CQC inspectors have raised concerns about the safety and dignity of patients treated in corridors at Nottingham’s Queen’s Medical Centre, as its urgent and emergency care service was again rated requires improvement.
The Care Quality Commission (CQC) found the department was often caring for more people than it was designed for, with staffing pressures, gaps in training and inconsistent monitoring of patients in corridor areas.
However, most patients and families who spoke to inspectors were positive about staff. The regulator found a supportive culture within the emergency department, where colleagues worked well together despite the pressures.
Medical care services at both QMC and Nottingham City Hospital were also inspected and retained their good ratings across all five areas assessed.
The unannounced emergency care inspection took place in April as part of CQC’s checks on healthcare quality.
The service remained rated requires improvement for safety, responsiveness and leadership, while effectiveness was rated good. Its rating for caring fell from good to requires improvement.
CQC has requested action plans from Nottingham University Hospitals NHS Trust covering dignity and respect, safe care and treatment, management and staffing.
The overall hospital ratings remain unchanged: requires improvement for QMC and good for Nottingham City Hospital.
Carolyn Jenkinson, CQC deputy director of hospitals in its central region, said:
“When we visited Queen’s Medical Centre’s urgent and emergency care services, we found a department under pressure that was often caring for more people than it was designed for. Staff sometimes cared for people in corridors because there wasn’t enough space and, as a result, they didn’t always properly monitor people or provide effective handovers with colleagues.”
Inspectors found overall compliance with mandatory training among adult emergency department staff was 63%, below the trust’s target of 85%.
Areas of concern included safeguarding, infection control and recognising when a person’s mental capacity to make decisions needed assessment.
Ms Jenkinson said: “Most people and their families we spoke to were positive about the staff, who provided effective care and treatment. We also found a positive, supportive culture among emergency department staff, who worked well together despite the pressures they faced. However, people in corridors found it difficult to access staff, and staff didn’t always keep people updated on their treatment plan.”
She added: “We have told leaders where issues remain in urgent and emergency care, particularly around staffing, training and the safe management of people cared for in corridors. We’ll continue to monitor the service and expect to see further improvements.”
Inspectors found in urgent and emergency care at Queen’s Medical Centre:
- Staffing pressures sometimes meant staff didn’t maintain people’s privacy and dignity. People treated in corridor areas had limited privacy, and a lack of toilet facilities meant people often had to wait.
- Only 25% of people receiving time-critical medicines received a pharmacy review in the department, rising to just 40% for higher risk time-critical medicines such as treatments for Parkinson’s disease, which put people at risk of harm if staff weren’t managing their medicines properly.
- Staff didn’t always monitor people in corridor areas consistently, risking a delay in spotting deteriorating conditions.
- Inspectors found several unlocked and unattended computers displaying confidential information, creating a risk that unauthorised people could access personal records.
- However, people told inspectors they were assessed quickly by trained nursing or medical staff when they arrived, and staff asked them appropriate questions to find out more about why they had attended.
Inspectors found in medical care at Queen’s Medical Centre:
- Staff treated people with kindness and dignity, worked well with partner organisations to support people after they left hospital, and ran creative projects to improve people’s experiences of care.
- Staff worked well with community organisations to make sure people’s care continued smoothly after they left hospital.
- The trust collaborated with a local hair salon to provide wigs that matched the hair and skin colour of people from ethnic minority groups undergoing cancer treatment, improving their dignity and wellbeing during a difficult time.
- Ward leaders had created an open and inclusive culture where staff worked well together to achieve the best outcomes for people.
Inspectors found in medical care at Nottingham City Hospital:
- Staff understood people’s needs and provided consistent, compassionate and person-centred care. They treated people with kindness and respect.
- The trust had responded well to previous issues around medicines management. Staff safely stored oxygen cylinders, while medical policies and medicines guidance were available on the intranet. Staff completed medicines management audits and had ensured all clinic rooms had non-retrievable medicines waste bins to promote the safe disposal of medicines.
- Leaders had systems and processes in place to reduce the risks people faced and keep them safe.
- People and their relatives told inspectors they were happy with the care they received, and staff ensured they spent enough time with people despite being busy.
- Staff ensured people’s care plans reflected their current needs and reflected their choices and preferences.
