The Care Quality Commission (CQC) has published a report following a focused inspection of the emergency department at King’s College Hospital, part of King's College Hospital NHS Foundation Trust.
The inspection was carried out in July to follow up on concerns about patient care, culture, governance and leadership of the service, after a previous inspection in November 2019, which resulted in enforcement action being taken. Inspectors were also looking at whether the service was coping under pressure due to COVID-19.
Nigel Acheson, CQC’s deputy chief inspector of hospitals, said:
“During the recent inspection of King’s College Hospital, we found a workforce that was committed to providing safe, dignified care to its patients. However, the age and layout of the building sometimes made it difficult for staff in the emergency department to provide the best possible care for people, as it created issues with access to, and flow within, the emergency department. For example, it was difficult to maintain social distancing in the waiting area of the walk-in reception, which put people at risk of catching infections such as COVID-19. Although the trust had undertaken work to alleviate this situation where possible, there were limits to the action they were able to take due to the age of the building.
“In addition, some patients from outside the area were being treated at King’s, due to the specialist services the hospital provides. Following their treatment, they were sometimes unable to be transferred back to their original hospital due to a lack of beds. This meant that other patients in the emergency department who needed to be moved elsewhere in the hospital had to be held in the emergency department for longer than necessary until a bed became free for them. To alleviate this problem when it occurs, other regional healthcare systems need to work to support King’s to provide the necessary bed space in their own hospitals to remove these blockages.
“We have reported our findings to the trust leadership, which knows what needs to be done to bring about further improvements. We will continue to monitor the service to ensure that the improvements are made and fully embedded.”
During the inspection, CQC found:
- Several areas of the emergency department were untidy and cluttered with opened boxes of equipment and other items left lying around which were hazards for both staff and patients
- People’s privacy wasn’t always maintained. Inspectors saw the ambulance triage station remain unmanned for 15 minutes. The computer screen was left unlocked and was displaying patient details in an area which unauthorised members of staff and anyone walking past could access
- There was no clear signage to indicate which cubicles may have a patient with confirmed or suspected COVID-19 inside which put people at risk of catching the virus
- Poor hand hygiene by some medical staff also put people at risk of infection.
Inspectors also found:
- In the emergency department area for children there was a room used for the check the wellbeing of mental health patients. Inspectors found two potential ligature points on the internal door handles. This could put children at risk of harm of choking. We highlighted these to the leadership team who carried out work to manage this risk. In future, any patient who needed to be assessed would be accompanied by a member of staff until the ligature risk was removed
- Staff understood how to recognise and protect patients from abuse and the service worked well with other agencies to do so
- The staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs
- The service had enough nursing staff and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed the staffing levels and skill mix
- Patient records were kept updated and the nationally recognised early warning scores, sepsis reviews and other observations and assessments were properly completed
- The service made sure that only equipment which was in date was available for use within the emergency department.
Full details of the inspection are given in the report published on our website.
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