A report on health and safety issues in 11 of the Republic's hospital accident and emergency departments has focused on overcrowding as a key problem requiring remedial action. It asks the Health Service Executive (HSE) to assess whether additional capacity can be made available "within existing units".
Following a series of countrywide inspections by a team of inspectors from the Health and Safety Authority (HSA) during March and April, the authority yesterday published a report on their findings.
Among the issues which it said required immediate attention were: inadequate risk assessments; poor safety training; and the inadequate protection of healthcare workers from the risk of violence.
The HSA said it was especially concerned about "the prevalence of overcrowding in a majority of the hospitals and the associated increased risk of violence and aggression".
"Overcrowding in accident and emergency units may increase the risk of injuries due to slips, trips and falls, manual handling, aggression/violence from frustrated patients, and may also lead to an increased risk of infection. It also has the potential to compromise fire evacuation procedures and may increase the risk of stress for staff," the report said.
In a section detailing its "guidance" in relation to overcrowding in accident and emergency units, the HSA advised that managers of A&E units concentrate on the avoidance of risks and the combating of risk at source.
"It is imperative that every effort be made by the Health Service Executive (HSE) to address the overcrowding issue."
The HSA report also asked that consideration be given to the addition of extra capacity within existing A&E units.
"In doing so, it should have regard to international best practice in areas such as improving workflow issues and increasing the use of more community-based interventions to reduce the out of hours pressure on A&E units."
While the inspectors' report said that staff had linked clinical problems associated with overcrowding to an increased risk of stress, it noted "it was difficult in the context of the inspection programme to quantify this problem as record management in this area was not adequate". The inspectors also noted that while overcrowding had the potential to increase the risk to health and safety, "it can only be alleviated where health and safety issues are tackled within an overall strategy for the general management of the healthcare sector".
The report found that overcrowding is contributing to the incidence of slips, trips and falls in the workplace.
"Inspectors encountered a number of situations where patients on trolleys were obstructing movement around the accident and emergency department."
Fire safety issues were also highlighted. Inspectors found that trolleys, chairs, catering trolleys and medical equipment were stored in corridors and fire-exit doors were obstructed.
An analysis of safety issues surrounding chemical and biological agents resulted in individual hospitals being advised of staff non-compliance with clinical waste policy.
Hospitals inspected:
Naas General Hospital; Beaumont hospital, Dublin; Mater hospital, Dublin; St Joseph's Hospital, Clonmel; Our Lady of Lourdes, Drogheda; Wexford general; Mercy Hospital Cork; Limerick regional; James Connolly Hospital, Blanchardstown; Sligo regional and University College Hospital, Galway.