Emergency Department - our journey to "good"


Juliette Hughes

“It’s been a long and sometimes difficult journey since we moved to the new hospital” – says Southmead’s Emergency Department Matron Juliette Hughes. “But throughout the entire time, I couldn’t be more proud of my team.”

When inspectors from the Care Quality Commission (CQC) first visited the department in November 2014 – six months after the move from outdated facilities at Frenchay Hospital to the new hospital at Southmead – they had significant concerns around overcrowding, primarily due to issues associated with flow and patients accessing beds in a timely manner.

A warning notice was placed on the department and when the report was published in February 2015, the Emergency Department was rated as “inadequate” overall.

Juliette said: “Although the CQC had significant concerns, they were extremely complimentary about the team and the high quality care provided to patients, despite the obvious difficulties and pressures we were working under.”

Since then there has been a relentless focus on making improvements – so much so that in its latest report, published today, the CQC has rated the service as “good” overall. The requirements of the warning notice were fully met following a subsequent inspection in October last year.

Some of the positive changes that have taken place include:

  • An additional triage nurse on duty for every shift, day and night. This has halved the time people are waiting to be triaged and pain relief, if appropriate, can be administered in a more-timely manner. The nurse can also ensure that investigations and X-rays are done before the patient sees a doctor and, for those patients who are deteriorating, the triage nurse can escalate them through into the main department where they can be assessed by a consultant or doctor.
  • More space has been created by moving the seated assessment area into the Acute Medical Unit (AMU) next door. This is an area for patients who have been referred into the hospital, primarily, by their GP. They can be assessed and investigations can take place before a decision is made to admit them to hospital or discharge them back into the care of their GP or social care provider. For the Emergency Department, this has created more space for patients to wait in a more comfortable and safer environment while our staff continue to assess or wait for results of investigations. Moving this area in the AMU has been an integral part of making the whole department work smarter and more efficiently.
  • Documentation has been consolidated into one form for healthcare providers across the Bristol area. This means that the patient record from ambulance to admission to the Emergency Department is all in one place. Previously, staff lost time by switching between forms, documents and computer systems. Now the entire patient journey is in one place – freeing up time to care for patients. This has also helped with auditing processes, meaning that we have much more robust records to enable us to evidence things like how often we administer pain relief to patients.
  • There has been a change in shift patterns for doctors and consultants – meaning that an additional consultant is on duty in the department during the middle of the day – this has helped flow through the department in preparation for busier periods at the end of day and into the evenings.

Juliette said: “Perhaps we underestimated some of the challenges following the move, but everyone has worked so hard to make improvements despite the issues that are being experienced by the majority of Emergency Departments – not just here at Southmead.

“The changes that have been put in place have undoubtedly made things better for patients.

“This is a completely different department to the one visited by inspectors back in November 2014 and myself and lead consultant Dr Leilah Dare would like to thank everyone for their continued dedication and commitment to ensure we make this work.

“Yes, we are struggling to meet the four-hour target, but what we have proved is that during busy times we can continue to provide safe, excellent care and high quality treatment to patients – even though waiting times may be longer than we would like. It is fantastic for us and our patients to have this recognised by the CQC.”

Emergency Department - our journey to "good"