Bronglais Hospital Emergency Department Staff Praised for Compassionate Care Despite Significant Operational Pressures

The unannounced inspection, carried out over three days in July, praised the dedication and professionalism of staff working under considerable pressure, noting that patients were consistently treated with dignity and respect. Despite ongoing challenges with patient flow and patients being treated in non-clinical areas, staff maintained a compassionate approach and demonstrated strong teamwork across the department.

Inspectors identified several areas requiring improvement to protect patient safety and maintain the quality of care being delivered. These included concerns around medication management and storage, incomplete checks of emergency resuscitation equipment. Patient flow challenges were a recurring theme, with delays in triage, overcrowding, and inadequate paediatric provision contributing to operational pressures. Additional findings included incomplete risk assessments, and poor compliance with hand hygiene standards.

Patients were often cared for in non-clinical areas such as corridors, due to delays in discharging patients from other parts of the hospital, impacting privacy and dignity. HIW has recommended that the health board continues efforts to improve patient flow and reduce reliance on non-clinical spaces. Although trained staff provided good oversight of the waiting area, reception staff had not received ‘red flag’ training to recognise time-critical conditions, and delays in responses from specialist teams further affected patient care.

The inspection raised concerns about the safety and condition of emergency equipment. Checks on paediatric and difficult airway trolleys were not consistently recorded; appropriate safety signage was missing in the oxygen storage area, and temperature records for medication fridges were incomplete. These issues were addressed through HIW’s immediate assurance process, and the health board has committed to ongoing monitoring and improvement. 

Inspectors also found that the paediatric area was not consistently staffed with paediatric-trained nurses and was used to accommodate adult patients. Hand hygiene compliance was low, and there was no dedicated provision for cancer patients or those at increased risk of infection. Inspectors identified incomplete patient assessments and inconsistencies within some patient records, advising the health board to improve documentation practices and explore implementing a service-wide electronic records system.

Staffing levels within the department were generally acceptable, with minimal reliance on agency staff. However, there was no ED Matron in post at the time of inspection. An ED Matron is a senior nurse who oversees the day-to-day running of the emergency department, supports staff, and ensures care standards are maintained. Consultant cover was also limited, particularly overnight and at weekends. HIW has urged the health board to progress recruitment and ensure safe and effective cover arrangements. Staff reported feeling well supported by the department’s managers, though support from senior management and the GP Out of Hours Service was described as inconsistent.

Despite these challenges, the culture within the department was found to be positive and inclusive. Staff worked well together and were committed to providing high-quality care. Systems were in place for managing complaints and learning from incidents, and patients had opportunities to provide feedback.

The health board has produced a comprehensive improvement plan with detailed actions on how improvements will be made at the emergency department.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said:

Staff at Bronglais Hospital’s Emergency Department are clearly dedicated to providing safe and compassionate care despite very difficult circumstances. Our inspection highlighted areas of good practice but also identified significant issues with patient flow – challenges that are present across many Emergency Departments in Wales. We will continue to engage with Hywel Dda University Health Board to ensure improvement and progress against our findings.

July 2025 – Hospital Inspection – Emergency Department – Bronglais General Hospital, Aberystwyth