Care Quality Commission inspectors visited our Emergency Department in an unannounced inspection on Monday 15 April.
We are delighted the inspectors saw for themselves “a supportive and friendly culture within the department which was centred on the needs of patients” and that the “emergency department had a committed and well-motivated leadership team.”
We would like to publicly applaud and thank our emergency team for this. As our patient feedback so often tells us, this team work exceedingly hard to give great care and it is often hugely appreciated by patients and their families.
Our Emergency Department was originally built for a maximum of 240 people attending every day. The average attendance across the last year has risen, with regular attendances of more than 300 people per day. We had 393 patients one day last month (April 2019). This results in cramped facilities and sometimes overcrowding.
This was also noted by the inspectors who found: “There were not enough available beds in the hospital to allow emergency patients to be admitted to a ward as soon as this was required. This had resulted in a crowded emergency department with patients receiving care and treatment in unsuitable environments.”
We know this and are working to address it, both in terms of flow through the hospital and space within Emergency. In December 2018, we were awarded £30m to develop a new fit-for-purpose Urgent and Emergency Care Hub and work is expected to start in 2020. We are doing everything we can to try to reduce crowding in the meantime, having also invested in a large Acute Assessment Unit which regularly sees 60 patients every day; with around 29 of these referred direct from the main Emergency Department. We have also invested in additional staffing.
CQC inspectors were positive reporting that “patients arriving by ambulance were assessed and treated quickly”, and noted “innovative ideas had been used to prevent unnecessary admission to hospital.”
We know the situation around primary care in Plymouth is challenged and we are doing everything we can to manage the increased emergency demand which comes through our Emergency Department doors. We have made good progress, for example, despite seeing an increase in the number of ambulances arriving with patients, we have reduced the number of times ambulance crews are delayed.
As a Trust, we run a People First programme, which is about encouraging team-driven improvement and innovation. As part of this, the Emergency Department is driving their own improvement practice around “T20” – triage in 20 minutes. This will help address one of the concerns the inspectors raised: “Initial clinical assessment (triage) of patients did not take place according to guidance produced by the Royal College of Emergency Medicine and the Royal College of Nursing. Self-presenting patients sometimes waited for up to an hour to be triaged.”
A full report of the inspection will be made available on Friday 31 May via the CQC website.