The Care Quality Commission (CQC) has used its enforcement powers at Norfolk and Norwich University Hospitals NHS Foundation Trust, following an inspection which rated Norfolk and Norwich University Hospital’s emergency department Requires Improvement.
CQC inspected the department in December, prompted by performance data indicating that patient safety could be at risk because national targets for waiting times were not being met.
Inspectors found that walk-in patients were not always triaged within 15 minutes of arriving at the department, which is a national standard. They also found that there was no clear system to escalate patients from the triage queue if they deteriorated, and that triage processes needed embedding to improve patient safety.
Consequently, CQC served the trust a section 29A warning notice – meaning that it must address these issues to avoid more significant enforcement action.
However, CQC found an improved culture within the department compared to its previous inspection. Staff were motivated and sought to work as a team to address patient need.
In addition to being rated Requires Improvement overall following the inspection, CQC rated the department Requires Improvement for being safe and responsive. The department was previously rated Requires Improvement overall, following a comprehensive inspection of the trust which concluded in January 2020.
The trust remains rated Requires Improvement overall.
Fiona Allinson, CQC head of hospital inspection, said:
“We are aware that at the time of our inspection and throughout much of the last year, the department has been under significant pressure due to challenges caused by COVID-19. However, the information we received about its performance meant we had a duty to inspect it to support the trust to ensure patient safety.
“The trust must improve the department’s staffing arrangements and triage processes, so that it assesses and treats patients promptly and ensures their safety. It must also ensure that equipment is checked for safety, and that guidelines to prevent the spread of infection are followed.
“The department’s leaders were aware of the challenges they faced, and they discussed the care being provided to patients with its frontline staff. This helped staff understand their roles. “Following the inspection, we reported our findings to the trust. Its leaders know what must be done to ensure that people are assessed and treated within the timeframes they should be able to expect. “We continue to monitor the department closely to ensure that patients receive safe and effective care and treatment.”
The trust must make several improvements in the department to comply with the section 29A notice that CQC served, including:
- Improving triage to better respond to patients at greater risk of deterioration.
- Continuing to take all reasonably practical steps to mitigate the risks of failing to meet key national and trust performance targets.
- Ensuring that a shortage of nurses does not cause delays in triage, and ensuring that the safety nurse can fulfil their role properly.
CQC saw two areas of outstanding practice during the inspection:
- Specialist emergency department provision for older people
- Employment of safety nurse to assess patients in ambulances, when the department was too busy to assess people brought by ambulance inside.
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