North Bristol NHS Trust’s response to CQC report into Emergency and Urgent services at Southmead Hospital

Friday, 17 July 2015

The Trust takes the findings of the Care Quality Commission’s (CQC) report extremely seriously.

We fully acknowledge that the quality and safety in the Emergency Department when the CQC re-inspected was not at a standard our patients should expect and for that we are very sorry. 

The inspection took place on an exceptionally busy day and patients were waiting unacceptable lengths of time for admission to the main wards and had to wait in areas that were not conducive to our staff being able to deliver high quality care.

To provide absolute assurance, our clinical team carried out a thorough review of the notes of all patients from that day and were satisfied that no one came to harm.

Thanks to the enormous efforts and commitment of our staff, we are now in a much better place and significant improvements have been made, which has been acknowledged by the CQC.

For many months, there has been a relentless focus by all staff on improving patient flow through the hospital and discharge processes to relieve pressure on the Emergency Department. I would like thank them for all their hard work.

We had hoped to be in a much better place at the time of re-inspection and are extremely disappointed with this outcome.

Despite changes being made, which were positively noted by the CQC in its report, some of the internal systems and actions to manage patient flow, which impact on the availability of beds, had not yet been completed by the time of the visit.

Further actions have been implemented following the visit, which have had a significantly positive effect on the running of the Emergency Zone and for the last six weeks we have met or exceeded the four hour performance standard.

At a local Risk Summit held in June the CQC noted our very positive progress since they visited the department in May.

Overall the rating of the Emergency Department remains ‘inadequate’ and the warning notice issued in December 2014 on the Emergency Department remains in place.

The Trust is fully committed to working with the CQC and we will be providing them with regular updates to track progress. In addition they will be making a further unannounced visit to the Emergency Department in the near future.

We are confident that with the changes put in place that are now firmly embedded, we can deal with busy periods much more effectively. Our priority is to provide the safest and best quality care for our patients and have the warning notice lifted.

Relentless focus on improving patient flow and pressure on Emergency Department

Tackling the issue of patient flow and subsequent pressure on the Emergency Department (ED) has been the Trust’s number one priority for many months.

The CQC noted some improvements when they visited in May which included changes to the reception area to ensure greater visibility of those patients at risk of deteriorating plus additional staff to triage patients with minor injuries.

  • Over the last six weeks, the Acute Assessment Unit (AAU) has been completely remodelled and is now called the Acute Medical Unit (AMU). This 64-bed area has been reconfigured to provide early triage and assessment of all patients referred to Acute Medicine. This has significantly relieved pressure on the Emergency Department where the majority of GP-referred patients were previously sent.


  • The teams that previously managed the Acute Assessment Unit and the Emergency Department have come together with one matron overseeing both areas and one consultant lead for the emergency area and one for the Acute Medical Unit. This has led to a much closer working partnership.


  • We have a new reporting system which gives our staff a clearer picture of who is in the department, information on waiting times, the urgency of the patients’ needs and when they are given pain relief.


  • There has been additional investment in both medical and nursing teams throughout the Emergency Zone with an increased skill mix in the department including the recruitment of more emergency nurse practitioners.


  • Nurse staffing, shift times and medical rotas are now staggered to reflect predicted surges in activity and workload.


  • A rota has been developed of named staff from other wards and department who can be called to help during unpredicted busy periods. This means that people with the right skills and expertise are deployed to the unit.


  • Every morning before 8am, a consultant and team meeting takes place to agree operational priorities and tasks to manage patients safely and efficiently that day. This has enabled both departments to prioritise their resources and ensure patients are in the right place at the right time. The meeting also reviews what happened in the previous 24 hours and any lessons to be taken forward. Hourly “huddles” and walk rounds from the operational team are then undertaken to track progress.


  • We have also opened a new discharge lounge which can accommodate up to 12 patients at any one time. This means that wards can discharge patients and free up beds earlier in the day.


  • An improved flow of patients from the main hospital to Elgar House, our rehabilitation facility, has also been achieved by working with partners to ensure patients can move out of Elgar into other community settings.


  • In addition, we are working with partners to ensure adequate packages of care are in place that enable patients to be discharged back to their homes and receive treatment from a visiting team of healthcare professionals including community nurses and physiotherapists.