Privacy issues at Emergency Dept

A HIQA report into Sligo University Hospital has revealed that only five out of 15 recommended nurses for the Emergency Department in 2022 had been appointed, even though the hospital had admitted that there was a shortfall.

And 31 out of 36 patients surveyed had to wait more than nine hours to be seen in the Emergency Department.

The report also raised concerns about the safety of patients in the ED-concerns it said were highlighted in a previous report.

An unannounced inspection was carried out at the hospital on July 12 and 13 last year.

The three clinical areas assessed were the Emergency Department, Medical South and Surgical North.

Inspectors spoke with a number of patients in the Emergency Department about their experiences and patients stated they had ‘no complaints’ and were ‘seen quickly’.

But patients did speak about the difficulty of maintaining privacy and dignity and overhearing conversations about past medical history.

The report found that of 36 patients surveyed 23 were waiting in the ED for more than six hours, 31 patients were wating for nine hours and three patients were wating for 24 hoursthe longest waite was for 45 hours (awaiting isolation bed).

Compared with HIQA’s findings in September 2022-these times showed a deterioration in waiting times for patients in the Emergency Department.

Inspectors found staff to be kind, caring and respectful to their patients.

In summary the report found that the hospital had been partially compliant in that some improvements in the patient experience times were seen but were not conclusive enough to a represent a true improvement for patients.

Regarding staffing on the day, inspectors were informed that the department had only 10 of 12 nurses rostered for duty and rosters reviewed for the four weeks before inspection showed that 54 per cent of shifts were short nursing staff ranging from a shortfall of one nurse to three nurses from the 12 rostered.

Agency staff were used to supplement the nursing workforce on almost half of the entire shifts.

A report in 2022 recommended an extra 15 nurses be appointed but inspectors had been told that only five of these posts had been approved.

But there was no evidence of an increase in the approved posts in the latest inspection.

Inspectors were told that approval for any recommended posts would need submission through the estimates process in 2024.

Overall inspectors found that management were striving to organise and manage their workforce to support the provision of high quality, safe health care.

However management must prioritise recruitment efforts to address staff vacancies across the hospital to support the provision of high-quality and safe care to their patients.

Shortfalls in the ED Department were having a significant effect on the ability to provide the required staffing complement for day and night shifts.

The EMT had recognised that the nurse staffing level within ED was not sufficient at the time of the last inspection and no improvement was seen.

Meanwhile, the report found the hospital to be non-compliant in relation to the Quality and Safety Dimension of the ED.

Staff working in the ED were committed and dedicated to promoting a person-centred approach to care. Staff were observed to be kind and caring towards patients.

But the report found that there were no shower facilities within the ED. It was also found that eight admitted patients were on trolleys and the narrow emergency corridor was a busy thoroughfare for all ED activity which had an adverse impact on the opportunity to provide dignity and privacy for these patients.

A lack of dignity was validated by patients who spoke with inspectors and was consistent with findings in 2022.

Overall, despite staff efforts to maintain patients’ dignity and respect, the practice of accommodating in-patients and placing patients on trolleys on the ED corridor impacted on any meaningful promotion of the patient’s dignity, privacy and autonomy.

And, there was no significant improvement in this environment where patients were cared for since HIQA’s last inspection in September 2022.

The report found there was a “deterioration in waiting times for patients in the ED for more than nine hours and an improvement in the number of patients waiting in the ED for more than 24 hours.”

Overall, HIQA was not assured that the design and delivery of healthcare services in the ED protected people who use the service from the risk of harm.

The patient experience times breached most of the HSE target and this was no improvement compared to previous inspection findings.

There had been a recent increase in the number of patients who left the ED before completion of their treatment and the hospital reported prolonged ambulance turnaround times.

Complaints relating to the department were not tracked and trended at the hospital. Complaints management training was not provided to staff in the ED.

It was the responsibility of hospital management to make sure that the treatment and accommodation of patients is safe and that medical supplies are stored appropriately.

The hospital should ensure minimal distancing between people receiving care in line with national guidance.

In relation to the wider hospital and clinical areas Medical Ward South and Surgical North the hospital was found to be substantially compliant.

Inspectors observed staff responding to patients needs in a timely manner in both of the clinical area and there was effective communication between staff and patients in both areas.

The interactions were very kind, respectful, reassuring and not hurried. This was confirmed by patients who described staff as “very good and could not do enough for you.” And “very nice altogether.”

Inspectors observed staff responding to patients needs in a timely manner in both of the clinical areas inspected and patients told of how their needs were met quickly.

In summary the report said that information from the process was being used to improve the quality and safety of healthcare services.

There was scope for improvement in the management of complaints and patient feedback. The hospital was also found to be also substantially compliant in relation to Quality and Safety Dimension for the Service users dignity, privacy and autonomy are promoted.

It found that staff interviewed were aware of the challenges when patients were placed in trolleys in corridors.

Screens for patient privacy were provided for patients in the corridors.

Inspectors were informed that patients on trolleys were brought to the treatment room for physical examinations and in cases where the treatment room was in use then the patients were brought to the day room or nursing office if possible.

Overall, the hospital management and staff were aware of the need to respect and promote dignity, privacy and autonomy of those in care.

However, the accommodation of patients on trolleys negatively impacts the ability to promote those aspirations.

The hospital was found to be compliant in promoting a culture of kindness, consideration and respect and patients said the nursing staff were “very busy” and “did not get paid enough” and that “they were not paid enough” and that “they were doing all they can for me.”

HIQA was assured that hospital management and staff promoted a culture of kindness, consideration, and respect for people accessing and receiving care at the hospital.

On the issue of patients complaints, the hospital was found to be partially compliant.

In response, SUH stated in a press release that the report found that the hospital had formalised corporate and clinical government arrangements in place that monitored performance against key performance indicators to improve the quality and safety of the hospital.

“There was clear evidence that the hospital management and staff were aware of the need to respect and promote the dignity, privacy and autonomy of people receiving care of the hospital promoting a culture of kindness, consideration and respect.”