by Louise Doyle
THE State’s health watchdog has said it is ‘satisfied’ gynaecology services at Letterkenny University Hospital have significantly improved, but added further monitoring will continue.
The findings are contained in the Health Information and Quality Improvement (HIQA) overview report of monitoring and regulation of healthcare services between 2021 and 2023, published on Friday.
It highlights HIQA’s inspection and monitoring activity during a time where the health service was responding to the challenges posed by the Covid-19 pandemic.
The report also provides an update on the gynaecology services at LUH, which was been subject to a governance review during 2021 following concerns about governance, quality and safety of gynaecology services at the hospital dating back to 2018.
These concerns were forged on the basis of information HIQA had received through its monitoring activities, and also in the context of a number of external reviews commissioned within the HSE to address areas of these concerns following incidents of delayed diagnosis of endometrial cancer.
Between 2018 and 2021, HIQA engaged with senior management at the hospital, Saolta Group, and nationally in the HSE seeking assurances about the effectiveness of the governance structures and quality and safety of gynaecology services at the hospital.
HIQA found that the changes and initiatives introduced at the hospital and Saolta Group levels to improve efficiency, quality and safety of gynaecology services at LUH had only resulted in some improvements for women referred to the hospital with post-menopausal bleeding at the time of this review in 2021.
At the time of HIQA’s review, the implementation of the revised governance, Health Information and Quality Authority structures and accountability arrangements at the hospital and Saolta Group levels had commenced and were in the early stages of implementation.
HIQA’s findings highlighted the shortfalls in the approach to the governance and oversight of gynaecology services at hospital and hospital group levels.
It also raised questions about the overall effectiveness and sustainability of the changes and initiatives introduced.
In response to HIQA’s work in this area, the Saolta Hospital Group committed to implementing corrective actions to address the weaknesses in the governance and quality assurance mechanisms identified by HIQA.
This was achieved, in part, by improving a suite of measures for new referrals to the general gynaecology clinic, reviewing all cases where appointment timelines set by the hospital and national HSE were not met.
A sample of healthcare records of all women who attend the gynaecology services were also audited to ensure compliance with timelines and key performance indicators set by the hospital and national HSE.
HIQA further engaged with the hospital and Saolta Hospital group in early 2022 to determine progress achieved in implementation of required improvement measures.
A follow-up inspection of LUH was carried out in November 2022.
HIQA for Safer Better Healthcare’s inspection team met with the external clinical director supporting the improvements in the gynaecology service and visited the Gynaecology ward.
More recently, this year, further assurances and metrics were received periodically on the service since that inspection, in addition to the final report of the outgoing external clinical director and action plan based on his recommendations to validate this assessment.
Findings conclude: “HIQA has been since satisfied that this service has seen significant improvements relative to findings identified in 2021.
“Notwithstanding this identified improvement trajectory, ongoing monitoring of this service will be required to ensure that the improvements are sustained.”
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