The accident and emergency department at a hospital in Lincolnshire must improve “as a matter of urgency”, according to regulators, who highlighted staff shortages among other concerns.
An inspection carried out by the Care Quality Commission found “serious concerns” surrounding the services provided in the emergency department at Pilgrim Hospital in Boston.
“Of particular concern was the fact that acutely ill patients were not prioritised and treated quickly”
As a result, the CQC has told United Lincolnshire Hospitals NHS Trust that the service must improve as a matter of urgency and has also called for additional clinical support for the trust.
A focused inspection was carried out by the CQC on 30 November after concerns were raised over patient care in the department.
Inspectors found serious concerns in the triage, assessment and monitoring of patients in A&E and, in particular, the management of patients attending the department who were acutely unwell.
Meanwhile, systems to identify critically ill patients were ineffective, meaning these patients were not treated as a priority, said the regulator in its inspection report, which was published on 20 December.
Concerns were also highlighted about staffing levels, which the CQC described as “not sufficient to meet patient’s needs”.
“This trust is already in special measures, but it clearly needs additional targeted clinical support”
Inspectors noted that the department was under extreme pressure at the time of their visit but warned there was no capacity to access and revise staffing levels to meet the increasing demand.
The CQC also said for the patients that arrived by ambulance, they were experiencing waiting times between 20 to 65 minutes just to enter the department.
It noted that once inside, there was then further significant delays within A&E, where patients were then waiting to be clinically assessed by the medical team.
The regulators also said there was no oversight of patients pre-and post-triage in the main waiting room and routine observations were not performed on patients following triage.
Findings of the inspection also indicated that leadership was ineffective, said the CQC, with a lack of co-ordination between the consultant in charge, nurse in charge and the site management team.
In addition, the CQC stated that it saw insufficient action to manage delays because of handovers or overcrowding and poor staffing levels, adding that this lead to poor patient experience.
“We have been concerned for some time about the challenges faced at Pilgrim A&E”
Patients were not always getting their medication on time or when they needed them and children in the department were placed at risk of harm as they were not cared for by nursing staff with the necessary competencies to provide safe and effective care, the inspectors said.
The CQC also flagged up significant issues in relation to patient flow, which it said led to overcrowding and patients being cared for in corridors.
It added that staff did not follow the escalation policy in place to ease and manage the flow of patients effectively.
Professor Ted Baker, the CQC’s chief inspector of hospitals, said inspectors were “alarmed” by what they found during their visit.
“Of particular concern was the fact that acutely ill patients were not prioritised and treated quickly, with inspectors needing to intervene in the care of patients to ensure their safety,” he said.
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“We raised immediate concerns with the trust and NHS Improvement and were clear that urgent action was needed to keep people safe,” said Professor Baker.
He described how the CQC made a further unannounced inspection of the emergency department earlier this week to check if the most serious of concerns had been addressed.
“We found that the department was better organised, and steps had been taken to address crowding concerns – but it was obvious that there are still significant further improvements needed,” he said.
United Lincolnshire Hospital NHS Trust is currently rated as “requires improvement” by the CQC and is in special measures.
It was put back in the system for struggling NHS organisations in April 2017, having left in 2015 after being first placed in the regiment in 2013 due to its high mortality rate.
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“This trust is already in special measures, but it clearly needs additional targeted clinical support to ensure that it can provide a safe service on an ongoing basis – something the trust’s leadership acknowledges,” said Professor Baker.
The chief inspector went on to highlight that the “geographic isolation” of the Pilgrim Hospital meant that local people were particularly reliant on its services.
He said the CQC had asked NHS Improvement to ensure the trust received additional support “as soon as possible” to make sure people in South and South East Lincolnshire “get safe, high quality care from their local hospital”.
Professor Baker noted that the CQC would continue to monitor the trust “extremely closely”.
In response, the trust’s director of nursing, Michelle Rhodes, said: “We know that this report will be upsetting for our patients, public and staff to read.”
Ms Rhodes noted that it made “very difficult reading” for all at the trust but that organisation “fully accepts” the CQC’s findings.
“We have been concerned for some time about the challenges faced at Pilgrim A&E and had escalated it earlier this year,” said Ms Rhodes.
“Providing safe, compassionate, patient-centred care is always our priority, but we know that A&Es across the country are struggling with large numbers of patients and shortages of staff, and these things acutely affect Pilgrim Hospital,” she said.
The trust said it had addressed a number of the issues highlighted by the CQC and had invested a further £800,000 in staffing and support to the A&E department to ensure safe care for patients.
Ms Rhodes added: “All of the individual cases included in the report have been fully investigated so that we can assure ourselves that no patients were harmed on the evening of the inspection.
“As a result of the work we have been doing over the last few weeks, we are confident that the service is more resilient, and with the continuing support from our partners we will build on this progress to help secure it further over the winter period,” she said.