Inspection finds Emergency Department at RVH operating below quality standards

The inspection took place last winter

Royal Victoria Hospital A&E Department
Author: Chloe StjohnPublished 26th Jul 2023

An un-announced inspection has uncovered that the Emergency Department at Belfast’s Royal Victoria Hospital is operating below quality standards.

The watchdog investigation took place last winter and concluded the ED was operating “beyond its core purpose and capacity”.

Concerns were raised over issues including overcrowding, staff burn-out, and lack of dignity and privacy for patients.

The report noted that there was a potential fire risk due to the level of crowding in ED meanwhile, around 85% of staff reported low morale linked to being unable to always provide the expected standards of care.

Nine areas for improvement have been made however the RQIA says it's concerned about how quality standards can be met in the context of wider system pressures.

Briege Donaghy, the RQIA’s Chief Executive said the report comes ahead of a predictable increase in demand this coming winter.

She said, “Without service reform, the ED will continue to be pressed to operate beyond its capacity and outside its core purpose with resulting increased risks to patient safety and to its staff.”

Royal Victoria Hospital

“RQIA recognise that many of the pressures observed during the inspection are occurring at Emergency Departments across Northern Ireland. We have shared our findings with the Department of Health (DoH).”

The Belfast Trust says the inspection took place during extreme winter pressures and that its taking steps to address the concerns raised.

A statement from the Trust said, “The Regulation and Quality Improvement Authority (RQIA) conducted an inspection of the Emergency Department (ED) at the Royal Victoria Hospital between November 8 2022 and the February 3 2023. Following the inspection the RQIA held meetings with Trust staff to discuss the report’s findings and consider the implications of their recommendations.”

“This inspection took place during a period of extreme winter pressures, unprecedented ED overcrowding, and unacceptable waiting times, with the entire Health and Social Care system under considerable pressure. These pressures are attributed to an ageing population, increased waiting lists exacerbated by the pandemic, and challenges in both primary and social care leading to difficulties discharging patients with the appropriate support in place.”

“We have taken steps to address some of the concerns raised by RQIA ahead of the report’s publication. This includes the establishment of new triage pathways, significantly improved ambulance turnaround times at our ED, and the reconfiguration of the RVH Emergency Care Village to create a dedicated Medical Assessment Unit, including a frailty assessment area. Further measures will be undertaken to address additional issues raised in the report.”

“Delivering these recommendations can only be achieved with our talented and dedicated workforce who ensure our patients and service users continue to receive the highest possible standard of care in spite of these challenging circumstances.”

“Belfast Trust continues to work closely with the Department of Health on these issues within the hospital and to create additional community capacity.”

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