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Spotlight Case Study of Good Practice – University Hospital of Wales Emergency Department

We want to ensure healthcare services reflect on our inspection and assurance work and measure their own services against these findings to drive forward service improvement. We hope the findings of good practice illustrated within this case study below can be transferred between organisations, and across the wider health service to support system improvements.

University Hospital Wales - Emergency Department

Following an inspection of the Emergency Department at the University Hospital of Wales in March 2024, we believe that the results from the inspection demonstrate an area of good practice and considerable improvement. It is our hope that the findings illustrated within this case study can be transferred between organisations, and across the wider health service to support improvements across the system.

It was positive to see that many improvements have been made since our previous inspection in June 2022, with many areas of good practice noted.

Despite the department being extremely busy, the unit felt calm, and staff members had taken appropriate action to manage the situation. The Rapid Assessment and Treatment Zone (RATZ) was a commendable initiative set up to reduce waiting times. The health board had introduced RATZ where appropriate patients received a rapid assessment, investigation, diagnosis and treatment by an Emergency Department doctor. Two RATZ assessment cubicles were based near to the ambulatory and ambulance entrances. Following prompt assessment and treatment, patients either discharged or moved to another area of the ED. The RATZ service operated during the hours 10am to 10:30pm. We found this to increase the turnaround time and decrease waiting times and subsequently decrease service pressure. 

Staff were committed to providing a high standard of care to patients, and our inspectors witnessed staff being respectful and friendly towards patients. We found the refurbished environment promoted dignity and enabled staff to provide treatment privately.

Our previous inspection in June 2022 highlighted the need to improve within the area of Infection Prevention and Control. A recent refurbishment of the unit addressed these issues, and the physical environment of the unit was laid out and well maintained. We found areas to be clean and free from clutter. Surfaces including flooring and seating now allowed for appropriate cleaning and decontamination. Following the improvements identified at the previous inspection, the health board introduced a daily ‘walk around’ where a Band 8 would complete a daily checklist which included IP&C checks. 

The Welsh language was well promoted within the Emergency Department. Most signs and patient information were seen to be bilingual, including information inviting patients to give feedback.


A suitable management structure was in place, with clear lines of reporting, and visible, supportive leadership. We saw evidence of new initiatives to increase staff retention, including an induction pathway for new staff. This included shadowing experienced staff, completing competencies and training over a twelve-month period. It was also positive to see new staff had been recruited to critical roles following our previous inspection.

There are mounting pressures on NHS services and the University Hospital of Wales, like all hospitals, continues to face extraordinary challenges due to increased demand. Despite some persistent challenges, it was positive to see evidence that the health board has started to implement systems and processes to address areas of improvement identified during our previous inspection in June 2022. 

This case study provides a positive example of how settings are striving to improve following our inspection and assurance work, and demonstrates how valuable sharing learning and insight can be in driving forward improvement within health care services across Wales. 

You can read our full report here.