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Medway Maritime Hospital Requires improvement

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Inspection report

Date of Inspection: 9 December 2014
Date of Publication: 4 February 2015
Inspection Report published 4 February 2015 PDF | 88.19 KB

Overview

Inspection carried out on 9 December 2014

During a routine inspection

On 31 December 2013 we carried out an unannounced inspection of the Emergency Department (ED) at Medway Maritime Hospital in response to information we had received from an anonymous source regarding the safety and effectiveness of the ED. We found that the service was failing to meet the national standards that people should expect to receive. As a result, we issued formal warning notices to Medway NHS Foundation Trust, telling them that they must improve in a number of areas within a specified period of time.

Medway Maritime Hospital was inspected again as part of a comprehensive inspection of Medway NHS Foundation Trust because Medway NHS Foundation Trust was rated as high risk in the CQC's intelligent monitoring system and the trust had been placed into 'special measures' in July 2013 following a Keogh review. This inspection took place between 23 and 25 April 2014 with an unannounced inspection visit on 1 May 2014.

As a result of the comprehensive inspection, overall, the hospital was rated as inadequate. We rated it good for being caring but improvement was required in providing effective care and being well-led. The safety of the hospital and being responsive to patients' needs were rated as inadequate. Whilst some core services were rated as good overall, for example critical care and services for children and young people, the emergency department and surgical services were both rated as inadequate.

We carried out further unannounced inspections of the ED on 27 and 28 July 2014 and again on 26 August 2014. In 28 July 2014 we also reviewed the surgery department to determine whether the trust had commenced making the necessary improvements to the service.

During our inspections of the ED in July and August 2014, we found that the ED lacked robust clinical leadership.

The ED had failed to review and optimally utilise its escalation policy within the ED to avoid the need to 'stack' or 'cohort' patients. Whilst patients were being stacked they were not undergoing regular nursing observations, and were not being seen in a timely manner by medical staff. We therefore took urgent action to impose additional conditions on the trusts legal registration with the Care Quality Commission. These conditions required the trust to operate an effective system which ensured that patients could expect to undergo an initial assessment by a skilled and qualified health care professional within 15 minutes of presentation to the Emergency Department. We also required the trust to report to us on a weekly basis, any patients who were not assessed within 15 minutes to determine whether those patients experienced sub-optimal care or had a poor experience upon initial presentation to the department.

Our reason for imposing these conditions was to ensure that staff working in the ED were acutely aware of all patients present in the department; this helped to enhance the safety of the department; we had previously found that patients who were acutely unwell could experience long delays before being initially assessed.

We carried out a further unannounced inspection of both the ED and the main theatre department on 9 December 2014. The inspection team included a general acute physician and a theatre specialist advisor.

Our key findings of the inspection were:

Emergency Department:

The department continued to experience significant issues with transferring patients to wards once a decision had been made to admit them. Delayed transfer of patients was resulting in patients experiencing delays in being treated once they had presented to the ED. However, the trust had implemented initiatives including undertaking an initial assessment of all patients within 15 minutes of their arrival to the ED. Improvements were required to ensure that patients arriving by ambulance received the same level of care as though who self-presented. This included ensuring that trust policies and procedures were consistently adhered to, including those relating to the management of "cohorted" or "stacked" patients.

Clinical leadership was starting to develop; staff were, however extremely candid with us regarding the current pressures of working within the department.

Theatres:

We found that there had been some improvements in the delivery of theatre services although we were concerned that the department was still not being well-led in some aspects; we have referred our concerns back to the trust executive team. Management of emergency theatres and trauma surgical lists was slowly starting to improve although it was difficult to measure the impact that this was to have on patient experience and the quality of care patients could expect to receive as the interventions remained in their infancy. Patients continued to experience delays in being transferred from the recovery department to a ward bed; this was attributed to the continued and significant capacity issues experienced across the hospital.

Medical Escalation Area - Sapphire Ward

We found that the environment of Sapphire Ward was not conducive to ensure that the individual needs of patients could be met. Capacity issues across the hospital had resulted in excessive numbers of patients being placed on Sapphire ward. A lack of curtains impacted on the privacy and dignity of patients and a lack of piped oxygen and suction potentially placed patients at risk of harm.