CQC: Hospital Emergency Department Overcrowding Posed Safety Risks

An inspection revealed that an emergency department at a hospital was “not functioning effectively” because of considerable overcrowding. Following an unannounced visit in March, the healthcare regulatory body instructed Arrowe Park Hospital in Wirral to enhance its urgent and emergency services. The Care Quality Commission (CQC) stated that it had arranged the inspection subsequent to receiving “information of concern.” Wirral University Hospital NHS Foundation Trust, the operator of Arrowe Park, indicated that it had already started tackling certain problems highlighted by the inspectors. According to the CQC, employees had reported diminished morale “due to a stressful working environment,” though the trust had initiatives planned to boost staff levels. Karen Knapton of the CQC commented: “Staff told us overcrowding meant they weren’t functioning as an effective emergency department and people were being cared for in areas not designated for care and treatment.” She added that “Leaders were also struggling to mitigate the risks of staff shortages due to a high rate of sickness absence.” The CQC indicated that patient dignity and privacy were “being compromised” as a result of overcrowding. Inspectors observed: “We saw staff taking bloods from someone in the middle of a waiting room and privacy screens weren’t always used around people who were on trolleys in the corridors.” They further noted: “In addition, confidential conversations between staff and people receiving treatment, as well as staff handovers, sometimes occurred where other people could overhear.” Furthermore, inspectors reported that certain patients in the waiting area were not being monitored for signs of worsening conditions subsequent to triage. Nevertheless, they commended senior personnel for their visibility and assistance, and patients expressed favorable opinions of staff when questioned. The CQC also mentioned that the service had several initiatives already in progress to lessen the effects of overcrowding. Dr. Nikki Stevenson from the trust noted that the hospital had received a “good” rating for being “effective,” “caring,” and “well-led,” notwithstanding its overall “requires improvement” assessment. She added that the emergency department, similar to numerous other trusts, encountered “very high levels of attendance.” She stated: “The CQC inspection report is critical of the practice of providing care to patients in the corridor of the hospital.” She continued: “This is an issue of national significance not isolated to our department and is as a result of a number of factors including our commitment to release ambulance crews back into the community to attend to those in need, unplanned care demand and bed occupancy.”