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Poor patient flow impacting on timeliness of care delivered within the emergency department at Prince Charles Hospital

Healthcare Inspectorate Wales (HIW) has issued a report (2 November 2023) following an unannounced inspection of Prince Charles Hospital in Merthyr Tydfil.

Prince Charles Hospital Emergency Unit and clinical decisions unit

The inspection took place over three consecutive days in July 2023, and focused on the Emergency Unit (EU) and Clinical Decisions Unit (CDU) at the hospital. The CDU is used for patients who have been treated for an emergency and are waiting for admission to a ward or require short term monitoring before being discharged.

During the inspection we found staff working extremely hard to provide patients with safe and effective care at a time when the hospital was under significant service pressures.

Inspectors observed staff treating patients and their carers with respect and kindness, making efforts to promote the privacy and dignity of patients. However, within the EU Ambulatory Care area, where patients receive same day assessment, diagnosis, and treatment, there were inadequate facilities for protecting the privacy and dignity of patients.  This included a lack of privacy screens or curtains within dedicated treatment waiting areas.

In addition, patients were accommodated in close proximity to each other, or within the corridor which presented significant challenges for staff in protecting the privacy and dignity of patients and their confidentiality. Some patients had been waiting in the Ambulatory Care area for more than 24 hours. Whilst some patients were sat in recliner chairs, offering a degree of comfort, others were sat in fixed position chairs which were uncomfortable for patients having to wait for extended periods of time. We recommended that the health board take suitable action to promote the privacy, dignity, and comfort of patients.

Inspectors found staff working within the units were committed to providing patients with a good level of care. Feedback from patients and their carers was generally positive regarding the service they had received. The majority of respondents to our survey rated the service they had received as ‘very good’ or ‘good’.

The inspection identified the need for improvement in a number of areas. There were two areas where we required the health board to take immediate action. Inspectors identified gaps in the records of emergency equipment checks. Inspectors were not assured checks were being conducted to confirm the necessary equipment was available in the event of an emergency. There was poor compliance with mandatory resuscitation training, and inspectors were not assured that a sufficient number of staff had the required up to date skills in resuscitation of patients.

We received positive staff feedback on the approach of managers within the department and the impact they had on the working culture. Inspectors found strong leadership and a good management structure in place with clear lines of reporting. Staff we spoke with were knowledgeable regarding their roles and responsibilities and aside from resuscitation training levels, there was good compliance with other mandatory staff training.

Whilst established care pathways were in place, the inspection found patient flow through the EU was delayed due to the lack of available beds within the wider hospital. In addition, inspectors were told the number of patients self-presenting to the EU was increasing, placing addition pressure on the service. The EU environment was not conducive to promoting sleep and rest for those patients who were waiting for extended periods, due to lack of privacy and uncomfortable seating. The toilet and washing facilities in the EU were inadequate, especially in light of the extended duration of stay there for many patients.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:

‘The pressure on NHS services continues to be high, and we found staff working extremely hard to provide patients with safe and effective care at a time when the hospital was experiencing high levels of demand.  Some immediate improvements were identified during our inspection, and I hope this report will provide Cwm Taf Morgannwg University Health Board with a clear understanding of the challenges being faced by the department and support the action they need to take to improve. We will be working with the health board to ensure these improvements are made and evidenced.’