Cleveland Clinic London Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff provided safe care and treatment, there were systems and processes in place to keep patients safe. The environment was safe, well maintained and met people’s needs. Leaders adjusted staffing levels when needed to ensure keep the department and people safe. Staff were trained and competent and had the right skills to meet people's needs. Staff maintained high standards of infection prevention and control and demonstrated safe medicines management.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff used systems to process and deliver care and keep patients safe. Staff completed risk assessments and identified risks were managed appropriately. The service had an admission criterion to ensure they only accepted patients into the service they could safely care for, all patients were assessed before admission to ensure the service could meet their individual needs. Staff told us most patients were pre-booked admissions following surgery. They also admitted patient transfers, including patients from overseas, from other providers when a higher level of care was required, that the referring provider could not deliver.

There were daily handovers between nursing staff and safety huddles where patient care was discussed ensuring continuity of care. A traffic light system of green, amber and red was used to identify which patients were ready to be discharged to a ward. Staff told us there was good patient flow across the hospital meaning patients were discharged from critical care in a timely manner. Good communication between teams and healthcare professionals throughout the hospital facilitated assessment and transition between critical care and other wards. Staff told us they could access the patient’s consultants 24 hours a day, seven days a week, and they felt supported in providing safe patient care if the patient’s needs changed.

A critical care outreach team was on call 24 hours a day, seven days a week to review deteriorating patients across the hospital, facilitating timely assessments of deteriorating patients by the critical care staff and transferred into the critical care if necessary.

The service used an electronic system to collect patient observations and calculate the National Early Warning Score (NEWS). This identified patients at risk of deteriorating and staff could escalate the risk. The recognition and management of acutely unwell patients’ policy had a process for staff to follow and referenced national guidance.

Patients attended a pre-assessment appointment before admission for treatment. During this appointment patients were told about the level of care they might need which included critical care and were involved with their care planning from the beginning.

Staff we spoke with described the daily safety huddle where patient safety issues were discussed. There were three levels of the safety huddle, and this was how risks were escalated from the ward to senior leadership. We attended the level three huddle, attended by representatives from all departments and observed staff were encouraged to rise concerns no matter how minor and that staff spoke up during these meetings.

Daily ward rounds were consultant led, and we observed good interaction between staff during these rounds. Nursing staff were encouraged to challenge medical staff when discussing patient care and did so.

The service operated point of care testing which is when tests were carried out at the patient’s bedside if possible. The benefit of this approach is that for some tests immediate information is available to medical staff. We saw glucose point of care testing with the results immediately available for review.

The multidisciplinary meeting we attended, had input from all staff. Staff discussed the thoughts of the patient and their families, and their views were considered in the care plan. Referrals to other teams, such as the pain management nurse, were made and assessments from these teams were reviewed at this meeting.

The service had access to additional support such as dieticians and diabetes service to help manage patients’ nutrition. All patients were assessed using the malnutrition universal screening tool (MUST) which was used to establish any nutritional risk to patients and staff could develop a care plan.

The service used the safer nursing staff model to calculate the number of staff they needed to safely care for patients as a minimum requirement. The safe staffing policy evidenced that nursing staff levels for critical care were based on national guidance to ensure the service had the right number and skill mix of staff to safely care for the patients on the unit. The service had one nurse for each patient on the unit for all levels of care which was higher than required by national guidance. The chief nurse told us nursing staff numbers were reviewed daily and bank staff were used if needed. Bank staff were internal staff who were trained and familiar with the unit. At the time of our assessment the unit was fully staffed with no vacancies. Staff we spoke with told us they thought the staffing levels were right and met the patient’s needs.

The nurse in charge told us all staff received an induction to the unit and there was a preceptorship and support system in place. Staff undertook mandatory training relevant to their role and compliance on the unit was at 90%. Additionally, the provider offered an internal critical care course to upskill their own staff to become critical care nurses. The fellowship programme started in January 2024 with six registered nurses and a second cohort starting in October 2024. The meeting minutes for the monthly ward meeting showed training and education was discussed, and staff were encouraged to attend study days.

There was a lead clinician for critical care with between 8 to 10 consultants from different specialities working under them, such as anaesthetists and intensivists. A resident consultant was onsite seven days a week 24 hours a day. At the time of our assessment there were no medical vacancies. Resident medical officer received critical care training meaning all patients had access to a medic with additional training in critical care. Medical staff we spoke with told us senior staff who were approachable and supportive.

Clinical areas we visited were visibly clean and had suitable furnishings which were clean and well maintained. We saw equipment labelled indicating it was clean and ready to use. Cleaning staff were visible throughout our assessment.

To prevent cross infection all patients were routinely screened prior to admission to the hospital for infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and again once admitted to the critical care unit. Admissions were signed off by the consultant and the infection control lead who reviewed the patient’s infection status.

Clinical waste bins were clearly marked and there were contracts in place to dispose of clinical waste appropriately. Cleaning audits were carried out monthly and showed the unit was always above 96% compliance.

We observed staff adhering to ‘bare below the elbow’ in line with national guidelines and washing their hands between patients. Monthly audits demonstrated the critical care unit did not consistently achieve their target of 100% in hand hygiene. Team meeting minutes showed this was discussed at the meetings and staff were reminded of the importance in daily huddles. A link practitioner for hand hygiene worked on the unit to support staff and a monthly quality review was carried out by the nurse manager to check compliance and meant staff were continually reminded of the importance of hand hygiene.

Staff had access to hospital infection prevention and control policies and followed infection control principles including the use of personal protective equipment (PPE). We observed a patient in isolation and saw staff wearing PPE and washing their hands before and after entering the room. The door had clear signage indicating PPE was required and visitors were directed to speak with nursing staff prior to entering the room.

The service had safe and robust systems for the storing and handling of medicines including controlled drugs. The service had processes for ensuring that administration records accurately showed how medicines were prescribed and administered. Governance requirements were in place for processes such as medicines audits and medicines risk assessments. In one ward, we did however find expired medicines and at least one newly-admitted patient who had not received a medicines reconciliation for more than 24 hours.