Royal Cornwall 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

At our last assessment we rated this key question requires improvement. At this assessment the rating was changed to good. We assessed four quality statements.

We looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Staff comprehensively assessed people, so the care and treatment provided met their needs. This included both their mental and physical health and any personal circumstances that needed to be considered. Staff worked in a strong culture of evidence-based practice. Staff worked together and with others when assessing people's needs and shared information to maintain continuity of care. The service carried out regular audits, including monitoring against the emergency care standards.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff used the trust's systems to follow the latest guidance and evidence-based practice. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures.

The service planned and delivered patient's care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Individual teams were assigned to the Royal College of Emergency Medicine (RCEM) 2025 Healthcare Quality Improvement Plan (QIP). QIPs are a structured approach to improving the quality of care delivered in an Emergency Department (ED). RCEM's QIPs focus on specific areas of emergency care, like mental health, care of older people, and time-critical medication.

The hospital scored similar to other trusts in the Urgent and Emergency Care Survey 2024, regarding questions such as availability of food and drinks and were patients involved enough with decisions relating to their care. The department offered patients food and drink. Patients told us that they had access to food and drink. We saw patients being supported with their dietary needs and also being assisted with drinks.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records demonstrated care was provided in line with current guidance. For example, we reviewed the records of a patient who was pregnant. The Modified Early Obstetric Warning Score (MEOWS) in Detecting the Seriously ill and Deteriorating Woman Clinical Guideline was followed.

The trust audited practice against evidence based research. For example, between January and March 2025 nearly 90% of patients had intravenous (into a vein) antibiotics started within 1 hour for the management of sepsis in line with sepsis guidance. This was an improvement since our last assessment when in April 2024, when data showed 72% of patients who met the criteria received antibiotics within an hour. Sepsis is an extreme reaction to an infection.

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. There were not robust processes and dedicated time to support effective handover between clinical teams.

Due to operational pressures and challenges, informal processes had been developed and had become acceptable. This included staff completing the Situation, Background, Assessment, Recommendation, and Decision (SBARD) paper form prior to transferring a patient to another department without giving a verbal handover. SBARD is a structured communication framework used to facilitate clear and concise information sharing. We heard of instances where patients had come to harm because crucial safety information was not handed over between teams. We raised our concerns with the trust. This resulted in a rapid change to the handover processes which included additional time allocated for staff to complete handovers and the ceasing of the practice of not giving a verbal handover and arrangements to monitor compliance with the new process. Audits for April and May 2025 showed there was still variable compliance. For example, in April 2025, 96% had a nurse-to-nurse handover completed, 80% had a transfer form acceptably completed and 70% had a handover form signed and completed by receiving nurse. In response to the audit results, the trust was taking further actions. For example, reinforcing the responsibility of the receiving nurse to complete the form and arranging refresher training for teams with recurrent non-compliance.

Staff did not always have access to the information they needed to appropriately assess, plan, and deliver care, treatment and support in line with people's individual needs. There were multiple IT systems used for accessing patient records, blood test results, and ordering other investigations. Clinical notes were paper based. This meant staff had to access several different systems to gather the information they needed, therefore, there was a risk that important information could be missed. Staff told us that it was time-consuming to use all the different systems. The trust was due to role out an electronic patient record system bringing all the different systems into one by the end of the year.

Care was not always coordinated well with different teams. Despite some specialities such as medical care being based in the department, patients requiring review by a specialty service still experienced delays due to the workload elsewhere in the hospital. Whilst specialty staff reviewed patients following referral, this regularly took longer than 30 minutes which delayed specialist care and slowed admission to a ward area. Between October 2024 and March 2025 the average time from referral to review by the acute medical team was over 20 hours. However, the trust told us that there may be data quality issues with the data provided.

The multidisciplinary team were all involved in assessing people's needs. We observed plans being made for a discharge from the emergency department. For example, joint planning between the mental health trust and staff working in the emergency department.

Staff were noticeably very busy in the department, but staff were positive about support and relationships in the department. We saw good multidisciplinary working which demonstrated mutual respect amongst staff.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff told us treatment plans were evidence based and monitored for outcomes. The patient records we reviewed confirmed that care was evidence based. For example, we reviewed the records of a patient who attended who was having a heart attack. The records showed that care and treatment was in line with National Institute for Health and Care Excellence Guidance in the management of acute coronary (heart) syndromes.

Having senior decision makers working alongside triage trained nurses in the same location was an effective pathway. Senior decision-makers can quickly assess patients, initiate necessary tests, and start treatment earlier in the process, potentially preventing delays.

Patients care was reviewed and updated, and appropriate referral pathways were in place to make sure that needs are addressed. For example, there were specific pathways for patients who had sustained a broken hip or a heart attack. Data showed for March 2025, 100% of patients were started on the broken hip pathway.

The trust percentage of patients reattending the ED within 7 days of the original attendance was slightly worse than England percentage between January 2025 and March 2025.The percentage of patients leaving the department before treatment was completed was less than the than England percentages between January 2025 and March 2025.

Patients were supported to manage pain or discomfort during waiting times. Patients we spoke with reported they had received help to manage their pain. The Urgent and Emergency Care Survey 2024 showed that the response to ‘Do you think the hospital staff helped you to control your pain?’ was about the same comparing with other trusts. The trust pain audit for adults found good compliance with assessing pain at the time of triage, the latest data for March 2025 showed 100% compliance and just over 90% compliance with administering pain relief at the time of triage. However, only 43% of patients had their pain assessed hourly.

There was a full audit plan in place for the department with clear audit leads and timetable in place. Leaders could describe the outcomes of audit and actions taken in response to them.

Patients understood their rights around consent to the care and treatment they were offered. Patients received information about care and treatment in a way they understood and had the appropriate support and time to make decisions.

Staff had access to the trust consent policy and understood the relevant consent and decision-making requirements of legislation and guidance. Staff knew who to contact for advice.

Staff had access to the mental health team 24 hours a day to support them and patients. We were told the team were responsive and supportive. We observed the mental health team in the department supporting patients and offering advice to staff and most people seen within an hour by a specialist clinician.

We observed staff gain consent from patients for their care and treatment in line with legislation and best practice guidance. Staff received training on the application of the Mental Capacity Act for staff who would need to assess patients to give consent.

Staff understood specific requirements of taking consent from children. They had received training and knew how to apply it, for example Gillick competence.

When patients did not have capacity to consent, staff made decisions in their best interests and documented them.