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16 April 2019, 11:10
The watchdog's calling for further improvements to emergency care at the QA Hospital in Portsmouth.
Inspectors found a poorly managed flow of patients, not enough seats in the waiting room and a nurse-in-charge with too much to do. It meant patients often standing for long periods and some not being given enough privacy during treatment. Inspectors provided examples to the trust of occasions when nursing staff had failed to cover patients up, instead opting to half close cubicle curtains.
The Care Quality Commission (CQC) carried out a focused inspection in the emergency department at the hospital in February 2019, as part of a programme to assess safety during the winter period.
But it found there was an appetite among staff to improve the quality of care provided in the department and make a difference. Staff said they felt supported and were encouraged to be open and transparent. Health professionals reported good multi-team working with positive working relationships existing between doctors and nurses.
Inspectors were told that a range of acute medical pathways had been established as part of the Portsmouth Hospitals NHS Trust Emergency Floor Programme to reduce demand on the emergency department. The programme included a consultant-led telephone advice line to help patients who might not need to attend hospital in the first place. The trust reported that less than half of all calls received by the helpline resulted in a patient being referred to the ED or other clinical in-patient settings.
Dr Nigel Acheson, CQC's Deputy Chief Inspector of Hospitals for the South, said:
"When we visited the Queen Alexandra Hospital emergency department we did see improvements from previous inspections although clearly there is still work to be done. Handovers from ambulance teams to hospital staff were still taking too long at times - although we noted that to manage the risks involved, the initial assessments for patient treatment is now always done by a nurse in the first instance and as soon as possible.
"The trust's work to reduce pressures on the emergency department are welcome - but we note that patient movement through the department is still a problem during busy times and this must be addressed. We will continue to monitor the trust closely and will return to inspect again soon."
Portsmouth Hospitals NHS Trust is currently rated as Requires Improvement. This inspection was not rated and does not change the overall rating for the trust.
Mark Cubbon, Chief Executive of Portsmouth Hospitals NHS Trust, said:
"The Care Quality Commission (CQC) has today published its report following its focused inspection of our Emergency Department (ED) at Queen Alexandra Hospital (QA) in February.
"We welcome this feedback and the recognition by the CQC that improvements have been made from previous inspections. However we recognise that there is still more work to do to ensure all of our patients receive the consistently high quality care we aim to deliver.
"At the time of the CQC visit the hospital was under considerable pressure, with increasing numbers of patients accessing our urgent care services. Since the start of the year we have been working against the backdrop of increasing pressures. In February alone, we saw over 1,300 more patients in our ED than in the same period last year. This is the reality of the challenges facing our staff working day to day in our urgent care services. However we fully recognise that it is not acceptable for any patient to wait longer than they should and no matter what the operational pressures, our focus on patient care and experience must remain paramount. In particular every one of our patients should be treated with dignity and respect at all times. Anything less is unacceptable.
"Some of the challenges we face are longstanding and I have been clear that these will not all be resolved overnight. We are working closely with our partners to ensure there are a range of alternatives to accessing our ED as well as ensuring patients who require ongoing care are discharged out of hospital as soon they are medically fit to leave.
"The recently announced £58m funding to transform our urgent care services, which will include building a new Emergency Department, is a central part of how we will provide a higher quality environment to improve the experience of our patients and staff. We will continue our focus on ensuring the required improvements are made."