Inspectors warn hospital over emergency department triage times and PPE lapses

Staff in a hospital emergency department did not always wash their hands between patients or wear appropriate personal protective equipment (PPE), inspectors have found.

Healthcare watchdog the Care Quality Commission (CQC) said staff at Norfolk and Norwich University Hospital did not always adhere to the trust’s hand hygiene policy and procedure.

Staff did not always wear face shields when they were within a metre of patients, inspectors said in a report, despite this being required by the trust’s PPE policy.

Inspectors, who visited the hospital in December, saw one member of staff help a patient walk to the toilet without wearing a face shield.

They also saw five triage nursing staff who were not wearing eye protection within two metres of patients, placing them at risk of contracting Covid-19.

The emergency department’s main waiting area “did not clearly highlight the need for people to socially distance using signs or furniture”, according to the CQC.

While some chairs had labels on advising patients not to use them, people were sitting within a metre of each other, inspectors found.

The report said the service “did not always control infection risk well”.

Inspectors also found that national waiting time targets were not being met, with walk-in patients not always triaged within 15 minutes of arriving.

Seven patients’ triage was delayed by more than an hour, including one who was waiting in “physical discomfort with clear abdominal pain”, the report said.

The CQC issued the trust with a warning notice to make improvements.

Fiona Allinson, CQC head of hospital inspection, said: “We are aware that at the time of our inspection and throughout much of the last year, the department has been under significant pressure due to challenges caused by Covid-19.

“However, the information we received about its performance meant we had a duty to inspect it to support the trust to ensure patient safety.

“The trust must improve the department’s staffing arrangements and triage processes, so that it assesses and treats patients promptly and ensures their safety.

“It must also ensure that equipment is checked for safety, and that guidelines to prevent the spread of infection are followed.”

The trust remains rated as “requires improvement” overall.

In their report, inspectors said: “Medical staff told us there were ‘extreme staff shortages’ which put a lot of pressure on the other staff.”

Inspectors identified some examples of outstanding practice, including specialist emergency department provision for older people.

This meant older patients did not have to attend the main emergency department, which could be “busy and confusing for frail elderly patients”, the report said.

Inspectors said the trust also employs a safety nurse to assess patients in ambulances, when the department is too busy to assess them inside.

Sam Higginson, chief executive of Norfolk and Norwich University Hospital, said: “We took immediate action in response to the CQC’s concerns and we now have dedicated staff supporting patient triage available 24/7, we have increased our nursing numbers, and have eight new consultants joining us soon to help bolster the improved culture and stable leadership acknowledged by the CQC.

“Our staff have gone above and beyond during the pandemic and that is reflected in the recognition of outstanding practice in our older people’s emergency department and safety nurses, and we are determined to continue to improve our performance together to deliver the best possible care and patient experience.”

Since the inspection, the hospital has implemented further infection control procedures and enhanced PPE for workers in the emergency department and in “red zones”.

Of these staff, 98% have had their first Covid-19 vaccination.