Aged infrastructure issue at the Mercy hospital

Patient care was affected by both “aged physical infrastructure” and staffing shortages, according to a report into The Mercy University Hospital (MUH), in Cork city, by the Health Information and Quality Authority (Hiqa).

Hiqa’s announced inspection of MUH found the hospital to be compliant with three national standards, substantially compliant with five, and partially compliant with three.

On the day of inspection, the hospital’s emergency department (ED) was busy and inspectors found that management should work to improve its patient-experience times (PETs).

While there was improvement on most HSE PET targets, compared to the hospital’s previous inspection, the average time from triage to medical assessment had increased and the average length of stay for patients remained higher than targets.

Staff were observed to be “kind, caring, and respectful,” and patients were very complimentary about the staff and the service or care.

But there were still not enough staff in several areas, the inspector wrote, explaining: 

“While nursing and healthcare staffing levels have improved, there was no further improvement with compliance with this standard since the last inspection.”

Almost a quarter (24%) of pharmacist positions were unfilled, which “impacted on the ability to provide a comprehensive clinical pharmacy service across the hospital”, and there were also shortfalls in consultant microbiologists and the infection prevention-and-control team.

Arrangements were not in place to ensure comprehensive consultant cover in the ED 24/7, and staff attendance at mandatory and essential training had not improved since the last inspection.

Further areas for improvement identified by Hiqa included ensuring that the physical environment of all areas fully supported the delivery of high-quality, safe, reliable care.

Inspectors noted infrastructural issues, with some floors “in need of significant repair” and narrow corridors, with the inspector identifying risks associated with the layout of the aged physical infrastructure, “which impacted patient movement”.

The hospital had systems in place to monitor, evaluate, and improve its services, but quality improvement initiatives were not always implemented when standards fell below acceptable levels.

While a dedicated group completed outbreak reports, “there was no record of lessons learned in the reports to mitigate the risk of another outbreak”. The hospital also had no safety group in place to monitor the water systems, and this was an issue, “particularly in light of the legionella outlet risk and the age of the hospital infrastructure”, the report said.

A spokesperson for the hospital told The Echo: “The Mercy University Hospital welcomes the publication of the Hiqa inspection report, following an unannounced inspection conducted on April 18-19, 2024.

“The report identified no areas of non-compliance, with eight of the standards assessed rated as compliant or substantially compliant,” they noted.

“Under the standards related to person-centred care and support in the report, it was particularly noted by inspectors that staff were respectful, kind, and caring towards patients when providing all aspects of care, and all grades of staff observed promoted the dignity, privacy, and autonomy of people receiving care at the hospital.”

Margaret McKiernan, Mercy University Hospital CEO, said: “We welcome this positive Hiqa report and see it as an affirmation of our ongoing efforts to provide exceptional care.

“The inspectors’ feedback is invaluable, as we continue to strive for excellence and enhance the experience for every patient who walks through our doors.”

A compliance plan has been submitted to Hiqa, outlining actions to achieve full compliance with all standards, the spokesperson said.

The plan includes the hiring of more staff, with ED consultants, microbiologists, and pharmacists to be in place by April, 2025; setting up a water-safety group; work on PET targets, as well as maintenance and refurbishment works on some areas of the hospital, while an extension is being developed to improve compliance.