Inspectors say lack of processes could put patients at risk
PATIENTS visiting Wales’ newest emergency department were likely to have been put at risk of harm due to the lack of processes and systems in place, inspectors found. Healthcare Inspectorate Wales (HIW) carried out an unannounced inspection of The Grange University Hospital in Cwmbran between November 1 and 3 last year and published its findings this week.
On the day of their arrival inspectors said The Grange was at full capacity with no empty beds in A&E or in the hospital in general. Despite the best efforts of staff who were “working hard under pressure” the report stated the emergency department had several issues which could have compromised the privacy and dignity of patients. This included problems with the physical environment of the waiting room, which was described as a “major cause of anxiety” for visitors, as well as with the flow of patients through the hospital in general.
It found that patients were not triaged and medically managed in A&E in a timely fashion with many being placed on uncomfortable chairs or in corridors for hours on end.
The report said some issues required immediate action including the fact patients in the waiting area were often left to “deteriorate without being overseen”. There were also infection control failures which could have led to the cross-contamination of Covid-19. “We were not assured that all the processes and systems in place were sufficient to ensure that patients consistently received an acceptable standard of safe and effective care,” the report stated.
Staff were also asked to give their feedback on working in the A&E. One stated: “Patients are deteriorating and spending days in chairs with complaints that are inappropriate to sit out with.” Another added: “They know it’s overcrowded and understaffed . . . It’s soul-destroying working there . . . Staff are just leaving all the time.”
Inspectors also found that the emergency unit needed to reduce its reliance on agency and bank staff.
The inspectors did find positives too including the feedback given by some patients. During their inspection 84% of patients rated the service as ‘very good’ or ‘good’. However 16% described it as ‘poor’ or ‘very poor’.
The report stated: “Most patients rated the quality of the patient experience provided during their stay in hospital as very good and were complimentary about the staff in the patient survey completed. Patients, including those on ambulances, were provided with food and drinks during their time at the unit.”
On the day the inspectors arrived at the emergency department they said there were approximately 20 ambulances waiting to move patients into A&E.
In response to the report a spokesman for Aneurin Bevan University Health Board said: “We’re pleased to see that the report highlights the professionalism of our staff and that patients were treated with courtesy, dignity, and respect. During the inspection HIW identified some areas where ‘immediate assurance’ was required and these matters were addressed promptly. We also have an action plan to focus on the other recommended areas for development.
“HIW have also indicated that improvements to patient flow are required which is a nationally-recognised problem exacerbated by the ongoing Covid pandemic. The health board has since implemented an urgent care improvement plan. However it’s important to recognise that the challenges associated with emergency department overcrowding and delayed transfers of care are ongoing. We’re sorry for the experiences of the patients whose care has fallen below our usual standards and to those who are experiencing delays in their care. We’re incredibly thankful to our staff who are working under significant and sustained pressure in such challenging circumstances.”