CQC Focused Inspection at Gloucestershire Royal Hospital

Despite an unprecedented year of challenge, Gloucestershire Royal Hospital (GRH) has maintained its overall rating of ‘Good’ following an unannounced inspection by the Care Quality Commission (CQC). The focused inspection looked at urgent and emergency care services at GRH including the Emergency Department (ED or A&E) considering whether the service is safe, responsive, and well-led.

Inspectors made a number of positive observations in their report:

• Staff in the department felt respected, supported and valued by their colleagues. They were focused on the needs of patients receiving care. There were strong examples of staff feeling able to speak up and raise concerns without fear
• Leaders in the Emergency Department demonstrated the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were supportive, caring and approachable in the service for patients and staff
• All patient interactions we observed were seen to be caring, kind and empathetic
• Despite growing activity during the day, the department remained calm and professional throughout
• Staff understood how to protect patients from abuse and acted on any concerns. They recognised when abuse might be occurring and were trained in how to deal with their concerns to keep patients safe
• Staff kept detailed and comprehensive records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to staff providing care
• Patients had an assessment of their infection risk and other clinical risks on arrival at the department
• There were effective systems to recognise, report and understand performance, including a live dashboard available.

The inspection team rated urgent and emergency care services’ safe domain as ‘Requires Improvement'. We fully recognise that at times of peak demand, when the department is at its busiest, the quality of care is impacted on these occasions despite the very best efforts of our teams.

We have been continually assessing and making changes to the way our EDs are run and a number of measures have already been introduced which have had a positive impact. These include:

• Eliminating corridor care within the ED by creating more space in the department
• Improving ambulance drop off times by establishing additional drop off points
• Seeing walk-in patients more rapidly
• Ensuring that patients are seen by the most appropriate doctor first time, by-passing ED if appropriate.

The impacts of these measures are encouraging. In March, for example, we recorded 50 occasions when patients had to wait in a corridor for 30 minutes or more whilst there have been no such waits in the current month. Similarly, the average wait of a patient on an ambulance in March was 63mins which reduced to 18mins in May and, on average, patients in March waited 30mins to be triaged after arrival but in the latest month, this was down to 19mins.

Professor Mark Pietroni, Director of Safety and Medical Director, said: “Given the momentous challenges we’ve faced over the last year in response to the pandemic it’s right to recognise that Gloucestershire Royal has maintained its good rating overall. That’s a real credit to the incredible effort put in by our staff in the last year – they’ve gone through so much to deliver patient care in quite extraordinary circumstances. It’s important that we don’t lose sight either of the successes we’ve had, particularly in delivering cancer surgery to our patients throughout the pandemic. We are confident that the way we worked in these last 15 months has saved lives but are no less committed to ensuring we respond to the issues raised by the CQC.”

Rob Stacey, Emergency Medicine Consultant and Speciality Director, added: “While we are disappointed that the CQC rated urgent and emergency care services as requiring improvement given the efforts of all staff, we are absolutely committed to turning this around for our patients. We’ve already introduced a number of measures that have had a positive impact. For example, we’ve eliminated corridor care in the department by expanding the footprint of ED which we did by relocating another service. We’ve created additional ambulance space for patients to be safely transferred into our care and we’ve embedded new processes so that patients receive quicker clinical assessments and onward care within ED or specialist areas. I’m very proud of everyone I work with, in these services, who despite the year they’ve had, work tirelessly to deliver the very best care”.

Professor Pietroni added: “We are absolutely determined to get this right and improve care for our patients in urgent and emergency care. The report by the CQC also acknowledges the external factors which have a direct impact on our ability to improve performance in ED. We will continue to work closely with our system partners on finding solutions to these challenges.”