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A&E problems highlighted by CQC at major London teaching hospital

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A major London hospital has been told to improve its accident and emergency performance, despite being rated “good” overall by regulators who also highlighted areas of “outstanding practice”.

Emergency care and medical care at University College London Hospitals NHS Foundation Trust were both rated as “requires improvement” by the Care Quality Commission.

“Incidents were going unreported due to pressure on staff”

Ted Baker

Among a long list of A&E problems, the CQC noted that the department was failing to meet patient needs at the time of its inspection in March, in spite of having introduced a new streaming process to try and cope with increasing demand.

Incidents were going unreported due to staff pressure and early warning scores, sepsis screening and pain management were not being consistently recorded in patient records.

In addition, mandatory training targets were not being met consistently and staff complained that their concerns were not being listened to, noted the CQC in its report on the trust.

It was “not assured”, said the CQC, that those in charge of the department were “providing sufficient or timely information” to the trust’s senior managers of concerns identified by staff about a recent service redesign.

Professor Ted Baker, CQC deputy chief inspector of hospitals, stated: “Patients in the emergency department experienced delays in initial assessment, and incidents were going unreported due to pressure on staff.”

“We found all staff to be dedicated, caring and supportive of each other”

Ted Baker

Meanwhile, on medical wards, risks were not being recorded in registers, documentation and patient records was “inconsistent and sometimes of poor quality”, and outcomes were “variable”.

The two areas identified as having poor practice were in contrast to much of the rest of the trust, which provides acute and specialist services in five hospitals in central London.

The CQC rated the trust as “good” overall. Inspectors gave the same rating to surgery, critical care, maternity and gynaecology, services for children, and outpatients and diagnostic imaging.

It was also rated “good” for being effective, caring, responsive and well-led, but was rated “requires improvement” for being safe.

Care Quality Commission

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Edward Baker

The CQC report, published today, highlighted a number of areas of “outstanding” practice, including local leadership in critical care, where it found high levels of staff and patient engagement.

In maternity and gynaecology – based in the Elizabeth Garrett Anderson Wing – the CQC noted examples of “outstanding practice”, including an integrated “one-stop” service that provided an efficient diagnosis and treatment facility.

Meanwhile, in surgery, it said staff showed good knowledge of reporting, investigating and learning from incidents, and there were ongoing improvements in using the World Health Organization’s safety checklist.

Professor Baker added: “Throughout UCLH we saw areas of good and outstanding practice. We found all staff to be dedicated, caring and supportive of each other and we found patient feedback to be overwhelmingly positive.”

University College London Hospitals NHS Foundation Trust has an annual turnover of around £933.9m and employs 7,617 staff.

As well as University College Hospital, its sites include the National Hospital for Neurology and Neurosurgery, the Hospital for Tropical Diseases, the Royal London Hospital for Integrated Medicine, the Royal National Throat, Nose and Ear Hospital and the Eastman Dental Hospital.

Sir Robert Naylor

Sir Robert Naylor

Source: Tom Howard

Sir Robert Naylor

Responding to the CQC report, trust chief executive Sir Robert Naylor said its overall “good” rating was a “testament to the dedication and excellence” of staff.

“I am extremely proud of our highly committed teams who received overwhelming praise from the inspectors for the compassion, dignity and respect with which they treat and care for our patients,” he said.

“The CQC’s report also highlights examples of innovation and best practice across UCLH, particularly within our maternity and gynaecology services,” he noted.

Sir Robert added that the trust had begun an “extensive redevelopment” of its A&E department, which was currently seeing “more than double” the number of patients each year that it was designed for. The £21.7m redevelopment is due to open in 2018.

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