Solihull 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

The service completed assessments and followed patient pathways which were nationally recognised and evidence-based. Managers used information from audits to improve care and treatment for patients. Staff followed national guidance to gain patients consent for treatment.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us they felt their needs were being assessed and they understood their care and treatment. There were no concerns reported.

Staff completed an initial triage assessment for each patient. This was not always within the 15-minute national standard. At times, especially when the department was busy, there were delays. However, all patients we saw were fully assessed by an EP within 60 minutes of arrival to the department; this was in line with national guidelines. We were told on average it took 57-59 minutes for the EP’s to review the patients after arrival to the department.

Staff triaged patients on arrival and assessed their care needs. We observed 4 patients being triaged and a plan put in place for their care. We saw patients were mostly triaged well but not all patients’ pain was assessed using a pain score. The departments standard operating procedure stated that all patients should have a pain score in the initial triage assessment. However, all patients had been given analgesia where required and often by the triage nurse. All patients’ records we reviewed had a pain score completed by an EP if it was not completed during triage and an up-to-date treatment plan.

Patients were assessed in line with national standards for initial assessment in an emergency department. There was a standard operation procedure (SOP) which described how patients were streamed within the service. They arrived at reception and the team directed them to minor injuries or minor illness depending on their condition. However, we found, at times, patients were turned away from the department without review if the patient was deemed as inappropriate by the reception team or following advice from a nurse or EP. This was not in line with national standards or their SOP. The SOP stated that a nurse should complete an initial triage assessment for all walk-in minor injury patients prior to redirecting them elsewhere. The nurses and EP’s gave advice to the reception team if they were unsure of where a patient should be seen. There was an online system to complete observations and further assessments if required. There were 2 different systems for adults and another system for children. The service was working to streamline this into 1 system and this was on their risk register.

Patient notes were not audited. We were told it was a new service and these audits were planned but had not yet been carried out. They were planning on auditing documentation quarterly once implemented.

Patients we spoke to were given advice about their treatment which was up-to-date and in line with guidance.

Staff followed up-to-date policies to plan and delivered high quality care according to best practice and national guidance. They used Royal College of Emergency Medicine (RCEM) and National Institute for Health and Care Excellence (NICE) guidance to ensure they were delivering evidence-based care.

Staff told us they used pathways based on the RCEM guidance such as treatment for patients who had a head injury.

The service used NICE guidelines to ensure care was evidence-based. Policies, processes, and other supporting documentation were based upon national guidance and standards. There were specific pathways and guidelines such as a fracture pathway, foreign body guidelines and acute knee injury referral pathway.

The clinical lead consultant was a clinical guidelines reviewer. This meant they were sent all of the up-to-date NICE guidelines and ensured policies were updated. They looked at RCEM and NICE guidelines in conjunction with the other clinical leads across the trust in emergency medicine to ensure they had combined policies and pathways. There was an education group for all urgent and emergency care services and any updated pathways or policies were fed through this and disseminated down to staff. The Urgent Treatment Centre (UTC) was compliant with the NHS England UTC principles and standards (2023).

There was not enough evidence gathered to rate this, but no concerns were reported.

Staff worked well together and with other teams. They had good links with the other hospitals within the trust and called the consultants for advice and referrals when required. Most patients were in the department for less than 4 hours and did not require further input. However, some patients needed further support at home if their circumstances had changed, such as a broken leg. There was a team from 8am until 4pm, Monday to Friday, consisting of an occupational therapist and physiotherapist who arranged further support, respite, and equipment. They completed a full assessment of the patient and if they were not safe for discharge home, they arranged an admission and liaised with their consultant to do so.

Patients were referred to other services such as fracture clinic and were given appointments to attend. The unit closed at 10pm and reopened at 8am. Staff created a communication book which was reviewed each morning at 7am to ensure tasks were handed over and actioned promptly.

We spoke to the minor illness staff who told us they worked well together with the minor injuries staff. They were able to refer patients between the services if they were more appropriate for the EP’s to see them.

There were pathways that staff followed to ensure patients received the care they required. Some of these pathways involved transitioning between different services. Staff were aware of how to appropriately hand patients over and refer to different services.

There was not enough evidence gathered to rate this, but no concerns were reported.

Staff told us they gave patients advice regarding healthy lifestyles depending on the nature of their injury. For example, we were told if a patient came in with acute knee pain who was overweight, they would discuss this with them and offer advice about healthier lifestyle choices to reduce their weight which would potentially help reduce the knee pain.

There were leaflets available which offered a guide to help with health and wellbeing. It gave information about support for stopping smoking, living well, moving more, managing weight, supporting mental health and better sleep. There were links to the support services available in the Solihull area to support this.

Patients told us they had a positive experience. They achieved good outcomes, and their care was prompt and efficient.

Managers and staff carried out a programme of repeated audits to check improvement over time. There were a few audits they had not started in the department since it had opened such as documentation audits and infection prevention and control assurance audits. Managers told us they used information from the audits to improve care and treatment and they shared and made sure staff understood information from the audits. However, we did not see any action plans associated with the audits and we did not see audits discussed with staff at team meetings. We were told they were often shared in the encrypted messaging groups.

The service participated in relevant clinical audits. They shared the outcomes with staff but they did not always create actions to make improvements. The service operated in line with NHS England Urgent Treatment Centre standards (2023). They had an informatics dashboard which sat alongside the type 1 emergency departments for time metrics. These included time to assessment, time to clinical review and time to complete treatment. The service mostly met these metrics. They did not always triage patients within 15 minutes of arrival due to low assessment nurse numbers and increased attendance at certain times creating a bottleneck of patients to be seen. The unit was walk-in and the only urgent treatment centre in Birmingham and Solihull minor injury service that included X-ray facilities. They were also the only provider that offered a walk-in service, along with a 111 booked appointment offer. The lead consultant had looked at the national specifications for Urgent Treatment Centres and wanted to expand certain pathways such as deep vein thrombosis. We saw this was discussed in governance meetings.

The service measured outcomes using the Friends and Family Test (FFT) metrics. They found in June 2024 88% recommended the service and the most recent results for July 2024 showed 100% of patients had recommended the service.

There was a pain dashboard for urgent and emergency care units based on the RCEM guidance on assessment and management of pain for adults and children. The dashboard showed that for 2024, on average 50.2% of patients had their pain score assessed during their attendance. Staff were not recording it properly on the system and often wrote it in the notes rather than completing it online. Managers were working to improve the pain score recording by sharing the dashboard data with the team, including drilling down to specific days to provide individual feedback. Data was poor for administering analgesia. This was because the data was pulled through via the online prescribing system and did not consider the Patient Group Directives used within the department for administering medication; this is how most analgesia was administered. They had submitted a request to clinical audit registration management system in March 2024 to request a paper-based audit of analgesic administration to enable them to have a true reflection of the data. They had discussed this issue within their quality and safety meetings and looked at the FFT feedback which did not suggest there were any issues with pain relief.

Patients told us staff gained consent to provide treatment. They told us the EP’s explained their condition and the plan of care well. All patients we spoke to knew what they were waiting for. We observed treatment being delivered and found the staff to be engaging, informative and always asked for consent prior to treatment commencing.

Staff supported patients to make informed decisions about their treatment. They followed national guidance to gain patients’ consent. Staff made sure patients verbally consented to treatment based on all information available.

Staff received and kept up to date with training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLs). This was included within their safeguarding level 3 training. Staff were 100% compliant with this. Staff could describe and knew how to access the policy and get advice on MCA and DoLS. Staff gained consent from children’s parents or guardians in line with guidance. They were aware of Gillick Competence and explained when this was appropriate to use. All consent was verbal for the treatments used within the unit.

There was an up-to-date consent policy which staff followed when gaining consent from patients. Staff clearly recorded consent in all the 9 patient records we looked at which was in line with the policy.