The Chief Inspector of Hospitals has told Aintree University Hospital NHS Foundation Trust that they must make improvements in their urgent and emergency care department following a focussed responsive inspection by the CQC in April 2016.
The trust was rated as Good overall following a comprehensive inspection in May 2014. CQC ask five questions for each core service, are they safe, effective, caring, well-led and responsive. In May 2014 inspectors rated the safety of urgent and emergency services provided by Aintree University Hospital NHS FT as Good, but have downgraded this core service rating to Requires Improvement following an inspection on 1 April this year.
CQC carried out an unannounced responsive inspection on services in this area in response to concerns that were raised about their safety and quality. This inspection focused predominantly on the safety of the urgent and emergency services provided; however, where inspectors observed practice in other areas this information has been included in the report.
This report is available to view on the CQC website.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“At our previous comprehensive inspection in May 2014 we rated Aintree University Hospital’s urgent and emergency services as Good for being safe. We have re-inspected these services as a result of concerns that were raised with us about their quality, and we have now rated them as Requires Improvement for safety.
“We were concerned upon inspection, that the processes in place for recognising and escalating the care of deteriorating patients were not always followed which put people at risk. We reported these urgent concerns to senior staff at the trust at the time of inspection and actions were put in place to address this issue. We have been monitoring these actions regularly to make sure improvements were being made.”
“We also saw that nurse staffing levels were lower than the safe recommended amount. We do acknowledge that the trust was taking action to address the nurse vacancy rate but it remained evident during our visit that the wards were not always staffed as they should be.”
The key findings included the following:
- CQC found that staff were using a national Modified Early Warning Score (MEWS) tool to help monitor a patient's condition and identify signs of deterioration in their condition. However inspectors found that this was not being used correctly in line with the trust’s own procedures and caused concern that this may not appropriately identify patients who were deteriorating.
- Nurse staffing levels were not always filled to the safe staffing establishment, and staffing was below this threshold on the surgical assessment unit, ward 31 and in the accident and emergency department at the time of the inspection. There were periods of understaffing over a number of days prior and post inspection and there was evidence that staff had raised staffing concerns using the incident reporting process.
- Inspectors found there was poor staff compliance with the trust’s mandatory training target. The trust had a plan in place to reach 85% compliance by March 2017. However, patients could be at risk if staff were not adequately trained in a timely manner.
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We were concerned upon inspection, that the processes in place for recognising and escalating the care of deteriorating patients were not always followed which put people at risk.
The Chief Inspector of Hospitals, Professor Sir Mike Richards