Inspectors tell Bristol Royal Infirmary to 'make improvements' after unannounced visit
Urgent and emergency services at Bristol Royal Infirmary have been rated as requires improvement by the Care Quality Commission
Last updated 31st Oct 2024
Urgent and emergency services at Bristol Royal Infirmary have been rated as 'requires improvement' by the Care Quality Commission.
It follows an unannounced inspection of the UHBW Bristol Campus earlier this year, after concerns were raised about the services being provided.
It found the emergency department at the site, which is part of the University Hospitals Bristol and Weston NHS Foundation Trust, was often understaffed and there were missed opportunities for learning.
Following the inspection, the urgent and emergency service was re-rated as requires improvement overall, as were the ratings for safe and responsive.
Effective and well-led were re-rated as good, however, and the BRI overall remains also rated as 'good'.
The overall rating for University Hospitals Bristol and Weston NHS Foundation Trust is also unaffected and remains as good.
Catherine Campbell, CQC deputy director of operations in the south, said: “During our inspection of Bristol Royal Infirmary, we found an emergency department which was often understaffed, especially at weekends, which led to delays for people needing care and treatment.
“Leaders didn't monitor the quality of staff handovers from the emergency department to the wards. This meant there were missed opportunities for learning and to improve the future care of people being transferred on to inpatient wards.
“The trust also needs to improve how they are risk assessing and managing people who potentially have sepsis. A recent audit showed staff didn’t always identify and manage sepsis using the trust’s guidelines, which put people at risk.
“However, leaders had a strong awareness of the risks of managing the flow of people through the department and surges in demand. Staff also worked well together to deliver good care and worked with leaders collaboratively to improve the service.
“Ambulance handover times had improved, and staff worked together to manage the risks of overcrowding in the department.
“The trust leadership know what they must do to improve, and we will continue to monitor them to make sure people are safe whilst this is happening, as well as reinspecting to check on their progress.”
During the inspection, the CQC picked up on a number of places where improvements could be made.
They found:
- There were not enough trained fire wardens, which is a breach of the regulation for safe care and treatment because of the potential impact on people’s safety in the event of a fire
- Records used in the department were a mix of paper and electronic, with junior medical staff commenting that the hybrid notes system led to a significant duplication of work and made them less efficient
- Inspectors found that support from mental health liaison staff could be improved out of hours and at weekends
However, they also noted the service had rolled out a campaign in collaboration with another organisation to support staff to improve people’s journey from the emergency department, and that leaders there had improved the availability of same day emergency care services to improve access to medical, frailty, cardiology, and surgery specialities.
Professor Deirdre Fowler, Chief Nurse and Midwife at University Hospitals Bristol and Weston NHS Foundation Trust, said: “Patient safety is our top priority. We have taken immediate steps to address concerns the CQC have raised to ensure timeliness of treatment and the safety of those we serve.
“We welcome the CQC’s recognition that colleagues innovative and joined up approach to safety is maximising the effectiveness of people’s care, and treatment and are pleased that this is resulting in positive experiences and feedback from patients cared for at our Bristol emergency department.”