- NHS hospital
Whipps Cross University Hospital
Report from 16 December 2024 assessment
Contents
Ratings - Urgent and emergency services
Our view of the service
We last inspected the emergency department (ED) at Whipps Cross University Hospital in October 2018. Their rating remained Requires Improvement following that inspection. This inspection was completed following the Care Quality Commission’s new approach to assessment; Single Assessment Framework (SAF). We carried out our unannounced on-site assessment of the emergency department on 15 and 16 July 2024. We assessed all quality statements in safe and responsive, one quality statement in caring and one quality statement in well led. We inspected the adult ED, the children’s ED, and looked at mental health provision within the department. We spoke to consultants, nurses and health care assistants (HCAs) as well as patients and relatives. The team also reviewed policies and held remote interviews with senior leaders. We rated the department as requires improvement overall. We issued a warning notice to the trust as we felt there were areas which required significant improvement. We had concerns around poor flow through the ED and we were not assured triage practices kept patients safe. We found that privacy and dignity within the ED was not always protected and there were insufficient numbers of staff to provide care for mental health patients. We were concerned that time sensitive medicines were not being managed safely across the ED; hand hygiene practices were poor and staff understanding of the deteriorating patient was poor. We also found that a number of key policies were overdue a review and patient documentation was not always consistently completed.
People's experience of this service
We issued a warning notice to the trust as we felt the following areas required significant improvement: • Flow through the ED was poor, and patients remained within the department for significant periods of time due to lack of beds across the trust and suitable external beds. • We were not assured triage practices kept patients safe or were sufficient to ensure the service’s ability to safely assess, treat and care for patients in a timely manner. • Privacy and dignity within the ED, especially within the areas where care was provided in the corridor, was not always protected. • There were insufficient numbers of staff to provide one-to-one and two-to-one care for mental health patients when assessed as being required by the psychiatric liaison team. Patients at high risk of self-harm were left unsupervised in areas where there were known ligature anchor points or other risks to their safety. • Time sensitive medicines were not being managed safely across the ED, resulting in missed doses and delayed administration putting patients at risk. There was no consistent approach to managing patients own medicines in the ED. • Hand hygiene practices were poor. • A number of key policies were overdue a review. • Staff understanding of the deteriorating patient was poor. • Documentation in patient notes was not always consistently completed.