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

The service managed patient safety incidents well as part of an integrated safety and governance structure. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Staff had the required levels of training to safeguard vulnerable people and knew what actions to take to keep people safe from avoidable harm and abuse. There were extensive, multidisciplinary systems and pathways to maintain safe standards of care. Embedded throughout the service, staff had a demonstrable and exhaustive focus on patient safety. There was continuity of care when people moved between different services through a highly collaborative approach to care that included other specialist organisations. The design, maintenance and use of facilities, premises, and equipment kept people safe. The service had enough staff with the right skills, training and experience who received effective support, supervision, and development opportunities. The service controlled infection risk well and staff used control measures to protect patients, themselves and others from infection. The imaging service used systems and processes to safely prescribe, administer, record and store medicines according to national evidence-based practice.

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.

The learning culture was embedded across all departments and staff teams and was supported by clear and consistent support from the patient safety and experience team. The team prepared learning discussions for any incidents that resulted in moderate harm or above and shared these across every team. This approach promoted shared learning and empowerment in safety and meant staff could identify learning for their own practice even if the incident occurred in a different department. They used this approach to avoid risk and near misses in their own department. Staff discussed errors and omissions in a culture that valued honesty and openness to drive improvement. They responded quickly to embed learning and recommendations from incidents.

Recent incidents involved radiologists protocoling patients outside of their scope of practice and an X-ray foot pedal radiation exposure, which took place outside of the main imaging department. The patient safety and quality lead for diagnostics ensured learning was shared with all relevant teams. No patients or staff came to harm as a result of the incidents and staff discussed outcomes through monthly quality monitoring meetings and regular departmental and team meetings. The hospital’s executive team had oversight of all incidents and near miss reports through a tiered system of governance.

In the previous 6 months, staff reported 60 incidents in imaging, across all sites. Of these, 62% resulted in no harm to patients and 38% resulted in low levels of harm.

Subject matter experts established safe systems of working. These were evidence-based and embedded across all aspects of the service.

The provider had implemented the patient safety incident response framework (PSIRF) tool. The tool is part of an NHS England patient safety process, which the patient safety team and clinical educators had adapted. Patient safety leads established an investigation team for each incident, including a patient experience lead, and worked with the responsible clinician to follow Duty of Candour guidance.

Staff used a critical, urgent, and unexpected findings policy to treat patients whose scans showed immediate or unexpected need.

Staff facilitated good standards of radiation safety using national diagnostic reference levels (DRLs) to optimise radiation doses. This provided assurance that patients received minimal exposure, including when using mobile X-ray machines.

The imaging team established safe working protocols to manage the response to an emergency following British Institute of Radiology guidance. Staff undertook simulated emergency scenarios, such as in-scanner cardiac arrests, to test knowledge and understanding.

Staff followed national guidance for pre-scan pregnancy checks that could be potentially harmful to unborn babies.

Radiologists vetted and protocolled MRI referrals within the electronic records system that ensured only qualified professionals made referrals.

Electronic patient record systems were integrated with imaging and point of care testing equipment, providing access to clinical records and facilitating auditing of safety tools including radiation dosage.

Staff used the World Health Organisation radiological safety checklist during invasive treatment to meet national and local safety standards, which reflected high standards of practice.

Radiographers used a consistent process when scanning that meant the same member of staff screened, positioned, and scanned the patient, reducing the risk of errors.

All staff completed safeguarding training to level 3, including for children and young people. While staff did not treat children in this clinic, they completed training in recognition that young people may be present when accompanying an adult patient. Staff knew how to contact safeguarding leads and could give examples of scenarios in which they would do so, including during out of hours care.

The service had established risk management systems in place. Multidisciplinary by design, the clinically led systems were based on information sharing across the provider so that staff could learn from risks, near misses, and incidents in other departments. The imaging team met daily before the start of service to discuss the scans booked for the day, any capacity or staffing issues, and any pressures on the service. The imaging team from the provider’s 2 London sites joined the meeting, which helped to solve problems collaboratively. On one day of our inspection the MRI scanner at one site had failed and staff used the meeting to organise services to minimise impact or inconvenience on patients.

The medical physics expert and radiation protection supervisor monitored radiation doses by modality, patient condition, and over time.

Each diagnostic modality had clear guidance on how and when staff should canulate patients ready to administer pre-scan contrast. The guidance also included when patients should be identified and when staff should complete a contrast checklist as part of safe practices. We observed staff follow the system closely and were risk-averse in their delivery of care.

The service complied with IR(ME)R requirements, including use of lead-equivalent aprons for staff, with tracked and monitored exposure data. Radiation control areas were indicated with illuminated signs and hazard warning notices, in line with national guidance. Staff audited the maintenance and integrity of aprons.

There was a need for improvement in how staff exposed to ionising radiation adhered to the radiation dose policy. Each member of staff was issued with a radiation dose monitor badge. All-site audits showed inconsistent practice, with not all staff wearing their own badge. Compliance improved between April 2024 (71%) and November 2024 (93%), but did not meet the provider’s 100% target.

The estates and facilities team provided engineering support for equipment failures and the provider had service contracts for specialist equipment with manufacturers, including urgent response agreements for critical equipment.

All staff completed fire safety training, including practical evacuation training using manual evacuation aids and evacuation lifts.

Staff followed a maintenance programme for imaging equipment. Using daily, weekly, and monthly checklists, they checked and documented cleanliness, functionality, and calibration. Audits from the previous 12 months showed consistently high levels of reliability.

The health, safety, and fire manager led audits and compliance activities to meet the requirements of the Control of Substances Hazardous to Health (COSHH) Regulations. The department held an inventory of COSHH substances and trained champions carried out monthly audits. The health and safety team monitored results and were in the process of adopting a risk-based approach that would streamline the frequency of safety checks.

All areas were equipped with resuscitation equipment. Daily and weekly checks were documented and up to date.

The imaging department operated on an outpatient basis and most scans were booked in advance with preplanned staffing levels. Radiographers carried out scans with support from nurses as part of wider care pathways. Radiologists were on site 4 days each week and staff could contact them at any time. Radiographer assistants provided a range of support within defined competencies. A cardiac physician and consultant cardiologist led a cardiac echocardiogram (ECG) service.

Most staff rotated between the provider’s 3 London sites. Bank staff and regular agency staff, all of whom undertook the same induction as substantive staff, supplemented the team. There was always an imaging lead on shift whenever the department was open.

At the time of our assessment, 94% of staff across the 3 sites were up to date with mandatory training and all staff had undergone supervision and an appraisal. Staff had access to external specialist courses, such as cardiac MRI training, in addition to internal training.

The team provided access to scans for patients referred on the day by consultants and GPs if staffing levels meant it was safe to do so.

Staffing levels were supplemented by radiologists who worked remotely. Records systems enabled secure access, ensuring on-demand radiologist input.

A resuscitation team was on duty at all times. Healthcare assistants and non-clinical staff completed basic life support training, and all other staff had training in immediate life support or above.

The induction programme included the local rules and The Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R). Staff undertook up to 6 weeks of modality training in addition to corporate and standard training, followed by a 6-month probationary period.

The hospital had recently introduced an on-call system for radiologists to provide urgent X-rays and CT scans for inpatients. The system had proved effective, and the provider was expanding capacity through recruitment.

We observed high standards of infection prevention and control (IPC). A dedicated housekeeping team maintained cleanliness and good hygiene in the environment and clinical staff used antibacterial procedures on equipment between patients. For example, staff use a disinfection process for ultrasound probes approved by the equipment manufacturer. This was in line with Department of Health and Social Care best practice guidance. Good hand hygiene practices were embedded in practice and staff undertook regular training although audits showed a need for more consistency. In the previous 12 months staff averaged 80% compliance in hand hygiene standards against a target of 95%. The infection control team were working with staff to improve practice.

Staff worked within a range of policies and standard operating procedures (SOPs) that provided assurance of consistent standards. Policies were in place for outbreaks and emergencies, such as viral haemorrhagic fever.

Staff with specialist training maintained cleanliness of the MRI safety zone to ensure hygiene was maintained whilst protecting staff from exposure to the magnetic field.

Staff monitored hand hygiene standards using monthly observational audits. In the previous 12 months, staff achieved an average of 83% compliance with expected standards. This included 3 consecutive months of 100% compliance in the most recent audits, reflecting improved practice. In the same period, the team achieved 98% compliance with safe management of the care environment requirements.

Medicines used within the imaging service were administered under patient group directions (PGDs), with oversight of each prescription by a radiologist. PGDs provide a legal framework that allows some registered health professionals to supply or administer a specified medicine to a pre-defined group of patients, without them having to see a prescriber. The most commonly used medicine was a contrast agent used during computed tomography (CT) scans and X-rays to help staff more clearly visualise arteries and veins.

Staff used steroids in ultrasound-guided injections and the pharmacy team maintained continuous monitoring and quality control in stock, dispensing, and administration. Staff followed good practice in documenting steroids used in each patient’s electronic record.

Some people experience allergic reactions to contrast, and staff used a protocol to minimise this risk and to provide immediate care if a reaction occurred. The service monitored updates from the Resuscitation Council UK regarding increased instances of anaphylaxis amongst patients who receive contrast media. The imaging team updated the SOP for managing anaphylaxis whenever new guidance was released and all staff who administered contrast were trained in immediate life support.