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Tallaght - unsafe ED caused patient death
[Posted: Thu 17/05/2012 by Niall Hunter, Editor www.irishhealth.com]
Shocking deficiencies in the way Tallaght Hospital has been providing emergency care and in the way the hospital looked after its patients and its finances are expressed in a long-awaited HIQA report .
The comprehensive review initiated following the death of a patient in an ED corridor at the hospital in March 2011, also highlights major ED safety issues in other hospitals nationally and in the way they are managed and governed.
The review reveals that a patient death in the corridor adjacent to Tallaght's ED in March of last year was attributed by a hospital report to sub-optimal conditions there for safe patient care.
The Dublin County Coroner last year raised concerns about the conditions at the hospital at the inquest into this death. A further unexpected death in the corridor took place in July.
The review reveals that hundreds of adverse incidents have been reported in Tallaght's ED and the corridor adjacent to it where ED patients were accommodated. The ED facilities were, the report found, poor, offering little in the way of privacy or dignity for patients. Clinical procedures were carried out in a corridor.
The review recommends sweeping changes in how both Tallaght and other hospitals should be run in future.
Overall, the 222-page report must raise serious questions about whether not only Tallaght, but other hospitals around the country, are being run in the best interests of patients and the taxpayer.
Based in part on an inspection it carried out last August, the review highlights safety concerns on overcrowding at Tallaght and how they were handled, and points to the dangers of putting ED patient on corridors, a practice which it says should cease nationally and has since ceased at Tallaght.
It also raises issues about how the hospital was managed and governed, and draws particular attention to how a €1.8 million contract was awarded to outside consultants (who were ironically, providing advice on hospital governance changes) without going through proper tendering, prior board approval or agreed costs at the outset.
This consultancy bill had been run up in 2010 at a time when Tallaght was facing a deficit on its budget for the year of €5.8 million. The firm, for legal reasons, was not identified by HIQA.
The review also found that there was a similar lack of accountability in the payment of hundreds of thousands of euro in 'top-up' pay to senior staff members, including payment of €150,000 to one person.
While HIQA accepted that in recent months Tallaght had initiated significant improvements in its emergency department and in its management and governance, it still had a long way to go.
The review states that its findings reflect a history of longstanding challenges in leadership, governance, performance, and management at board and executive level of the hospital, and a failure of the State to hold the hospital, which was in receipt of significant amounts of State funds, effectively to account for the quality and safety of services it provided.
The HIQA report follows the 2010 Hayes report's recommendations for major reforms in patient care, management and governance at Tallaght in the wake of the unreported x-ray scandal.
In the report, HIQA points out that there was a "persistent, and generally accepted tolerance of patients lying on trolleys in corridors for long periods of time with a lack of clarity as to who was accountable for patients. This puts patients at risk, is not acceptable and should not be tolerated in any hospital in Ireland."
Nationally, the review unearthed significant concerns on waiting times for patients in some hospital EDs and on the quality of the data and the amount of absent information about ED attendances, without which the performance of emergency departments could not be managed effectively.
As part of its probe, HIQA reviewed data supplied to it by the HSE on ED trolley waits nationally. However, no hospitals were able to fully supply the data requested, and nine hospitals were unable to complete any part of HIQA's data request through the HSE, as data was unavailable electronically.
HIQA Chief Executive Dr Tracey Cooper accepted that currently, Tallaght Hospital "is in a different place" compared to when its review started last summer, with many improvements made. However, "it still has a long way to go."
Asked about the progress made by Minister Reilly's Special Delivery Unit (SDU) in reducing ED waiting times in some hospitals since HIQA reviewed them last August, and on the accuracy of current ED waiting stats from the HSE, Dr Cooper expressed concern about the quality of and lack of data on ED performance.
"If you are not collecting the information, how are you managing your service?"
The HIQA report, referring to the SDU's current initiative to cut trolley waits, warns that this should ensure that the problems of patients waiting in EDs are not simply transferred to other parts of hospitals or that as a result, planned operations are not continuously cancelled.
Health Minister James Reilly has announced that his Department is referring the report to the Medical Council and Bord Altranais.
He said planned to call in the all hospitals to examine how they intended to implement HIQA's recommendations.
Among the findings on Tallaght's ED were:
* In the period January to August 2011, some patients were waiting within the ED for up to 61 hours before discharge. Waiting periods for admission of up to 140 hours for patients in the corridor adjacent to the ED were recorded. HIQA highlighted the risks of putting patients on corridors and this policy ceased on August 29 last.
* 83% of admitted patients had been allocated to the corridor with an average waiting time for admission from the corridor of 11-18 hours.
* Of the total number of patients who attended Tallaght's ED for the first six months of 2011, 14% left without completing their care.
*A review of documentation identified that in 2010, a total of 331 patient clinical incidents were reported in Tallaght's ED and the corridor beside it, with two unexpected patient deaths occurring in 2011. Nearly half of the incidents reported related to treatment issues. Contributing factors to one of the deaths centred on the sub-optimal environment of the corridor for patient treatment and the lack of an early warning system to identify deteriorating patients.
* It was unclear who was accountable for patients in Tallaght's ED.