The Care Quality Commission will continue to monitor the performance of the emergency department of the Great Western Hospital in Swindon after the latest inspection found that improvements are still needed.
The warning notice issued in December 2015 has not been fully met and remains in place.
CQC had issued Great Western Hospital NHS Foundation Trust with a Warning Notice following an inspection in September 2015 which found significant concerns in the hospital’s emergency department.
Following a further unannounced inspection in April, CQC has recognised that progress has been made but further improvements are required.
A full report of the inspection has been published.
Professor Ted Baker, Deputy Chief Inspector of Hospitals, said:
“During our inspection last year we were concerned about the safety of patients waiting in the observation area. This included incidents of elderly patients falling and the deterioration of seriously unwell patients waiting for treatment. We were also concerned about the safety of staff when patients or their relatives became physically or verbally aggressive.
“While we can recognise there have been some great improvements there is much more to do. At the moment we can’t be certain that people are getting the consistent high quality care that everyone should expect.
“Steps had been taken to improve patient and staff safety, including an increase in staffing including a mental health nurse and more staff for the children’s emergency department. There are more security staff, the format of patient records has improved and there has been an increase in relevant training.
“But, we cannot be sure that patient observations are being undertaken and recorded consistently. We are not confident that the work to reduce the risk of patients falling has had enough impact. We do not think that incidents are always investigated thoroughly and we can’t be certain that lessons are learned and shared.
“The trust knows what it must do and it has a plan in place to bring about the necessary improvements. We will continue to monitor this hospital and our inspectors will return at a later date to check the improvements have been made.”
The inspection coincided with a busy and challenging time for the hospital. There had been a significant increase in emergency attendances and unplanned admissions during the winter, compounded by staff shortages and ward closures due to infection.
Inspectors found the emergency department was frequently overcrowded, patients waiting too long in the department with unprecedented numbers waiting on trolley beds for space to become free on the wards. Accurate and up-to-date records of care and treatment were not consistently maintained, and staff did not always comply with systems to identify seriously unwell or deteriorating patients.
Nurse staffing levels had increased by twenty percent and recruitment was ongoing, but in the context of increasing demand, safe levels of staffing were not consistently provided and patients did not receive timely care.
Inspectors reported continuing concerns about the safety of patients and staff in the emergency department observation unit. Plans to relocate or reconfigure the unit to improve safety had not been finalised. But, comprehensive plans were in place into improve, with temporary managers brought in lead the work, with progress overseen by trust executives. Governance systems had been strengthened so that managers had a better view of risks to safety and quality.
Nurse staffing had increased including more staff to improve safety in the children’s emergency department and in the observation unit. Staff had received specialist training to help them care for patients with mental health needs who were at risk of causing harm to themselves or others.
Ends
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At the moment we can’t be certain that people are getting the consistent high quality care that everyone should expect.
Professor Ted Baker, Deputy Chief Inspector of Hospitals