The Care Quality Commission (CQC) has welcomed improvements in the treatment of patients with mental health conditions in the emergency department at Croydon University Hospital, but further improvements need to be made to ensure the safe care and treatment of all patients.
In September, CQC carried out an unannounced focused inspection of the emergency department of the hospital, which is run by Croydon Health Services NHS Trust. This was to follow up on concerns about the quality and safety of the service raised in previous inspections.
The inspection looked at whether the hospital’s emergency department was safe, responsive and well-led. Although improvements had been made in the care of patients with mental health problems, inspectors found regulation breaches relating to safe care and governance of the service. Following the inspection, the overall rating for the emergency department remained as requires improvement.
Nicola Wise, CQC’s head of hospital inspection, said:
“When we inspected the emergency department at Croydon University Hospital, we were pleased to see the trust had responded to our concerns about the care and treatment of patients with mental health conditions which we raised in previous inspections. The emergency department had a new leadership team in place who understood the challenges the service faced, and they were developing strategies to address these. Staff felt the leadership team was approachable, knowledgeable and supportive.
“However, we found further concerns on this inspection. The waiting area for children was overcrowded, and the waiting area for adult patients with suspected COVID-19 infections was near a corridor which people used to access the toilets. This meant that staff and patients were not being properly protected from the risk of spread of COVID-19 and other infections.
“We also found that staff had not completed equipment safety checks on some of the resuscitation trolleys in the children’s department, which meant that they could not be sure that the equipment would be ready to use in an emergency.
“Whilst it was reassuring that all serious incidents and near misses were reported immediately and reviewed, it was concerning that, at the time of the inspection, there were still over 1,500 incidents awaiting a full review and investigation, so lessons could be learned and shared with the wider team. Risks to the department, such as staff shortages and overcrowding in the waiting area, were also not being recorded, along with actions needed to address them. This meant that the service was missing vital opportunities to protect patients from harm. However, the leadership team assured us that they had plans to manage the backlog of incidents.
“We have told the trust that it must address all of these areas of concern and we will continue to monitor the service to ensure that improvements are made.”
Inspectors found the following areas of concern during this inspection:
- Infection and prevention control was not properly managed within the emergency department. Overcrowding in the children’s waiting area and the waiting area reserved for adults who were possibly infected with COVID-19, meant that there was a risk of infection to patients
- Resuscitation equipment was not checked daily
- There were shortages of nursing staff, particularly in the children’s department
- Assessing and prioritising patients in the children’s department did not meet the recommended 15-minute standard
- The service had a significant backlog of reported incidents to review and close
- People could not always access the service when they needed it. Waiting times for patients to be admitted, transferred or discharged were not in line with good practice
- Staff voiced concerns about the workload becoming unmanageable due to staff shortages
- Inspectors were not assured the risk register covered all risks to the department.
However:
- There was a stable leadership team in place and governance processes had improved since the last inspection
- The service had an auditing programme in place to support performance improvement, identifying good practice and supporting service development
- Staff in the adult emergency department said they felt respected, supported and valued by service leaders. They were focused on the needs of patients receiving care
- The service had improved its risk assessment of patients with mental health concerns. Notes from care plans by psychiatric liaison nurses were readily available and environmental risk assessments and actions completed
- The service had updated the physiological scoring measurement tool (used to assess people’s mental health and wellbeing) in line with clinical guidance
- Patients had access to a psychiatric liaison nurse 24 hours a day. Staff said that although the team was increasingly busy, staff were responsive and would see patients within one hour of initial referral.
Full details of the inspection are given in the report published on our website.
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