Patients at Aintree Hospital were found to be ‘at risk of harm’ during an inspection of the hospital’s emergency department.
The Care Quality Commission carried out a surprise inspection of the hospital in response to "information of concern" being raised. The focussed inspection of Aintree's urgent and emergency care department took place in October 2022.
Aintree is one of many hospitals to be struggling with capacity at present and inspectors said that during their inspection, the emergency department "exceeded its maximum planned capacity" and that "some patients were cared for on the corridor", something that had been an issue in the days and weeks beforehand as well.
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The inspectors also found a range of concerns within the department. They said patients did not always receive appropriate care and treatment in a timely way, exposing them to the risk of harm.
Inspectors also found that there was a risk that staff did not always recognise or respond appropriately to signs of deteriorating health and that staff did not always complete risk assessments for patients swiftly.
It was found that people could not always access the urgent and emergency service at Aintree when they needed it and did not always receive the right care promptly. Waiting times from attendance to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
One crucial issue recognised in the report was that Aintree's emergency department did not always have enough nursing staff and support staff "to keep patients safe from avoidable harm" and to provide the right care and treatment. Another issue raised was that staff did not always respect patients' privacy and dignity and did not always keep care confidential.
Expanding on the issues in the emergency room, the inspectors said: "Nursing staff triaged patients from the waiting room. However, on arrival patients were booked into the emergency department and had a basic health screen completed by the reception team.
"They were then asked to wait until they were called into a triage assessment room. This meant there was a risk of patients being in the waiting room without having their physical observations taken. We were told that staff completed hourly observations of the waiting room to identify any deteriorating patients and this was audited to monitor compliance. However, we saw limited evidence of staff walk rounds of the area or comfort rounds for patients during our inspection".
Echoing images seen at under-pressure hospitals across the country amid the current NHS crisis, inspectors pointed out that patients were being treated in an "ambulance admission corridor" located between the main hospital waiting room and the majors and resuscitation areas. Inspectors saw up to 19 patients in the ambulance corridor during their visit.
They added: "Staff told us this number was frequently higher and during periods of high demand patients on trolleys were placed on the main hospital corridor. During our inspection the ambulance admission corridor was safely staffed to support with patient observations."
On the issue of staffing, inspectors said the emergency department regularly exceeded the maximum planned number of patients and on one occasion during the inspection staff reported 111 patients in the department. The report added: "This meant there was a risk of patients experiencing delays in assessment and were exposed to risk of harm due to staffing levels not meeting the increased patient numbers."
It added: "The service did not always have enough nursing and support staff to keep patients safe. The number of nurses and healthcare assistants did not always match the planned numbers."
In fact from September 23 to October 6 2022, the emergency department at Aintree Hospital only achieved its planned nurse staffing on six out of 42 shifts and staff were frequently moved from other areas of the hospital to support the emergency department.
In recent weeks, the ECHO has reported on continuing issues at Aintree and other local hospitals that are struggling under immense pressure right now. Images show long lines of patients in trolleys on corridors and people in pain on the floor of packed A&E waiting rooms.
Despite the concerns raised in the inspection, the service was found to have enough medical staff for patients. Staff gave patients enough food and drink to meet their needs and improve health, assessed and monitored patients regularly and treated patients with compassion and kindness.
The spot visit followed a full inspection of the hospital in 2021 which rated the overall site as requires improvement but found the urgent and emergency services to be inadequate. The hospital was not rated at the inspection in October and so both ratings remain in place.
David Melia, Chief Nurse at Liverpool University Hospitals NHS Foundation Trust, which runs Aintree University Hospital said: “We accept the findings in the report and are committed to learning and improving. I would like to thank our incredibly hard working staff who the CQC said ‘treated patients with compassion and kindness’.
“The CQC found that, like every other emergency department in the country, there are too many people waiting in the department, and they recognised the challenges we face in admitting these patients to hospital beds, due to being unable to discharge patients who no longer need a hospital bed, but are waiting on social care or community support.
“Our priority is to provide safe, high quality care in a timely manner. Though health and care services are incredibly challenged, we are working to address the pressures we’re facing. We’re recruiting nursing staff, we’ve taken further action to provide timely access to treatment, we’ve introduced more measures to monitor patients in the waiting room and we’re working with local partners to support patients leaving the hospital with support in the community.”
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