Recruitment remains a top priority for Letterkenny University Hospital (LUH), Manager Mr Sean Murphy stressed.
He was reacting to a Health Information and Quality Authority (HIQA) which stated urgent action is needed to address the current staffing levels there.
The authority carried out two inspections at the hospital in November.
The report stated the hospital was meeting some HSE key performance indicators for the management of patient waiting times in the Emergency Department (ED). However, it added the ED remained overcrowded, particularly on the second day of inspection.
HIQA also found that immediate improvements were needed to address clinical governance and medical staffing levels in the emergency department.
“There was also limited evidence that comprehensive processes were in place to fully manage and respond to certain patient safety incidents as effectively as required, or that sufficient and timely learning was being shared and integrated into practice,” a HIQA report read.
In relation to gynaecology services at LUH, inspectors found there was good evidence from audit, patient satisfaction surveys and from meeting with staff that improvements have been progressed in the service.
While HIQA found examples of a number of positive initiatives designed to enhance patient care, further immediate work was required to address deficits in a number of areas. These included: the comprehensive infection screening programme for patients; to improve learning from patient incidents; to fully implement the clinical handover of patients; and to and fully integrate safe processes to manage emergency department patient attendances at the hospital.
In response, the hospital manager, Sean Murphy, released a statement this afternoon welcoming the report.
“We welcome this report and recognise the important and valuable role of HIQA in promoting safety and quality in the healthcare services,” he said.
“ Urgent action has been taken to address the issues identified by HIQA and significant progress has been made by all staff to ensure that we provide our services safely.
“I would like to acknowledge the on-going commitment and dedication of our staff in providing a patient centred approach and we will work together to build on the good practice highlighted in this report.”
Significant work, Mr Murphy added, has been carried out on all areas where the hospital was found to be non-compliant or partially compliant. In a number of areas this work had commenced prior to the HIQA Inspection.
In the area of Overall Governance, the revision of the Clinical Handover Policy has been completed.
As part of the implementation of the National Healthcare communication programme, facilitator training is underway with five members of staff identified to undertake the training.
A programme of work to strengthen governance within LUH has been identified.
“The LUH Hospital Executive Board (HEB) and the QPS service, working with the Change Implementation Manager and Saolta Executive will agree and implement changes to the governance structure at LUH to include updated terms of reference; membership; and reporting relationships.”
The HIQA concerns regarding the governance of the Respiratory Receiving Unit (RRU) were in the process of being addressed at the time of inspection.
“Changes were implemented in December 2022 and full management of the service was transferred to the emergency medicine service in January.”
In regards to access to diagnostics, a second CT scanner is now operational at the site with protected slots for AMAU each day. The MRI scanner at the hospital is scheduled for replacement later this year and the new scanner will increase both functionality and speed within the service.
In relation to the risk register internal audit, risk register meetings have increased from quarterly to monthly to ensure the timely implementation of all recommendations. five out of the seven recommendations are fully implemented with the remaining two almost fully implemented.
Recruitment remains a top priority for LUH, Mr Murphy stressed.
“Since November 2022 the hospital has recruited 140 new staff across all grades,” he explained.
“A new electronic employment control tracker has been implemented in April to streamline the recruitment process between LUH and Saolta. LUH HR Department has carried out significant recruitment over the last number of years for the Pharmacy Department at LUH, with an increase of 12 WTE (pharmacists and technicians) approved for LUH in the last two years, however like many hospitals, LUH faces significant challenges in recruiting senior pharmacists required to undertake clinical pharmacy roles.”
LUH has also received funding to employ four additional Consultant in Emergency Medicine. “This will allow the hospital to improve the availability of Senior Clinical Decision makers within the Emergency Department and extend their onsite presence.”
LUH is seeking to fill posts on a locum basis, pending permanent filling of same. A Consultant has been employed to cover AMAU which has direct responsibility for staff in AMAU under Medical Department governance.
“The Pathfinder project commenced in LUH in April 2023 to support admission avoidance by providing assessment and treatment at home. An ambulance liaison person is also now based in the ED to support nursing staff in caring for patients in ambulances. The hospital has also recently appointed a GP Liaison Senior nurse to be the link between GPs throughout Donegal and the LUH Emergency Department.”
A Pathway stream has also been developed to fast track patients presenting with minor injuries through the Emergency Department.
LUH are working with HSE Estates colleagues to provide a modular building to relocate non clinical functions in the Emergency Department and convert the non-clinical accommodation into additional patient treatment areas for patients with potential transmissible diseases.