InHealth MRI - Northumbria Specialist Emergency Care 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

The service had a positive learning culture, where staff and patients knew how to raise concerns and managers ensured that learning from incidents was shared. There were enough staff with the right skills, qualifications and experience to ensure high-quality care. Managers made sure that staff received appropriate training and had regular appraisals. The facilities and equipment met the needs of the patients, were clean and well-maintained, and any risks were mitigated.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service managed patient safety incidents well. Staff knew how to report incidents and near misses in line with the local procedure. We saw evidence of incidents reported with actions taken to mitigate risk. We were also told about examples of wider learning within the organisation taken from incidents. For example, following an incident at a different site where the wrong person was scanned, the process for checking a patient’s identity was changed across all of the provider’s sites at the trust to prevent a similar incident happening.

There were electronic systems in place for reporting incidents, and incidents were reported on the trust system and on the InHealth system to ensure learning occurred across both organisations.

In the year prior to our inspection the service reported no never events or serious incidents. A never event is a serious, preventable safety incident which should not occur if the available preventative measures are followed.

Staff understood duty of candour, but there were no events at the service in the previous year which required duty of candour to be carried out.

The service had a current incident reporting and reviewing policy, which reflected the provider and national guidance.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Safety was a priority throughout the patient journey in the department. Before being referred for a scan, patients were assessed by a clinician who completed a formal request for an MRI scan. The referring clinician completed a risk assessment to check for any reasons why the scan might not be safe for that patient, and we saw evidence of these risk assessments. All referrals included patient identification, contact details, clinical history, examination requested and degree of urgency, and details of the referring clinician. We observed 4 patients from their arrival into the department to their departure. Two completed their scans, while the other 2 were returned to their wards due to incomplete referral information.

During the operational hours of 8am to 8pm, referrals followed 2 clear pathways: one for A&E patients and one for inpatients and paediatric patients. The trust's duty radiologist vetted all referrals before proceeding to ensure the scan was appropriate. Once vetted, staff contacted the referring team and arranged porter transport where required. On arrival at the scan area, radiographers completed safety checks, confirmed consent, and reviewed documentation. If radiographers were satisfied that it was safe to proceed, they carried out the scan with appropriate trust staff support if necessary. Following the scan, patients were returned to their ward or A&E, and radiographers uploaded all documentation and images to the relevant systems. Trust radiologists reported all scans, and staff disposed of referral forms securely in line with confidentiality procedures. An external service was available for out-of-hours scans and where the radiologist did not have the required specialty.

Between 8pm–12am, a single on-call radiographer delivered the out-of-hours service, undertaking urgent scans that meet defined criteria, including cauda equina, metastatic cord compression, and stroke. From 12am-8am arrangements were in place to enable the transfer of patients requiring urgent scans to another local trust.

The service used the Society of Radiographers’ “Pause and Check” system. Pause and check consisted of the 3-point demographic checks to correctly identify the patient, as well as checking with the patient the site to be imaged, the existence of previous imaging and for the operator to ensure the correct imaging modality was used. We observed staff always used the 3-point demographic checks in line with the correct procedure. We reviewed the service’s pause and check safety audit, which showed records were checked monthly.

Patient records were electronic, with paper-based safety checks, and IT connectivity was consistently available which meant staff could access up to date patient records. There were contingency plans in place for several scenarios of IT failure, but staff told us that this rarely happened.

Following the completion of scans, staff communicated effectively with trust staff and completed a seamless handover for patients.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff understood how to protect people from abuse and the service worked well with other agencies to do so. Staff received adult and children’s safeguarding training. Data showed that 100% of clinical staff were trained to level 3 safeguarding adults. Administrative staff were trained to level 2 safeguarding adults. All staff were trained to level 2 safeguarding children.

Posters were displayed showing key contacts for the safeguarding team for the organisation and all the staff we spoke with knew how to find these and knew who to contact to raise a safeguarding concern.

When relevant, staff checked that people claiming lasting power of attorney had the appropriate documents to support this.

The service had up to date policies in place for adult and children’s safeguarding and an up-to-date chaperone policy. There were posters displayed in the department informing patients of their right to request a chaperone.

Staff followed safe procedures for visitors attending the department.

The clinical governance team organised monthly safeguarding sessions that were available to the whole organisation, and staff were encouraged to discuss local safeguarding concerns to support shared learning and best practice.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet patient’s needs which was safe, supportive and enabled patient to do the things that mattered to them.

The service worked with people to understand and manage risks and met their needs in a way which was safe and supportive.

Due to the nature of the service and the acuity of the patients being scanned, we were unable to gather feedback directly. However, we tracked the patient journeys of 2 patients, and we saw that risks were fully explained and patients were given opportunities to ask questions.

We reviewed 5 patient records for evidence of completion of risk assessments and found that risk assessments for renal impairment, MRI contraindications, mobility, spinal cord compression and contrast allergy were completed in all cases where appropriate.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely. Access to the department was secure. Trust porters brought patients from the ward or A&E at their appointment time and held them briefly in a designated waiting area. Patients who had been discharged before their appointment could use a small, seated waiting area.

The unit had a preparation area, an MRI examination room and an MRI control room. There was a small, shared staff room available.

MRI safety rules were in place and reflected best practise. The MRI scanners were fitted with emergency buttons which stopped scanning and switched off power to the magnet.

The service had enough suitable equipment to help them to safely care for patients. All the equipment used in the scanner met the Medicines and Healthcare products Regulatory Agency (MHRA) safety guidelines for MRI equipment. We saw the service log, which showed that the equipment was calibrated in line with the manufacturers’ guidance, and the manufacturers’ instructions for the safe use, cleaning and maintenance of the equipment was readily available to staff. Staff completed daily checks of equipment, and we saw evidence of this in the maintenance log.

Staff used handover forms when equipment was handed to engineers and physicists for servicing and testing, according to guidance and best practice.

The environment used for patient care reduced the risk of patient harm, and included safe flooring, handrails and view-only windows. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction. There was access to resuscitation equipment in the department, which was all in date.

Patients could summon assistance as needed and we saw that patients were provided with buzzers and encouraged to test them prior to the scan for reassurance.

The provider made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met people’s individual needs.

The service had enough clinical staff including radiography and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

The service had 3 whole-time equivalent (WTE) radiographers, a superintendent radiographer and a healthcare assistant (HCA). Two new HCAs had been hired and were undergoing training in phases. To ensure that there were always sufficient appropriately qualified staff available, the service worked together with staff employed at other sites at the host trust, to provide planned shift cover, sickness cover and on-call support. Therefore, staff rotated across 4 different hospital sites on a regular basis. This made sure that all staff were familiar with the different types of scanners at each site. Staff used an app to contact each other in the event of staff sickness, so that replacement staff could be found quickly.

Staff told us that there were always 2 radiographers on duty each day, 1 of which would always be a senior radiographer with specialist skills if required based on the type of scans being delivered on the day, alongside a healthcare assistant or an administrator. There were no clinical staff vacancies and the actual staffing levels were as planned during our inspection.

Medical staff employed by the trust reported on scans during core hours. An external reporting service provided reporting for some out-of-hours scans and all on-call scans.

New staff had a full induction tailored to their role before they started work and were subject to a 3-month probationary period. Competencies were checked before staff were allowed to work without supervision and we saw evidence of completed competency checklists with feedback. Managers supported staff with annual appraisals, mid-year review and supervision. Although management changes resulted in some outstanding year-end appraisals from the previous year, managers had completed 80% of mid-year reviews and scheduled the remainder for completion by the end of May.

We reviewed the recruitment files for all clinical staff on duty and saw all checks had been appropriately completed, including disclosure and barring checks.

Managers told us that there was an in-house learning and development programme delivered by InHealth, and where appropriate external courses were funded.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves and others from infection. The department was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained.

There was a provider infection prevention and control (IPC) policy and supporting guidance that was accessible to staff. We saw evidence of hand hygiene and cleaning audits for the 3 months prior to our inspection, which all showed compliance in most areas. However, we identified some gaps in the audit records, with certain days left blank and others not completed to confirm that floors had been swept and mopped.

We observed staff cleaning equipment after patient contact, and we saw that equipment was labelled to show when it was last cleaned.

There were processes in place to enable staff to respond to infection prevention and control risks such as transmittable infections. Staff told us that any patients with a transmittable infection were scanned at the end of the list and all equipment thoroughly decontaminated after.

We saw staff following infection control principles including compliant handwashing and the use of personal protective equipment (PPE) as outlined in the service’s standard operating procedure.

Staff understood the process for managing spillage of body fluids in the department and we saw that spill kits were available.

Staff supported infection prevention and control measures by following the uniform policy. Staff in clinical areas were bare below their elbows to allow for full hand decontamination.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The staff had access to required medicines, including emergency medicines and these were appropriately stored, including medical oxygen.

Staff told us that medicines were prescribed by patient group directive or patient specific directive. A patient group directive is a legal framework that allows authorised healthcare professionals to administer specific medicines to a defined group of patients without a prescription. A patient specific directive is an instruction from a prescriber to administer a medicine to a named individual after assessing their clinical needs. The service used systems and processes to safely prescribe, administer, record and store medicines.

The service had a medicines management policy, and we saw examples of medicines audits. Staff completed medicines records accurately and kept them up to date. There was effective governance of medicines, and we saw spreadsheets and forms which were used to reconcile medicines usage and stock. We checked a sample of medicines and saw that they were all in date.