The Care Quality Commission (CQC) inspected North Middlesex University Hospital’s emergency department (ED) in July to assess the standards of care being provided to people.
The unannounced inspection was prompted by information received by CQC about the quality of care being provided to people.
However, inspectors found evidence that at the time of the inspection people were safe at the service and staff were focused on patients’ needs, although some patients experienced delays accessing care.
As the inspection focused on areas where issues had been identified, it was not wide-ranging enough to update ratings for the department, hospital or trust. Consequently, the department remains rated good and the hospital and trust remain rated requires improvement.
Nicola Wise, CQC head of hospital inspection, said:
“We found some patients accessing the emergency department at North Middlesex University Hospital waited too long for assessment and treatment, while others couldn’t always access the service when they needed it.
“One of the reasons for this was a lack of available beds elsewhere in the hospital where people could be referred for further care.
“We also found there were delays discharging patients from ambulances into the hospital, however there were good processes for identifying people who needed escalating through the queue.
“There were enough staff to meet people’s needs and keep them safe, and there was a very open culture where people could raise issues and make suggestions for improvement.
“We have shared our feedback with the trust about what it needs to address but are pleased to see good standards of care being provided to people overall.”
The inspection found:
- There were enough staff to care for patients and keep them safe
- Staff had the appropriate skills and training to carry out their roles and knew how to protect patients from abuse
- Staff were focused on patients’ needs
- All premises and equipment were clean and well-maintained
- There was enough suitable equipment to safely care for patients
- All patients could access a call bell and staff responded quickly
- Leaders had good oversight of the service and the challenges it faced
- Leaders were visible in the emergency department and provided staff with support and guidance
- Staff felt respected, supported and valued
- The service had an open culture where patients, families and staff could raise concerns without fear.
However:
- Patients experienced long waiting times, with some people waiting for more than four hours to be admitted or discharged from the hospital
- A number of ambulances were unable to leave the hospital within 60 minutes of arriving, due to delays in transferring patients into the care of the emergency department staff
- Not all staff had up-to-date training on infection prevention and control
- Although people were kept safe, staff didn’t keep an accurate record to demonstrate hourly monitoring of patients was taking place.
CQC has told North Middlesex University Hospital Trust to work more closely with NHS ambulance services to review how ambulance crews could transfer patients into the hospital’s care more quickly.