Portlaoise not
resourced or structured to provide
emergency care

The Hiqa investigation team has claimed that Portlaoise Hospital is not adequately resourced or structured to provide care for any emergency which presents at the hospital.

The Hiqa investigation team has claimed that Portlaoise Hospital is not adequately resourced or structured to provide care for any emergency which presents at the hospital.

The Hiqa report into safety and quality of standards at the hospital says that although Portlaoise is regarded as a model three hospital, it was not resourced as such and was trying to deliver clinical services with the appropraite funding and staffing.

According to the 208 page report which was launced last week at Hiqa’s headquarters in Dublin, the Intensive Care unit infrastructure is unfit for purpose, while low volumes of critical care activity in the hospital is likely to result in difficulties in maintaining ongoing clinical expertise and competent staff.

There are insufficient acute and elective surgical presentations to ensure surgeons maintain the necessary competencies and expertise.

Surgeons who do not have the opportunity to treat sufficient numbers of patients and carry out a sufficient number of procedures run the risk of becoming de-skilled.

This potential risk has not been addressed by the hospital, according to the report.

However, at the time of the investigation last year, the HSE were in the process of appointing two colorectal surgeons.

According to the report, such appointments did not reflect the surgical demand, GP patient referral patterns or any clear direction for the hospital and are contrary to previous findings that the service was not set up to provide safe pre-planned surgery.

Hiqa also found that the radiology service was under pressure to efficiently respond to the demand from unscheduled, scheduled, outpatient and community care services.

It was reported to the Authority that some patients were waiting long periods for imaging tests, particularly ultrasounds.

At the time of the investigation, one of the radiologists was on long-term leave. The availablilty of a locum consultant radiology cover was described as “limited and inconsistent.”

During an interview with Hiqa, a senior clinician suggested that the hospital required four full time consultant radiologists. However, despite a recruitment campaign, no successful appointments had been made.

According to the Investigation Team, the ICU was also not fit for purpose, the floor space was limited, compromising patient privacy, comfort and dignity.

A HSE performance review in 2014 recommended that critical care services in the hospital should be discontinued.

The same HSE report, acknowledged that on-site anaesthesia cover would be required for obstetric patients and that emergency care resources would have to be reconfigured to divert patients requiring admission to an ICU in another hospital.

In light of this review and the concerns of senior clinicians, the Investigation Team said they were “not assured that critical care services are sustainable in Portlaoise.

Two seperate HSE reviews of the surgical services at Portlaoise Hospital both concluded that Portlaoise Hospital on its own was not structured for the provision of “safe, acute and elective surgical care.”

The investigation team found that medical services at Portlaoise Hospital required “significant restructuring and resourcing in order to deliver a service aligned to the HSE’s acute medicine programme.”

The investigation also found the medical team was under resourced, with local clinicians reporting that two additional medical consultants were needed for care of the elderly and endocrinology, based on the current patient population.

Medical consultants were also responsible for the management of all adult emergecny attendances in the Emergency Department in addition to hospital medical inpatients.

The Hospital also does not have arrangements in place for the routine audit of the effectiveness of national ambulance bypass protocols to ensure patients are taken to the most appropriate care setting.

There was also concerns about the way paediatric emergencies were dealt with, being redirected from the main Emergency Department to the paediatric ward, without being formally triaged to assess the serverity of their condition.