Portlaoise hospital is a 'wonderful place' with 'effective' A&E' says new inspection report

Portlaoise hospital is a 'wonderful place' where staff are ’really nice always friendly and so helpful' patients told health services inspectors who found an 'effectively functioning' Emergency Department (ED/A&E) and a hospital that is 'better performing' than most when it comes to length of stay.

The findings are contained in a new Inspection Report from the Health Information and Quality Authority (HIQA) the agency which previously found extensive issues across the hospital.  

HIQA conducted an announced inspection of Midland Regional Hospital Portlaoise (MRHP) on 4 and 5 April 2023. Inspectors visited the three clinical areas including the ED, Dunamaise ward and Slieve Bloom ward, as well as conducting a walk- through of the Acute Medical Assessment Unit (AMAU) and Acute Surgical Assessment Unit (ASAU).

It outlined its findings in summary.

"The hospital was found to be compliant in two national standards, substantially compliant in five national standards and partially compliant in four national standards.

"HIQA found the hospital had formalised corporate and clinical governance arrangements for assuring the quality and safety of healthcare. However, aspects of governance could be strengthened to further improve the effective oversight of the quality and safety of healthcare services provided at the hospital, for example, regular review of identified risks.

"The ED was functioning effectively at the time of inspection, and patient experience times and average length of stays for medical and surgical patients on the days of inspection were amongst the better-performing hospitals.

"While effective workforce arrangements were in place to support and promote the delivery of healthcare, improvements were required to advance existing staff vacancies in the service and improvement of the uptake of training," said an advance statement.

The report said Inspectors spoke with patients about the care they received in the hospital.

"It was evident that a culture of kindness, consideration and respect was actively promoted by all staff within the areas visited.

"Feedback was positive and patients reported that they were treated with kindness and respect and were happy with the level of care they received. When asked to describe their experience, patients commented that staff were ’really nice’ and ‘always friendly’, and ‘so helpful’.

"Patients told inspectors ‘it is the most wonderful place’. When asked if there was anything that could be improved about their experience, one patient’s family member commented that communication between medical specialties could be better so as to reduce waiting time for patients to be seen by other specialties they have been referred to," they said.

There was praise for staff.

Inspectors observed that staff actively engaged with patients in a respectful and kind manner and ensured patients’ needs were promptly responded to. This observation was validated by the patients spoken with. Patients commented that they ‘don’t want to leave. I am being waited on hand and foot’. Patients explained that they did not have to wait long for anything that they requested from staff. Patients spoken with knew who to speak to if they wished to raise an issue and commented that they could speak with staff if they had a concern or complaint.

"Overall, there was consistency in what patients told inspectors about their experiences of the care they received and what inspectors observed in the clinical areas visited," said the report.

The reported also commented on the activity at the ED where patient numbers are on the rise.  MRHP had 32,700 ED attendances to September 2022. ED attendances for the same period to September 2019 were 30,448. This was an increase of 2,252 attendances on 2019. In 2022, monthly ED attendances ranged from 2,850 in January to 3,631 in December.

The report indicated that hospital is coping.

"Overall, on the days of inspection, it was evident that the hospital had defined management arrangements in place to manage and oversee the delivery of care in the ED and AMAU/ASAU. There was evidence that the bed management and patient flow
structures in place were effective to ensure flow of patients from the ED to AMAU/ASAU and clinical areas within the hospital.

"Notwithstanding this, bed capacity in the hospital was a challenge and this was further demonstrated by the use of the AMAU/ASAU to board patients who were awaiting an inpatient bed," said the report.

HIQA was concerned with staffing.

"Staffing levels in the ED were maintained at levels to support the provision of 24/7 emergency care at the time of inspection, however, inspectors were concerned about the sustainability of medical cover in view of medical staffing shortages," it said.

"Where staffing deficits occurred, the hospital relied on agency staff to fill these posts, however, it was noted that the majority of shifts that required filling in the ED were filled by the hospital’s own cohort of ED staff who took on extra shifts. Risk assessments had been completed to reflect challenges related to staffing deficits," it said.

Stroke care was a cause of concern.

"Concern was raised by hospital senior management and some staff whom inspectors met with during the inspection,
regarding the absence of a formal by-pass protocol with the Dublin Midlands Hospital Group (DMHG) for MRHP patients that require timely treatment for stroke. Inspectors received a copy of a risk assessment undertaken in the ED in relation to this," it said.

HIQA said a high-risk letter was issued by HIQA to the DMHG following the inspection regarding the absence of a formal by-pass protocol with the DMHG for MRHP patients that require timely treatment for stroke. The reported added that the CEO of the DMHG outlined the interim arrangements in place for the timely treatment of patients presenting to MRHP with stroke.