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Spire Murrayfield Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 November 2017

Spire Murrayfield Hospital is operated by Spire Healthcare Limited. The hospital has 25 inpatient beds and 17 day-case beds. Facilities include three operating theatres, a pharmacy, a pathology laboratory, a physiotherapy treatment area, a sterile services department for the decontamination and sterilisation of theatre instruments, X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care and outpatients and diagnostic imaging. We inspected some aspects of surgical care services.

We inspected this service using our focussed inspection methodology. We carried out an unannounced visit to the hospital on 21 August 2017 as a follow-up to a warning notice that was issued following the last inspection in September 2016. This was issued due to concerns about the lack of assurance around the robustness of investigations of incidences of venous thrombo embolism’s (VTE). We also followed up concerns that had recently been raised with the CQC.

We found the following issues that the service provider needs to improve following the concerns recently raised with the CQC:

  • There were incidences of incorrect assessment of grading, according to the American Society of Anaesthesiologists (ASA) as part of patient preoperative assessments as part of NICE guideline NG45 (2016). This meant there was a risk that patients operations had either been cancelled or they should have been treated in a hospital with access to critical care facilities in case of any deterioration post surgery.
  • There was no evidence that the provider had reported incidents of patients who had an ASA level 3 who had undergone surgery. This meant there was a risk that potential learning had not been identified to improve services provided. During the inspection, there was no local policy or guidance for clarification for preoperative staff to classify the ASA level for patients to ensure that the hospital could provide the correct level of care post operatively. There were no audits of the accurate completion of preoperative assessments. There was no exclusion policy to assess the suitability of patients treated at the hospital, although the hospital had been working to put this in place.

  • There were staff employed in a surgical first assistant (SFA) role who had not received any theoretical training prior to assessment of practical competencies in line with recommended national guidance. Since the inspection the provider has told us that a tailored SFA module with a university has been commissioned to provide additional training.

However, we also found the following areas of good practice:

  • We were assured that the provider had addressed the concerns in the warning notice that included a review of the policy for the management of venous thromboembolism (VTE) and completion of root cause analysis (RCA) investigations to help improve practice.

  • Processes were now embedded for the management of investigations of venous thromboembolisms (VTE).
  • Staff, including health care assistants, were encouraged to develop their role, in theatres, whilst being supported and supervised.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected surgery. Details are at the end of the report.

Name of signatory

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 24 November 2017

We found the following issues that the service provider needs to improve following concerns raised with the CQC:

  • Patient preoperative assessments included grading according to the American Society of Anaesthesiologists (ASA). There were incidents when reassessment of patient ASA levels meant patient operations either being cancelled or they should have been treated in a hospital with access to critical care facilities in case the patient deteriorated.
  • There was no evidence that the provider had reported incidents of patients who had an ASA level 3 who had undergone surgery. This meant there was a risk that potential learning had not be identified to improve services provided

However, we also found the following areas of good practice:

  • We were assured that the provider had addressed the concerns in the warning notice that included a review of the policy for the management of venous thromboembolism (VTE) and completion of root cause analysis (RCA) investigations to help improve practice.

Effective

Good

Updated 24 November 2017

We found the following issues that the service provider needs to improve following the concerns raised with the CQC:

  • There were staff employed in a surgical first assistant (SFA) role who had not received any theoretical training prior to assessment of practical competencies as recommended in national guidance. Since the inspection the provider has told us that a tailored SFA module with a university has been commissioned to provide additional training.
  • There were no audits of the accurate completion of preoperative assessments.

However, we also found the following areas of good practice:

  • Staff were encouraged to develop their role, in theatres, whilst being supported and supervised.

Caring

Good

Updated 24 November 2017

Not inspected

Responsive

Good

Updated 24 November 2017

Not inspected

Well-led

Requires improvement

Updated 24 November 2017

We found the following issues that the service provider needs to improve following concerns raised with the CQC:

  • There was no exclusion policy to assess the suitability of patients treated at the hospital, although the hospital had been working to put this in place.
  • There was no policy or guidance for preoperative staff to classify the American Society of Anaesthesiologists level (ASA) for patients. This would help ensure that patients received the correct post-operative care.

However, we also found the following areas of good practice:

  • We were assured that, following the issuing of the warning notice for the lack of robust systems for managing and investigating venous thromboembolism (VTE) events, systems were now in place.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 7 April 2017

There was a culture of reporting investigating and learning from incidents. The departments were visibly clean and there were low levels of healthcare related infections. There were effective procedures to stabilise and transfer patients who became unwell. Evidence-based guidance and best practice was followed. There was effective multidisciplinary working, where different disciplines worked well together to provide a more holistic service to patients. Feedback from people who used the service was continuously positive, they said staff were compassionate and kind and were attentive to their needs. Patients were involved in decisions about their care and treatment. Care was planned and delivered in a pleasant and appropriate environment with the needs of patients and their relatives being taken into account. Complaints were dealt with appropriately. Leaders were visible, experienced, competent and enthusiastic. There were strategies and plans in place for the future of the hospital, in particular, the recent restructure of the outpatients department. There was effective governance, audits and internal measures of performance and quality. There was a positive staff culture.

Surgery

Updated 24 November 2017

Termination of pregnancy

Insufficient evidence to rate

Updated 7 April 2017

The service is available to self–funding patients from the age of 18 years and no later than 14 weeks gestation. The service offered both medical and surgical terminations of pregnancy. There were processes in place to protect patients from avoidable harm and abuse; however, hand–written records were difficult to read and provide clarity about discussions and treatment of patients, including prescription charts. Patients accessed the service in a timely manner with access to screening, counselling and contraception if required.