An NHS hospital has been told to make “significant and immediate” improvements to its emergency department following concerns over patient safety.
Inspectors at Medway Maritime Hospital in Gillingham, Kent, found people facing long delays before being admitted, including one patient waiting with ambulance staff for nearly eight hours.
The report by the Care Quality Commission (CQC) follows a surprise inspection at the hospital in December, as NHS staff battled the pandemic.
A warning notice has now been issued to Medway NHS Foundation Trust requiring action to mitigate the risks to patient safety posed by ambulance handover delays and improve patient flow through the emergency department.
The trust said that following feedback from the inspection it immediately took steps to address concerns raised, including measures to reduce waiting times, and to ensure patients did not deteriorate within the department.
Overall the emergency department is now rated as inadequate, with the department rated as good for being effective and caring but inadequate when it came to being safe, responsive to people’s needs and well-led, the CQC said.
Deputy Chief Inspector Hospitals for London and the South, Nigel Acheson, said: “We saw that staff were working hard to provide care to patients in very challenging conditions.
“Given the pressure the trust was under, the decision to inspect during this period was a difficult one.”
However he said the CQC had “significant concerns” and had a duty to inspect to support the trust and identify where improvements needed to be made.
“After the inspection we told the trust leadership of our concerns and issued a warning notice to ensure the necessary improvements not only took place but were embedded.
“Since the inspection, the trust has developed a detailed improvement plan. We will continue to monitor the service and will not hesitate to take further action if required, in accordance with our legal powers.”
Staff told inspectors they felt they were respected and valued by their local managers and were positive about their role.
However inspectors were told of “recurring concerns” around poor culture within the emergency department and low morale.
Trust chief executive James Devine said: “We have taken a number of steps since the CQC’s visit to address the findings from their inspection, including taking immediate action to improve the way we manage pressures within our Emergency Department.
“We have implemented an improvement plan to ensure we are consistently providing safe, high-quality patient care, which is already making a positive difference to patients’ care.
“Actions we have put in place include working with health partners to reduce the number of patients waiting in ambulances, introducing processes to quickly identify and prioritise patients who deteriorate in ambulances, and opening more beds so that patients don’t wait so long to be admitted.”
Inspectors rated the service inadequate for the following reasons:
– Staff did not always keep detailed records of patients’ care and treatment when completing records for urgent and emergency care patients. This included the completion of nursing care, falls and skin risk assessments.
– Care for patients showing signs of deteriorating were not consistently escalated, placing patients at risk.
– The department did not always control infection risk well, increasing the risk of cross infection.
– There was poor flow out of the department, and patients experienced substantial delays before being admitted or discharged.
– The leadership, governance and culture did not always support the delivery of high-quality person-centred care for patients.