The Chief Inspector of Hospitals has told Weston Area Health Trust that it must take action to protect the safety of patients using its urgent and emergency care services.
The Care Quality Commission has issued the trust with a formal warning after an inspection which found serious failings in the quality of care at Weston General Hospital in Weston-super-Mare.
Inspectors rated urgent and emergency care services as Inadequate – although the same inspection found there had been improvements in surgery, critical care and medical care including care of the elderly. Overall the trust remains rated Requires Improvement. Full reports and ratings for all services are available on our website.
Following the inspection in March CQC served the trust with a Warning Notice requiring significant improvement in these areas:
- To reduce crowding, the trust must review its use of the emergency department as the single point of entry to the hospital for both emergency and expected patients
- The trust must ensure a specialist senior doctor is available overnight to review patients in the emergency department, so as not to delay admission to wards.
- The trust must ensure the use of the corridor in the emergency department provides an appropriate and safe area for patients to receive care and treatment.
- The trust must work to improve the systems and processes to manage patient flow through the hospital more effectively
Professor Sir Mike Richards, CQC's Chief Inspector of Hospitals, said:
“We found the trust had been under increasing pressure to manage flow in the hospital for several months, with sustained pressure on the emergency department, leading to overcrowding and patients waiting too long to be admitted."
“We found there was a lack of support for the emergency department from other departments, with little evidence that they recognised that it was a problem for the wider hospital. There was no sense of urgency to resolve this. The bed management meetings were not as well attended as they should be. The flow of admissions and discharges was not on everyone’s agenda."
“There were not always enough senior doctors on duty to ensure safe care in the emergency department and medical wards, with a critical over-reliance on locums in senior positions. At night patients were waiting even longer to be admitted because there was no senior doctor available. The continuing difficulties in recruiting senior medical staff is a matter of concern."
“The corridor area in the emergency department was often used when there were no cubicles available, even though it was not a safe environment for emergency care and treatment. We found that ambulances had to wait too long to discharge their patients."
"Alternative strategies to relieve the pressure - such as the use of an ambulatory emergency care unit and discharge lounge and the medical assessment unit - were not effective."
“We have told the trust that it must make significant changes without further delay. We are fully aware that the trust will need to work with commissioners and other neighbouring providers to ensure that it is properly meeting the needs of people who live in North Somerset. We will return in due course to check that the trust has made the improvements we have identified and we will continue to monitor how Weston Hospital ensures that it is meeting the needs of all its patients.”
Inspectors found that even under this press, staff in the emergency department remained professional and compassionate, treating their patients with respect and consideration.
This inspection was to follow up on the findings of CQC’s previous inspections in May and August 2015, when the trust was rated as Requires Improvement overall.
Inspectors found there had been improvements in surgery and critical care, which are now rated as Good. In surgery,a new leadership team had taken a more proactive approach to the department, resolving previous concerns with safety.The trust had also made significant improvements to the safety, governance and risk management of the critical care service.
The report highlights areas of outstanding practice including:
- The oncology and haematology department demonstrated good practice with the way they assessed patient risk. Patients with a risk of neutropenic sepsis were easily identifiable through the use of a yellow j jacket placed on patient notes.
- Patients living with dementia were situated in the bays or side rooms that were most visible to the nursing station. Staff who provided enhanced supervision to these patients were wearing yellow tabards and were easily identifiable. Staff were allocated to a patient or a group of patients in a bay and were not to be removed unless another staff member had taken over from them.
Ends
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We have told the trust that it must make significant changes without further delay
Professor Sir Mike Richards, CQC's Chief Inspector of Hospitals