'Unclear' who was in charge at UHL site - HSE review

An HSE team that carried out a review of operations at University Hospital Limerick over a four-week period earlier this year found that it was "unclear from an operational perspective as to who [was] in charge on the UHL site on any given day".

The review, published today, found that overcrowding at the hospital was such that the ability of its Emergency Department and Assessment Units to function was "non-existent".

The review states that it was "not clear as to what 'Handover Plan' is shared at the day and night interfaces, and it was "also unclear as to the specific actions identified ... to address patient flow".

The review noted as "a particular concern" significant vacancies at Clinical Nurse Manager Grade II level.

While praising staff for their "ongoing commitment to patient care despite their levels of fatigue" the review states that "it appeared to [reviewers] that there was a level of acceptance in relation to the 'intractable' nature of the overcrowding problem in UHL," and a corresponding belief that the overcrowding would only be resolved by capacity enhancement.

Reviewers were tasked with examining the day-to-day functioning of the UHL site and also that of other hospitals and community healthcare facilities with whom UHL has a relationship.

Among its findings it notes that some inpatients remained in-house for extended periods awaiting particular types of diagnostics that could have been availed of as outpatients.

It states that reviewers were advised that staffing shortages and gaps in clinical governance in community facilities beyond UHL meant those units were sometimes unable to accept patients from UHL in a safe and timely manner.

"The team were advised of patients that had waited in an acute bed in excess of ten days before transfer to the community setting," the review states.

"The Support Team strongly recommend that the issues of safer staffing and clinical governance in these units be addressed as a matter of urgency to support improved flow and throughput," it stated.

As well as setting out findings, the document also recommends a number of other actions that should be taken.

The recommendations include:

- That a triumvirate team comprised of Hospital CEO, Hospital Director of Nursing and Hospital Clinical Director be on the ground in the hospital "to lead and support the various teams in what is a large and very complex organisation".

- That a full review of Medical and Surgical resources be carried out "to ensure that capacity and capability is enabled and optimised right across the MidWest and that appropriate governance and structures are in place to oversee and support same".

- That a full review of the nursing workforce be carried out "to ensure that patient care and patient flow are optimised". It said recruitment and retention of front line nursing staff "needs to be a priority".