‘There was much to be hopeful for in terms of resolutions passed’

Corridor care has become “normalised” at a hospital in the West Midlands, inspectors have warned.

The issue was flagged during the Care Quality Commission’s most recent inspection of emergency departments run by Worcestershire Acute Hospitals NHS Trust.

“Patient privacy and dignity was not always protected due to overcrowding”

Emergency services at Worcestershire Royal Hospital and Alexandra Hospital, both run by the trust, were rated “inadequate”.

Inspectors have been forced to take “urgent enforcement action” and “imposed conditions” on the trust’s registration to improve the quality and safety of care for patients.

In a report published today, the CQC found that the emergency department at Worcestershire Royal Hospital was “overcrowded with many patients being cared for in corridors”.

Inspectors compared the number of hours patients spent in the corridor from January 2019 – when the service was previously inspected – to the time of inspection in December.

The number of hours in January 2019 was reported as 9,530 hours and 7,952 hours in December 2019.

The CQC said this suggested that corridor care had become the standard practice at the hospital.

“A review of data for each month in 2019 suggested limited overall improvement, suggesting staff had normalised the use of the corridor, as compared to the use of the corridor only being reserved for times of significant surge,” the report said.

Concerns were also raised around an increase in pressure ulcers as a result of patients being cared for on trolleys in corridors.

The CQC uncovered a “number of incidents” during June 2019 to December 2019 where staff from other departments at the hospital had reported patients being admitted to wards from the emergency department with grade two pressure ulcers which had been caused as a result of waiting on trolleys.

“We discussed the increase in department-acquired grade two pressure ulcers with staff,” noted the report.

“They reported that due to a lack of space in the corridor, it was necessary to care for patients on trolleys.”

The CQC highlighted that action had been taken to address the issue by deploying a tissue viability nurse and introducing pressure-relieving devices.

"We observed frail elderly patients remaining on trolleys for extended periods of time"

Though the health watchdog said caring for patients on trolleys remained an issue.

“Staff reported, and we observed, frail elderly patients remaining on trolleys for extended periods of time, therefore pre-disposing those individuals to the risk of harm due to not being nursed on an appropriate bed,” said the report.

The CQC imposed a condition on the trust which requires it to “ensure staff undertook dynamic risk assessments of all patients in the ED to ensure patients were managed in the most appropriate clinical area”.

Meanwhile, the report also raised alarms around the safety of children in the emergency department because there was “not always enough nursing staff deployed”.

The trust's procedure was to have a registered nurse allocated at all times to provide care to children attending the emergency department.

However, during the inspection the CQC observed a student nurse who was “left alone and unsupervised in a high acuity clinical area” with six children.

A separate report on Alexandra Hospital echoed similar concerns around corridor care and called for action to be taken to reduce the number of patients being cared for in such circumstances.

Inspectors warned that at the time of inspection “patients were being cared for in a crowded corridor” and that “patient privacy and dignity was not always protected due to overcrowding”.

The CQC noted the number of hours patients had spent in corridors at Alexandra Hospita had increased up from 1,222 hours in November 2018 to 2,160 hours in November 2019.

Following inspections of both hospitals, the emergency departments were rated “inadequate”, having previously been rated as “requires improvement” in May 2019.

CQC chief inspector of hospitals professor Ted Baker said: “Our latest inspection of emergency departments at Worcestershire Royal Hospital and Alexandra Hospital found patients waited too long for assessment and treatment.”

“On behalf of the trust and all of our partners across the county, we apologise”

He added that the trust had “recognised an increase of patients sustaining pressure damage while waiting in Worcestershire Royal Hospital's emergency department”.

“It had taken action, deploying a tissue viability nurse and introducing pressure-relieving devices,” said Professor Baker.

“However, patients remained on trolleys for extended periods, due to lack of space in the department for them to be transferred to a more appropriate hospital bed.”

He said that “underpinning the issues in both departments was a lack of capacity and capability in the trust and wider health system”.

He warned that the CQC had raised such issues since 2015, but the trust’s response had been “insufficient” and that “new improvement plans have not been progressed enough to take effect”.

However, Professor Baker praised the staff in the hospital departments who he described as “cheerful and engaged with patients, even when working under pressure”.

“Interactions were positive and respectful,” he said.

“Leaders and staff were committed to driving improvements to keep people safe and to improve patient experience.”

The CQC said it would continue to monitor these departments and the wider trust with further inspections.

Responding to the CQC report, Matthew Hopkins, chief executive of Worcestershire Acute Hospitals NHS Trust, said: “Despite the enormous efforts of our staff, alongside GPs, community staff and social care, we know that some patients are still waiting too long to get into our emergency departments or are spending too long in the emergency departments waiting to be moved onto a ward.

“On behalf of the trust and all of our partners across the county, we apologise for this.”

Mr Hopkins stressed that the report was a reminder of the importance of “working together” with organisations across the local health and care system.

He said that since the CQC visit, the trust had increased the number of nurses in the emergency departments at both hospitals and increased the number of senior doctors working in its acute medical team in the afternoons and evenings at Worcestershire Royal.

In addition, he highlighted the launch of "onward care teams" at both hospitals.

The teams, which came into force this week, bring together social care staff, community nurses and discharge nurses to help patients go home or move onto another setting in a “safe and timely way”.

In addition, 33 new beds are due to be opened next week at Worcestershire Royal.

“Everything that we and our partners are doing will help us to make sure that more patients get the right care in the right place at the right time – not only in our hospitals but also at home or in community settings,” said Mr Hopkins.

“We will continue to work hard to support our ED teams – but this is not a problem they can solve without our support and the continuing active involvement of the whole of our health and care system.”

The increase in pressure ulcers is not surprising given what we know about their causation. Trolley mattresses are inadequate and mean extra prevention i.e more frequent turning are essential. The costs to the patient, the hospital and family will be considerable.

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