with 39 patients registered. Some 28 (71%) of them had been admitted but were on trolleys while waiting for beds.

Some 29 (74.3%) of the 39 patients had been waiting in the emergency department for more than six hours which did not meet the HSE target of 70% to be admitted within six hours.

The report also found that 10 of the patients (25.6%) had been in the emergency department for more than 24 hours, which did not meet the HSE target of 97% to be admitted to a hospital bed or discharged within 24 hours of registration.

Eight (61.5%) of the 13 patients aged 75 years or more had been in the emergency department for more than six hours, which did not meet the HSE target of 95% to be admitted to a hospital bed or discharged within six hours of registration, and 10 (76.9%) of the 13 patients aged 75 years or more had been there for more than nine hours, which did not meet the HSE target of 99% to be admitted to a hospital bed or discharged within nine hours of registration.

Three (23%) of the 13 patients aged 75 years or more had been there for more than 24 hours, which did not meet the HSE target of 99% to be admitted to a hospital bed or discharged within 24 hours of registration.

Patient experience

Inspectors spoke with a number of people using the emergency department services to hear about their experiences.

Patients who spoke with inspectors were waiting between 18-49 hours in the department from the time of registration at the hospital.

All patients spoken with said that they had received food and drinks and that the unit was found to be generally clean.

Inspectors observed a lack of patient flow which resulted in the placement of seven patients on trolleys in narrow corridors.

Designated staff were allocated to the care of patients in such circumstances, but inspectors noted that it was clear that the privacy, dignity, and confidentiality of patients accommodated on extra chairs and trolleys in the corridor was compromised.

Inspectors noted that while there was privacy and dignity in the emergency department for patients accommodated in individual cubicles, the lack of patient flow resulted in some admitted patients being cared for while on trolleys in the corridor.

The lack of patient flow also resulted in most patients having to remain in the emergency department for prolonged periods, which limited their access to toilets and showers and to visits from family or others, inspectors noted.

Inspectors noted that this situation also posed challenges to staff striving to provide dignity, privacy, and autonomy, as well as trying to provide emergency care in a suboptimal environment.

Despite these conditions, inspectors observed staff actively engaging with patients in a respectful and kind way and taking the time to talk, listen to, and support with mobility and personal care appropriate to their needs.

MUH statement

A statement issued to The Echo read: “MUH is dedicated to protecting the safety and welfare of its patients, and thus has closely analysed Hiqa’s report findings.

“Immediately following the inspection, urgent actions were implemented to address key issues identified by Hiqa.

“A comprehensive compliance plan has been submitted to Hiqa with short-term (three months), medium-term (six months), and longer-term (within three years) actions to address the findings from the inspection.

“Many of the short-term and medium-term actions to improve patient care have now already been completed.

“Work is ongoing to fully implement the hospital’s Compliance Plan so that the hospital is wholly aligned to the National Standards for Safer Better Healthcare.

“The hospital wishes to acknowledge the steadfast and ongoing commitment of its staff for their dedication in continuing to provide a patient-centred approach to the care delivered.”