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Inspection finds challenges with the management of patient flow and severe pressure at Wrexham Maelor Hospital’s Emergency Department

Healthcare Inspectorate Wales (HIW) has issued a report (3 February 2023) highlighting the challenges faced by the Emergency Department at Wrexham Maelor’s Emergency Department. The inspection concluded that despite staff efforts, patients were not consistently receiving safe care.

Wrexham Maelor Hospital - Emergency Department

HIW completed an unannounced inspection of the emergency department on three consecutive days in August 2022.

During the onsite inspection, HIW identified a number of areas where the pressure and challenges within the department were leading to increased risk to patients. Inspectors found that some patients had been waiting over 16 hours to be seen by a doctor. There was a system in place to help detect worsening patient condition whilst they were waiting to be seen, however, there were occasions when this was not at a frequency which would pick up deterioration in a timely way. During the inspection, the team noted two occasions when patients presenting with symptoms of Sepsis should have been escalated in a more timely way. However, once escalated, both patients received appropriate and timely care.

We found that there was a concerted effort to have patients triaged on ambulances and moved into the department as quickly as possible. Once in the department, the high volume of patients and lack of space to accommodate the number waiting for, and receiving, care was highly challenging. The main waiting area within the department is small and during our inspection, was very crowded. Patients were critical of the waiting times and also that they were not kept well informed of the wait times, or where they were in the queue to be seen. Elsewhere in the department, space for assessing and treating patients was also limited, meaning that specialist areas such as eye treatment and mental health treatment spaces were accommodating patients with more general care needs. Senior staff did tell us that there were plans being drawn up to increase the footprint of the department, but until this happens the space will continue to present a serious challenge if demand remains as high.

Patients were complimentary of staff once they were being actively seen and treated. We found friendly, professional staff throughout the department who demonstrated a commitment to providing high quality care to patients and were knowledgeable about patients’ needs. There was a high reliance on agency staff at the time of the inspection. Senior managers were visible within the department and often worked within a clinical role in support of staff.

We found the main areas within the department to be clean and tidy and that high throughput areas and touchpoints, including toilets and door handles, were being cleaned regularly and to a good standard. We also found that infection prevention and control measures were robust.

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

Chief Executive of HIW, Alun Jones said:

The pressure on NHS services continues to be extraordinarily high and as in other Emergency Department inspections we have undertaken, in Wrexham Maelor we have again found evidence of a service struggling to meet demand whilst maintaining patient safety. Whilst I acknowledge the hard work and dedication of staff working tirelessly within this service, our report sets out specific recommendations that the health board needs to address without delay in order to improve. It is also important that they continue seeking solutions to manage ongoing challenges with patient flow. 

We will continue to engage with Betsi Cadwaladr University Health Board to ensure progress against our findings.

Hospital Inspection Report - Emergency Department Wrexham Maelor Hospital, Wrexham

Inspection Summary Report - Emergency Department, Wrexham Maelor Hospital, Wrexham