The Care Quality Commission (CQC) has told United Lincolnshire Hospitals NHS Trust that services provided in the emergency department (ED) at Pilgrim Hospital in Boston must improve as a matter of urgency, and has called for additional clinical support for the trust.
CQC carried out a focused inspection at the hospital on 30 November 2018, following concerns about patient care in the emergency department.
The inspection found serious concerns surrounding the triage, assessment and monitoring of patients in the ED, and in particular the management of patients attending the department who were acutely unwell. Systems to identify critically ill patients were ineffective, meaning these patients were not treated as a priority.
Inspectors saw patients arriving by ambulance waiting between 20 to 65 minutes to enter the department and significant delays for patients inside the ED waiting to be clinically assessed by the medical team.
Staffing levels were not sufficient to meet patient needs, and while the department was under extreme pressure at the time of the inspection, there was no capacity to assess and revise staffing levels to meet the increasing demand.
Inspectors also found:
- There was no oversight of patients pre-and post-triage in the main waiting room and routine observations were not performed on these patients following triage.
- Patients were not always getting their medicines in a timely manner and when they needed them.
- There were significant issues in relation to patient flow which led to crowding and patients receiving care in corridors and staff did not follow the escalation policy in use to ease and manage patient flow effectively.
- Children in the department were placed at risk of harm as they were not cared for by nursing staff with the necessary competencies to provide safe and effective care.
- Leadership within the department was not effective. There was a lack of co-ordination between the consultant in charge, nurse in charge and site management team.
- We also saw insufficient action to manage handover delays, overcrowding and poor staffing levels, leading to poor patient experience.
Professor Ted Baker, CQC's Chief Inspector of Hospitals, said:
"When inspectors visited the emergency department of Pilgrim Hospital at the end of November, they were alarmed by what they found. Of particular concern was the fact that acutely ill patients were not prioritised and treated quickly, with inspectors needing to intervene in the care of patients to ensure their safety.
“We raised immediate concerns with the trust and NHS Improvement and were clear that urgent action was needed to keep people safe. We then made another unannounced inspection of the emergency department earlier this week to check that the most serious of our concerns had been addressed. We found that the department was better organised and steps had been taken to address crowding concerns – but it was obvious that there are still significant further improvements needed.
“This trust is already in Special Measures but it clearly needs additional targeted clinical support to ensure that it can provide a safe service on an ongoing basis – something the trust’s leadership acknowledges.
“The geographic isolation of this hospital means that local people are particularly reliant on its services. We have asked NHS Improvement to ensure that United Lincolnshire Hospitals NHS Trust gets the additional support it needs as soon as possible to make sure that people of South and South East Lincolnshire get safe, high quality care from their local hospital.
“We will continue to monitor the trust extremely closely and will return to inspect services again on an unannounced basis in the near future.”
United Lincolnshire Hospital NHS Trust is currently rated as Requires Improvement and is in special measures. This inspection was not rated and does not change the overall rating for the trust. The trust is currently subject to conditions on its registration which require it to report to CQC monthly on the measures in place to ensure safe care in the ED.
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