Royal Stoke University Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed the assessing needs, How Staff, Teams and Services Work Together and Monitoring and Improving Outcomes quality statement from the effective key question. Staff did not always complete and update risk assessments for each patient. Managers were aware of the inconsistency around completion and were working with the staff to increase compliance. Managers used information from audits to improve care, treatment and outcomes for patients. Staff worked well as part of a wider multi disciplinary team and worked effectively across teams and services to support people.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff were able to discuss examples of safeguarding concerns which they had identified and escalated. Staff were aware of the main safeguarding concerns relating to their local population. The service had 24-hour access to mental health liaison and specialist mental health support. Shift changes and handovers included all necessary key information to keep patients safe. Specialist support from staff such as dietitians and speech and language therapists were available for patients who needed it. Staff would refer patients for additional input if identified as required on admission from patient history. Staff worked across health care disciplines and with other agencies when required to care for patients

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients experienced long waits once they entered ED. Some patients we spoke with fully understood the pressures and strain on the NHS, however, some relatives were quite concerned about their loved ones having to wait long time and often many were elderly or frail on trolleys in the corridor. Royal Stoke University Hospital had a lower percentage of patients treated within 60 minutes compared to the England and Midlands average from 5 November 2023 to 24 February 2024. From 10 February 2024 to 25 February 2024 there has been a steep increase in the percentage from 17.1% to 35.4% which is above the England average. The total time in ED has been consistently longer than the England average since January 2022 and has recently seen a considerable increase from 13 hours 56 minutes in August 2023 to 21 hours 12 minutes in November 2023. The England average increased from 13 hours 12 minutes to 15 hours 25 minutes over the same period. The trust’s percentage of patients admitted, transferred or discharged within four hours of arrival showed little variation over the most recent 12 months, remaining lower than the England and Midlands averages. In January 2023 the percentage was 43.3% and in January 2024 the percentage was 42.9%. The trust’s percentage of patients waiting more than four hours from the decision to admit to admission has mostly been lower (better) than the England average and consistently lower than the Midlands average. There was a recent considerable increase in the number of the trust’s patients waiting more than 12 hours from the decision to admit to admission from 463 in August 2023, to 1,209 in January 2024. Over the last 12 months, the average number, per month, of patients waiting over 12 hours from the decision to admit to admission for the Midlands was 404 patients.

Managers and staff told us they carried out a comprehensive programme of repeated audits to check improvement over time. Managers shared and made sure staff understood information from the audits. Feedback from relevant audits was included in the weekly handover information as well as bulletins produced with key points. Staff did not always complete and update risk assessments for each patient and did not remove or minimise every risk, we observed that some patients did not always have their comfort rounds within a timely manner, some patients were left for hours without having their skin checked; however, staff told us this was delayed due to the demands on the department, staff told us that ED now have skin viability leads for additional support. Ambulance triage nurse said medics assess patients on ambulance at least every 3 hours while outside. We observed this during an inspection, for example at 14:30 an ambulance triage was performed within 14 minutes of patient arrival. The department had a television which showed patients the waiting times for the department as well as how many patients were waiting to be seen.

Royal Stoke University Hospital saw a reduction in the percentage of ambulance handovers taking more than 60 minutes from 48.47% in December 2022 to 8.13% in April 2023. Since then, the percentage has increased to 42.25% in January 2024. The trust’s median time from arrival to initial assessment was consistently shorter than the England average from January 2023 to December 2023. There has been a small increase from 6 minutes in April 2023 to 8 minutes in December 2023. Over the same period, the England average increased from 8 minutes to 10 minutes. The trust consistently reported a longer median time from arrival to treatment compared to the England average from January 2022 to December 2023. There was a small increase from 1 hour 7 minutes in April 2023, to 1 hour 25 minutes in December 2023. In December 2023 the England average was 1 hour 10 minutes. Managers and staff worked together to make sure that they started discharge planning as early as possible. Staff planned patients’ discharge carefully, particularly for those with complex mental health and social care needs. Staff supported patients when they were referred or transferred between services. The service moved patients only when there was a clear medical reason or in their best interest. The navigator provided patients with the information they required when they were streamed to other services. Patients were only streamed to other services if their clinical conditions were assessed as being safe to do so.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved some good outcomes for patients. The service participated in relevant national clinical audits. The department were signed up to participate in the Royal College for Emergency Medicine (RCEM) audits. Outcomes for patients were not always positive, consistent and did not always meet expectations, such as national standards. However, where outcomes did not meet the required standard or expectation, the department identified recommendations and implemented actions to learn and improve. We reviewed the trust "getting it right first time" (GIRFT) information, the aim of the GIRFT UEC work was to understand patient pathways into secondary care within a system through a peer-to-peer review, backed up with data and providing a suite of initiatives to enable local healthcare systems to tackle unwarranted variation. We reviewed various data and information provided by the trust. The trust carried out monthly check ins in ED, covering areas such as pressure ulcers, falls, complaints, C.Diff, MRSA, we saw on average the compliance was majority above 85%. We saw the department latest sepsis audit, a sample of 420 patient were audited, 307 were screened on admission for sepsis 73%, 56% of patients had their antibiotics within 1 hour and 86% of patients within 2 hours. Trust carried out thematic reviews to ensure any incidents, themes and trends were reviewed for any learning.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.