Dorset County Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Patient safety checklists included a requirement for staff to complete pressure area assessments at the 2-hour stay mark for all patients. In response to the increased patient length of stay within the ED and an incident where a patient developed a pressure ulcer after 5 days in the department, leaders introduced an evidence-based colour coded assessment framework called Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T). This was expected to identify the patients most at risk of developing pressure injuries and provide structured preventative interventions in line with national guidelines. The trust policy for Purpose-T aimed for staff to complete assessments within 4 hours of admission, improving upon the national guideline recommendation of 6 hours. The tissue viability team audited the completion of PURPOSE-T forms between June 2025 and December 2025 and found that staff did not always complete the form well and only elderly and vulnerable patients received this assessment. This matched feedback we received during the inspection where staff were not always certain when these assessments should be completed by. Leaders shared learning with staff in ED through meetings, safety briefs and emails. The service aspired to complete PURPOSE-T assessments for all adult patients who stayed in the department for longer than 12 hours and used quality improvement initiatives to support this.

While the trust's pressure ulcer policy had not been updated to reflect the latest European Pressure Ulcer Advisory Panel (EPUAP) grading guidelines, leaders provided evidence that staff were trained to current standards. The policy presented a potential risk of delayed identification and treatment of pressure injuries in patients with darker skin tones. However, the trust mitigated this risk through annual mandatory training which included the most recent best practice guidelines and skin tone assessment methods.

Additionally, clinical frailty assessments were not always completed in line with best practice recommendations for patients at a higher risk of poor health outcomes. NHS England recommends that all patients over the age of 65 should have a clinical frailty score documented within 30 minutes of arrival. On the day of inspection, we reviewed 4 records of patients in majors and found the clinical frailty score had been documented for 1 patient. For the remaining records, patients had arrived at the ED between 2 to 25 hours prior.

However, the service had effective systems and processes for monitoring and flagging when vital signs observations needed to be undertaken, such as for the National Early Warning Score 2 (NEWS2). Digital systems for care records in ED were designed to alert teams with visual cues, when hourly observations were due. High NEWS2 scores flagged warnings and prompted staff to act early.

PEWS assessments were completed on paper documents due to limitations to the ED’s digital systems. PEWS audits for December 2025 showed ED staff always recorded the date and time of each entry and kept clear readable records. Leaders identified areas of improvement where staff did not always ensure information was recorded consistently across every piece of documentation. Despite the mix of paper and electronic records, care records were completed consistently well.

Staff and leaders managed and mitigated risks well for patients who needed enhanced observations and documented assessment, care and treatment when this occurred. ED leaders used nationally approved Enhanced Therapeutic Observation and Care ETOC scoring tools to ensure patients with specific needs and clinical risks were cared for by staff with the appropriate level of training. Mental health observation rooms are a type ofETOC, used to support patients at risk of harm who need higher levels of supervision than standard nursing care. The highest risk patients cared for in mental health observation rooms typically required continuous arm's length support. The security team were involved in providing support in most instances where restrictive practices took place. This included when patients were cared for in mental health observation rooms.

FAB staff used a referral guide to determine whether patients could be safely streamed to SDEC. This included an agreed list of conditions that could be safely treated in the SDEC environment, with clearly defined inclusion and exclusion criteria. This enabled certain patients to receive care and treatment without unnecessary hospitalisation.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them in line with legislation and current evidence-based good practice and standards.

Staff used a range of nationally recognised tools and systems to deliver evidence-based care and treatment. On the day of inspection, we observed a trauma patient received good quality care and treatment according to major trauma centre guidelines. This included timely diagnostic imaging booked within 30 minutes and timely referral to the appropriate specialty in a timely manner.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group. Nurses undertaking triage in the walk in ED received competency assessments to safely use the Manchester Triage System. The Manchester Triage System is a clinical risk management tool used to safely prioritise patients based on urgency rather than arrival time. Leaders arranged extra training to improve triage performance as part of a larger quality improvement project. This was supported by 2 full time clinical practice educators who were employed to enhance staff training.

Clinical governance, audit and morbidity and mortality meetings occurred monthly. Leaders made sure that staff rotated attendance to participate in and share learning. Medical staff said that extra senior staff were rostered to work on Wednesdays to ensure good levels of teaching session attendance. They were satisfied by the availability and range of teaching sessions provided.

The NHSE Getting It Right First Time (GIRFT) team last visited the ED service in 2018. Leaders attended national GIRFT emergency medicine meetings and used updated guidance and learning to develop and improve service redesign and development.

Patients were able to access food and drink while waiting for care and treatment if they did not need to remain nil by mouth. There were hot and cold drinks dispensers in the different areas of ED. During the onsite inspection, we observed staff offering food and drinks to patients, including sandwiches and hot meals. Patients we spoke with knew where the vending machines were located and said staff regularly offered food and drink.

Staff assessed pain scores as part of regular vital observations checks and patients said they received pain relief when they needed it. Patients who were cared for on the fractured neck of femur pathway were routinely considered for early pain relief according to national guidelines.

The service used a silver trauma protocol to improve the care of older trauma patients. A silver trauma protocol is a pathway designed to improve outcomes for patients aged 65 or older who experience major trauma, particularly from low-energy mechanisms like standing-height falls. Staff were familiar with the rapid assessment process to identify and escalate risk of major injury for these patients.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The control desk situated in the main ED area was well located with good visibility of acute care areas such as resus and FAB. This included screens with the digital system for care records, live pre-alerts from ambulance services and handover records such as current risks and key messages. However, there was no nurse in charge of the ED overall. The main ED and walk in ED were in separate areas of the hospital main building and contributed to the challenges staff and leaders experienced. There was limited direct clinical oversight of the walk in ED by the ‘front’ nurse coordinator responsible for this area who relied on the walk in ED to escalate concerns via phone contact. They were usually located in the main ED, as their responsible areas also included the main waiting area, fit to sit and majors. The 'back’ nurse coordinator similarly had a large ED footprint they were responsible for, covering ambulance arrivals, resuscitation bays, fast assessment bays (FAB) and high care. ED leaders told us there were already staffing plans submitted to increase the number of nurse coordinators to 3 to address this concern. Following the onsite inspection, this was approved by the trust level senior leadership team and recruitment commenced.

Additionally, there was no Emergency Physician In Charge (EPIC) consultant in charge of the department. EPIC is a consultant-level role responsible for "air traffic control" of the department, essential for safe, effective and timely prioritisation of care planning and delivery. There were usually 2 consultants present for the day shift and they shared this responsibility. Despite this, staff and leaders reported this worked well due to exceptional team working.

There were no routine multidisciplinary departmental team huddles within ED for discussing current patient safety concerns and operational performance. There were separate nursing and medical staff handovers. This limited effectiveness and opportunities for escalation as these did not have physiotherapist or site management presence. However, during the onsite inspection, the consultant doctor and ‘back’ nurse in charge met hourly to discuss current patient risks such as insulin prescribing, violence and aggression and falls risks.

On the day of inspection, we observed mental health liaison teams reviewing patients with dementia to ensure their needs were being met and provide additional support if needed. A sample of patient records showed specialty staff completed good quality documentation of their clinical review. However, this was completed on paper records and required additional record keeping by ED medical staff to transfer this to the required digital format, creating delays in medical clerking for completion of digital records

ED staffing was reviewed at twice daily safer staffing meetings. There were effective processes to support leaders to escalate staffing challenges such as the escalation pathway for the ‘queue in’ strategy.

ED teams worked well with teams inside and outside of the trust to improve outcomes for patients who needed treatment for stroke. The Sentinel Stroke National Audit Programme (SSNAP) is a major national healthcare quality improvement programme used to measure the quality of stroke care. The service improved their SSNAP rating from D in 2024 to B in 2026. High ratings indicate that patients are receiving evidence-based care, such as timely brain imaging, fast admission to a stroke unit, and appropriate therapy. The front door pathway SSNAP indicators showed the ED team performed higher than the national average in 12 of 15 indicators. Teams worked well together to ensure patients were admitted to the stroke unit from ED within 4 hours.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives, through participation in various health and wellbeing initiatives. There were posters in the ED environment promoting lifestyle advice and courses for substance abuse support. Staff referred patients to the local recovery education centre if this was requested. Staff shared an example where a patient who presented with mental health concerns, but no physical health needs, was discharged from ED to support staff at the Hive. Staff communicated with family members to safely arrange the patient’s return home with social care support. Volunteers maintained daily phone call checkups following this. Teams had access to a full range of specialist teams to meet the needs of patients. This included palliative care teams, dieticians, occupational therapists and physiotherapists. The medical care division established a new frailty SDEC service in 2025 to enable frail persons to receive tailored care and return home whenever possible. One patient attended ED with heart failure, was streamed to SDEC, received a tailored intervention and package of care, returning home in less than 24hours.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Since the previous routine inspection of the ED in 2018, the trust bed base reduced from approximately 400 beds to 357 beds in January 2026. ED attendances increased by 10% since the previous year, with an average increase of 12% in the winter months. The ED service was significantly impacted by these factors, which negatively impacted on their ability to achieve the 7 priorities under the NHSE Urgent and Emergency Care plan. This included the ability to achieve the interim minimum standard of 78% of patients seen within 4 hours.

ED leaders and staff used monitoring information effectively to understand the challenges their service needed to address and worked with senior leaders at trust level to gain the resources they required. Despite this, between October and December 2025, the 4 hour wait ranged between 60.4-68.4%. Additionally, 12 and 24 hour waits in ED had significantly increased between 2024 and 2025. Between October to December 2025, there were 570 patients waiting over 24 hours compared to 236 patients in the same period in 2024. However, some areas of ED performance showed significant improvement. For example, in 2024, patients were waiting 41 minutes to be triaged, but this had decreased to 15 minutes on average, and the service now met the national standards for this performance area. The average time spent in ED had decreased from 314 minutes to 256 minutes. Patients waited an average of 1 hour less in 2025, compared to 2024.

The service monitored people’s care and treatment and used this information to make targeted improvements in ED and worked with external stakeholders to ensure this was relevant to the population they served. For example, the service took part in the NHSE initiative, the Model Acute Pathway, which helps trusts to measure and improve on the safety, quality and delivery of care for acutely unwell patients in their first 72 hours in hospital. ED leaders met with other health leaders and external stakeholders in the region to develop the services own 72-hour project, in line with the NHS 10-year plan and the needs of their community.

The service contributed operational, performance and outcomes data to a wide range of national mandatory reports and local improvement initiatives. ED leaders ensured National Major Trauma Registry (NMTR) data was submitted according to required deadlines and resourced this with 2 dedicated administrators. Information such as clinical observations, timing of care interventions and staffing is collected for patients with a major injury who have a length of stay of more than 3 nights or are admitted to critical care. Between January 2024 and 2025, the ED team submitted 225 cases to this audit programme and 99.6% of these records were completed within 30 days of discharge.

ED teams worked exceptionally well with ambulance services to reduce average handover times, despite the 7% increase in patient attendances by ambulance between 2024/2025 and 2025/2026. Between November 2025 and January 2026, the average time taken for paramedics to handover patient care to the ED team was 19-23 minutes. Ambulance services reported the main reason for handover delays was due to insufficient staff in the ED.

Similarly, the ED teams worked well with the Paediatric department to improve the experience of children and young people by reducing their time in the ED. ED leaders reported that overall performance for children and young people had improved by 4.2%. This included reductions in average time to assess from 28 minutes to 19 minutes, reduction in average time to treat from 1hr 43 minutes to 1hr 27 minutes and the time spent in ED reduced from 2 hours 46 minutes to 2 hours 30 minutes. Despite an increase in children and young people admission rates by 1.1%.

The ED service had not been involved with the RCEM audits or quality improvement projects between 2024 and 2025 due to service limitations and the 3-year participation cycle. However, ED leaders shared their intention to rejoin this initiative in 2026 and had used the RCEM framework in the meantime, to improve patient care in areas such as care of older people and adolescent mental health.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. All staff we spoke with were able to describe the process for gaining informed consent. This included when verbal consent to care and treatment needed to be recorded in line with trust policy or for use of visual and audio recordings. Care records, plans and pathways were designed to make record keeping of patient decisions easier. For example, the neck of femur care plans prompted staff to ask patient specific questions to ask for consent when a referral needed to be made for therapy input and for pain management decisions.

Staff completed competency-based training on how to gain informed consent. The toolkits available to guide staff decision making, included consideration of religious needs such as local Jehovah’s witness position on medical treatments, best interest decision making and advance decision statements.

The ED had 4 learning disability and autism advocates. These staff supported and empowered children and adults to make decisions or participate in decision making around their health needs.