DELAYS in access to diagnostic tests has been raised as a risk impacting the gynaecology service at Letterkenny University Hospital, an inspection has found.
A two-day inspection by Health Information and Quality Authority (HIQA) has disclosed a lack of capacity at Saolta group level was a factor in continuing to transfer women for gynae-oncology and urogynaecology cases to Dublin.
The hospital and Saolta University Healthcare Group must address these outstanding issues so that services are safe and sustained, the report states.
The announced inspection was carried out in the Emergency Department, Medical 2 Ward and the Gynaecology Ward in November 2022.
Report findings released this week revealed clinical governance and medical staffing levels at LUH’s emergency department need attention.
Inspectors met with external Clinical Director for gynaecology services who had been appointed on a six-month contract from September 2022 following HIQA’s targeted assurance review of gynaecology services in 2021.
An external Clinical Director was on-site three days per week at the hospital and had oversight of the processes and outcomes of the gynaecology services and was providing support to staff.
Inspectors were told that while there were four approved and funded posts for consultant obstetricians and gynaecologists, at the time of inspection, only one was filled on a permanent basis and three posts were filled on a locum basis.
The report states: “Delays in access to diagnostic tests was raised as a risk impacting the gynaecology service. The lack of capacity at Saolta group level was said to be a factor in continuing to transfer women for gynae-oncology and urogynaecology cases to Dublin. The hospital and Saolta hospital group need to address these outstanding issues so that services are safe and sustained.”
Inspectors reviewed the ambulatory gynaecology key performance indicators for the management of post-menopausal bleeding as measured by the percentage of women who were seen within 28 days of referral.
This averaged at 93.9 per cent over the period March to October 2022, with a range of 87.7 per cent in March to 98.1 per cent in August 2022. The target is 100 per cent.
The data for women receiving a diagnosis and test results within 28 days of being seen in the clinic averaged 95.4 per cent over the period March to October 2022 with a range of 87.5 per cent in May 2022 to 100 per cent (on three of the eight months).
The target is 90 per cent within 56 days. The percentage of women who were seen and received histological confirmation within 12 weeks of referral averaged 99.2 per cent over the period March to October.
It was 100 per cent in seven of the eight months and 93.8 per cent in May 2022 (target 100 per cent), according to the report’s findings.
There was good evidence from patient satisfaction surveys that improvements have been progressed in the service. A patient satisfaction survey of all women attending the ambulatory gynaecology and postmenopausal clinic had been conducted between November and December 2021.
There was a 62.6 per cent response rate and high levels of overall satisfaction were expressed by women using the service, with one score of 80 per cent and all others expressing between 90 to 100 per cent satisfaction.
HIQA were satisfied that this service has seen significant improvements however, this will need to be monitored carefully to ensure that the improvements are sustained over the medium and long term and beyond the period of the appointment of external supports.
In the course of the inspections, the ED was found to be overcrowded. While report findings noted the hospital was meeting some HSE key performance indicators for the management of patient waiting times in the ED, it remained overcrowded.
The focus of the inspection was to monitor the National Standards for Safer Better Healthcare. HIQA examined 13 National Standards in relation to leadership, governance and management and workforce. Of these, LUH was substantially compliant with three National Standards, partially compliant with six National Standards and non-compliant with four National Standards.
General Manager of LUH, Sean Murphy said urgent action has been taken to address the issues identified by HIQA. He admitted that while significant progress has been made by all staff to ensure the provision of services safely, challenges remain.
Mr Murphy said recruitment remains a “top priority”.
He said that since November 2022, the hospital has recruited 140 new staff across all grades.
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.”
He said significant work 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.
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.
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